Instant Download Netter's cardiology 3rd edition george a. stouffer PDF All Chapters

Page 1


Netter's Cardiology 3rd Edition George A. Stouffer

https://ebookmass.com/product/netterscardiology-3rd-edition-george-a-stouffer/ Download more ebook from https://ebookmass.com

More products digital (pdf, epub, mobi) instant download maybe you interests ...

Neonatal Cardiology 3rd Edition Michael Artman

https://ebookmass.com/product/neonatal-cardiology-3rd-editionmichael-artman/

Handbook of Plasticizers 3rd Edition George Wypych

https://ebookmass.com/product/handbook-of-plasticizers-3rdedition-george-wypych/

Netter Atlas of Human Anatomy: 8th edition A Systems Approach Frank H. Netter Md

https://ebookmass.com/product/netter-atlas-of-human-anatomy-8thedition-a-systems-approach-frank-h-netter-md/

Netteru2019s Clinical Anatomy: with Online Access (Netter Basic Science) 3rd Edition

https://ebookmass.com/product/netters-clinical-anatomy-withonline-access-netter-basic-science-3rd-edition/

Netter Atlas of Human Anatomy: A Systems Approach: paperback + eBook 8th edition Frank H. Netter Md

https://ebookmass.com/product/netter-atlas-of-human-anatomy-asystems-approach-paperback-ebook-8th-edition-frank-h-netter-md/

Netter Atlas of Human Anatomy Frank H. Netter

https://ebookmass.com/product/netter-atlas-of-human-anatomyfrank-h-netter/

(eBook PDF) Essentials of Sociology 3rd Edition by George Ritzer

https://ebookmass.com/product/ebook-pdf-essentials-ofsociology-3rd-edition-by-george-ritzer/

Atlas of Human Anatomy by Frank H. Netter seventh edition Frank H Netter

https://ebookmass.com/product/atlas-of-human-anatomy-by-frank-hnetter-seventh-edition-frank-h-netter/

Memofiches anatomie - Membres Netter

https://ebookmass.com/product/memofiches-anatomie-membres-netter/

NETTER’S CARDIOLOGY

EDITED BY

George A. Stouffer, MD

Ernest and Hazel Craige Distinguished Professor of Medicine

Chief, Division of Cardiology

Physician in Chief, UNC Heart and Vascular Service Line

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Marschall S. Runge, MD, Ph @

Professor of Internal Medicine

Dean, University of Michigan Medical Schoo\

Executive Vice President for Medical Affairs

Chief Executive Officer, Michigan Medicine Ann Arbor, Michigan

Cam Patterson, MD, MBA

Chancellor

University of Arkansas for Medical Sciences Little Rock, Arkansas

Joseph S. Rossi, MD

Associate Professor of Medicine

Director, Cardiac Catheterization Laboratory

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

ELSEVIER

ILLUSTRATIONS BY Frank H. Netter, MD

CONTRIBUTING ILLUSTRATORS

Carlos A.G. Machado, MD

John A. Craig, MD

David J. Mascaro, MS

Enid Hatton

Steven Moon, MA

Kip Carter, MS, CMI

Tiffany S. Davanzo, MA, CMI

1600 John F. Kennedy Blvd.

Ste 1600 Philadelphia, PA 19103-2899

NETTER’S CARDIOLOGY, THIRD EDITION

Copyright © 2019 by Elsevier, Inc. All rights reserved.

ISBN: 978-0-323-54726-0

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Previous editions copyrighted 2010 and 2004.

Library of Congress Cataloging-in-Publication Data

Names: Stouffer, George A., editor. | Runge, Marschall Stevens, 1954- editor. | Patterson, Cam, editor. | Rossi, Joseph S., editor. | Netter, Frank H. (Frank Henry), 1906-1991, illustrator.

Title: Netter’s cardiology / edited by George A. Stouffer, Marschall S. Runge, Cam Patterson, Joseph S. Rossi ; illustrations by Frank H. Netter ; contributing illustrations, Carlos A. G. Machado [and 6 others].

Other titles: Cardiology

Description: 3rd edition. | Philadelphia, PA : Elsevier, [2019] | Includes bibliographical references and index.

Identifiers: LCCN 2018013552 | ISBN 9780323547260 (hardcover : alk. paper)

Subjects: | MESH: Cardiovascular Diseases | Diagnostic Techniques, Cardiovascular

Classification: LCC RC667 | NLM WG 120 | DDC 616.1/2—dc23 LC record available at https://lccn.loc. gov/2018013552

Content Strategist: Marybeth Thiel

Publishing Services Manager: Catherine Albright Jackson

Senior Project Manager: Claire Kramer

Design Direction: Patrick Ferguson

George A. Stouffer, MD, was born in Indiana, Pennsylvania, and was graduated from Bucknell University and the University of Maryland, School of Medicine. He completed his internal medicine residency, cardiology fellowship, and interventional cardiology fellowship at the University of Virginia. During his cardiology fellowship, he completed a 2-year National Institutes of Health research fellowship in the laboratory of Gary Owens at the University of Virginia. He was on the faculty at the University of Texas Medical Branch from 1995 to 2000, where he became an associate professor and served as Co-Director of Clinical Trials in the Cardiology Division and as Associate Director of the Cardiac Catheterization Laboratory. He joined the faculty at the University of North Carolina in 2000 and currently serves as the Henry A. Foscue Distinguished Professor of Medicine and Chief of Cardiology. Dr. Stouffer’s main focus is clinical cardiology with an emphasis on interventional cardiology, but he is also involved in clinical and basic science research. His basic science research is in the areas of regulation of smooth muscle cell growth, the role of the smooth muscle cytoskeleton in regulating signaling pathways, thrombin generation, and renal artery stenosis.

Marschall S. Runge, MD, PhD, was born in Austin, Texas, and was graduated from Vanderbilt University with a BA in general biology and a PhD in molecular biology. He received his medical degree from the Johns Hopkins School of Medicine and trained in internal medicine at Johns Hopkins Hospital. He was a cardiology fellow and junior faculty member at Massachusetts General Hospital. Dr. Runge’s next position was at Emory University, where he directed the Cardiology Fellowship Training Program. He then moved to the University of Texas Medical Branch in Galveston, where he was Chief of Cardiology and Director of the Sealy Center for Molecular Cardiology. He was at the University of North Carolina from 2000 to 2015, where he served as Charles Addison and Elizabeth Ann Sanders Distinguished Professor of Medicine, Chair of the Department of Medicine, President of UNC Physicians, and Vice Dean for Clinical Affairs. He is currently Dean of the Medical School at the University of Michigan, Executive Vice President for Medical Affairs, and Chief Executive Officer of Michigan Medicine. Dr. Runge is board-certified in internal medicine and cardiovascular diseases and has spoken and published widely on topics in clinical cardiology and vascular medicine.

Cam Patterson, MD, MBA, was born in Mobile, Alabama. He was a Harold Sterling Vanderbilt Scholar and studied psychology and English at Vanderbilt University, graduating summa cum laude. Dr. Patterson attended Emory University School of Medicine, graduating with induction in the Alpha Omega Alpha Honor Society, and completed a residency in Internal Medicine at Emory University Hospitals and Chief Residency at Grady Memorial Hospital. He completed 3 years of research fellowship under the guidance of Edgar Haber at the Harvard School of Public Health, developing an independent research program in vascular biology and angiogenesis that was supported by a National Institutes of Health fellowship. He did a cardiology fellowship and was on the faculty at the University of Texas Medical Branch from 1996 to 2000. Dr. Patterson was at the University of North Carolina at Chapel Hill from 2000 to 2014 where he served as founding director of the UNC McAllister Heart Institute, Chief of Cardiology, and the Ernest and Hazel Craige Distinguished Professor of Cardiovascular Medicine. He received his MBA from the UNC Kenan-Flagler School of Business in 2008. He is an elected member of the American Society of Clinical Investigation and the Association of University Cardiologists. Until recently he was Senior Vice President and Chief Operating Officer at New York Presbyterian–Weill Cornell Medical Center and currently serves as Chancellor of the University of Arkansas for Medical Sciences.

Joseph S. Rossi, MD, was born in Hopedale, Illinois. He completed his undergraduate studies at the University of Illinois and then completed his medical education at the University of Illinois–Chicago, graduating with induction into the Alpha Omega Alpha Honor Society. He completed residency and fellowships in internal medicine, cardiovascular disease, and interventional cardiology at Northwestern University, where he also obtained a master’s degree in clinical investigation. Dr. Rossi is currently the Director of the Cardiac Catheterization Lab at the University of North Carolina. He is actively involved in multiple clinical trials and has received research grants to support his interest in the pharmacogenomics of dual antiplatelet therapy and complex coronary artery revascularization among Medicare beneficiaries. Dr. Rossi is particularly interested in pairing clinical and administrative data to enhance our knowledge of trends and resource utilization for patients with advanced vascular disease.

PREFACE

Our goal for the third edition of Netter’s Cardiology was to provide a concise and practical overview of cardiovascular medicine that has been updated to include new information and important clinical areas that were not well covered in the previous editions or in other cardiology texts. To accomplish this expansion while maintaining a focused text that could be used as a ready reference, we again avoided exhaustive treatment of topics. We also have made every effort to present the essential information in a reader-friendly format that increases the reader’s ability to learn the key facts without getting lost in details that can obfuscate the learning process.

The first two editions of Netter’s Cardiology were an effort to present in a concise and highly visual format the ever-increasing amount of medical information on cardiovascular disease. The challenge that clinicians face in “keeping up” with the medical literature has continued to grow in the 14 years since the first edition of Netter’s Cardiology. This need to process the ever-expanding medical information base and apply new findings to the optimal care of patients is acute in all areas of medicine, but perhaps it is most challenging in disciplines that require practitioners to understand a broad spectrum of evidence-based medicine, such as the field of cardiovascular diseases. The explosion of medical knowledge is also a real educational challenge for learners at all levels—students, residents, and practicing physicians—who must rapidly determine what is and is not important, organize the key information, and then apply these principles effectively in clinical settings.

The third edition includes substantial changes. All the chapters have been updated, there is a new section on Structural Heart Disease, and new chapters have been added on Basic Anatomy and Embryology of the Heart, Stem Cell Therapies for Cardiovascular Disease, Diabetes and Cardiovascular Events, Coronary Hemodynamics and Fractional Flow Reserve, Epidemiology of Heart Failure: Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction, Management of Acute Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support Devices, Cardiovascular Manifestations of Rheumatic Fever, Clinical Presentation of Adults with Congenital Heart Disease, Transcatheter Aortic Valve Replacement, Transcatheter Mitral Valve Repair, Tricuspid and Pulmonic Valve Disease, Deep Vein Thrombosis and Pulmonary Embolism, Cardiac Tumors and Cardio-oncology, and Cardiovascular Disease in the Elderly.

As in the first two editions, the contributing authors have taken advantage of the genius of Frank Netter by carefully selecting the best of his artwork to illustrate the most important clinical concepts covered in each chapter. When Netter artwork was unavailable or difficult to apply to illustrate modern clinical concepts, we again used the great artistic talents of Carlos A. G. Machado, MD, to create new artwork or to skillfully edit and update some of Frank Netter’s drawings. The combination of Dr. Machado’s outstanding skills as a medical artist and his knowledge of the medical concepts being illustrated was an invaluable asset.

As in the first two editions, we chose to use authors from the University of North Carolina School of Medicine at Chapel Hill or those with close ties to the university. This allowed us to select authors who are clinical authorities, many of whom are also well known for their national and international contributions. All have active clinical practices that require daily use of the information covered in their chapters, and all are well aware of the approach to patient management used by their peers at other institutions and in other practice settings. Many of the contributing authors for this edition also contributed to prior editions of this textbook. Each author, whether a previous contributor or not, was given clearly defined guidelines that emphasized the need to distill the large amount of complex information in his or her field and to present it concisely in a carefully prescribed format maintained across all

chapters. The result is a text that is truly clinically useful and less of a compendium than is commonly the case in many medical texts. We believe that the changes we have made in the third edition substantially improve Netter’s Cardiology and ensure that it will continue to be a highly useful resource for all physicians, both generalists and subspecialists, who need to remain current in cardiology—from trainees to experienced practitioners. Whether we have succeeded will obviously be determined by our readers. We welcome the comments, suggestions, and criticisms of readers that will help us improve future editions of this work.

George A. Stouffer, MD

Ernest and Hazel Craige Distinguished Professor of Medicine

Chief, Division of Cardiology

Physician in Chief, UNC Heart and Vascular Service Line University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Marschall S. Runge, MD, PhD

Professor of Internal Medicine

Dean, University of Michigan Medical School

Executive Vice President for Medical Affairs

Chief Executive Officer, Michigan Medicine Ann Arbor, Michigan

Cam Patterson, MD, MBA Chancellor University of Arkansas for Medical Sciences Little Rock, Arkansas

Joseph S. Rossi, MD

Associate Professor of Medicine

Director, Cardiac Catheterization Laboratory

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Algorithms have been color coded for quick reference.

Algorithm for Evaluating Patients in Whom Renal Artery Stenosis Is Suspected

Clinical findings associated with renal artery stenosis

Noninvasive evaluation

(duplex ultrasonography of renal arteries, magnetic resonance angiography, or computed tomographic angiography)

Follow clinically Treat risk factors

Renal artery stenosis present Renal artery stenosis absent

Nuclear imaging to estimate fractional flow to each kidney

Unilateral renal artery stenosis and asymmetric perfusion present

Follow clinically Treat risk factors

Unilateral renal artery stenosis and symmetric perfusion present

Follow clinically Treat risk factors

Consider revascularization

Bilateral renal artery stenosis present

ABOUT THE ARTISTS

Frank H. Netter, MD

Frank H. Netter was born in 1906 in New York City. He studied art at the Art Student’s League and the National Academy of Design before entering medical school at New York University, where he received his medical degree in 1931. During his student years, Dr. Netter’s notebook sketches attracted the attention of the medical faculty and other physicians, allowing him to augment his income by illustrating articles and textbooks. He continued illustrating as a sideline after establishing a surgical practice in 1933, but he ultimately opted to give up his practice in favor of a full-time commitment to art. After service in the United States Army during World War II, Dr. Netter began his long collaboration with the CIBA Pharmaceutical Company (now Novartis Pharmaceuticals). This 45-year partnership resulted in the production of the extraordinary collection of medical art so familiar to physicians and other medical professionals worldwide.

In 2005, Elsevier, Inc., purchased the Netter Collection and all publications from Icon Learning Systems. There are now more than 50 publications featuring the art of Dr. Netter available through Elsevier, Inc. (www.elsevierhealth.com).

Dr. Netter’s works are among the finest examples of the use of illustration in the teaching of medical concepts. The 13-book Netter Collection of Medical Illustrations, which includes the greater part of the more than 20,000 paintings created by Dr. Netter, became and remains one of the most famous medical works ever published. The Netter Atlas of Human Anatomy, first published in 1989, presents the anatomic paintings from the Netter Collection. Now translated into 16 languages, it is the anatomy atlas of choice among medical and health professions students the world over.

The Netter illustrations are appreciated not only for their aesthetic qualities, but also, more important, for their intellectual content. As Dr. Netter wrote in 1949, “. . . clarification of a subject is the aim and goal of illustration. No matter how beautifully painted, how delicately and subtly rendered a subject may be, it is of little value as a medical illustration if it does not serve to make clear some medical point.” Dr. Netter’s planning, conception, point of view, and approach are what inform his paintings and what makes them so intellectually valuable.

Frank H. Netter, MD, physician and artist, died in 1991.

Learn more about the physician-artist whose work has inspired the Netter Reference collection at https://www.netterimages.com/ artist-frank-h-netter.html.

Carlos A. G. Machado, MD

Carlos Machado was chosen by Novartis to be Dr. Netter’s successor. He continues to be the main artist who contributes to the Netter collection of medical illustrations.

Self-taught in medical illustration, cardiologist Carlos Machado has contributed meticulous updates to some of Dr. Netter’s original plates and has created many paintings of his own in the style of Netter as an extension of the Netter collection. Dr. Machado’s photorealistic expertise and his keen insight into the physician/ patient relationship inform his vivid and unforgettable visual style. His dedication to researching each topic and subject he paints places him among the premier medical illustrators at work today.

Learn more about his background and see more of his art at https://www.netterimages.com/artist-carlos-a-g-machado.html

ACKNOWLEDGMENTS

This third edition of Netter’s Cardiology benefited enormously from the hard work and talent of many dedicated individuals.

First, we thank the contributing authors. All are current or former faculty members at the University of North Carolina School of Medicine, Chapel Hill, or have close ties to the institution. Without their intellect, dedication, and drive for excellence, Netter’s Cardiology, third edition, could not have been published. We had a solid foundation on which to build the third edition, thanks to the hard work of the contributing authors of the second edition, many of whom we were fortunate to have continue on to this edition. We are also grateful for the invaluable editorial contribution that Dr. E. Magnus Ohman made to the first edition.

Special recognition goes to John A. Craig, MD, and Carlos A. G. Machado, MD. They are uniquely talented physician-artists who, through their work, brought to life important concepts in medicine in the new and updated figures included in this text. Marybeth Thiel at Elsevier was invaluable in bringing the third edition to fruition.

We would especially like to acknowledge our families: our wives— Susan Runge, Meg Stouffer, Emma Rossi, and Kristine Patterson— whose constant support, encouragement, and understanding made completion of this text possible; our children—Thomas, Elizabeth, William, John, and Mason Runge; Mark, Jeanie, Joy, and Anna Stouffer; Paul, Samuel, and James Rossi; and Celia, Anna Alyse, and Graham Patterson—who inspire us and remind us that there is life beyond the computer; and, finally, our parents—whose persistence, commitment, and work ethic got us started on this road many, many years ago.

CONTRIBUTORS

EDITORS

Cam Patterson, MD, MBA

Chancellor

University of Arkansas for Medical Sciences Little Rock, Arkansas

Joseph S. Rossi, MD

Associate Professor of Medicine

Director, Cardiac Catheterization Laboratory

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Marschall S. Runge, MD, PhD

Professor of Internal Medicine

Dean, University of Michigan Medical School

Executive Vice President for Medical Affairs

Chief Executive Officer, Michigan Medicine Ann Arbor, Michigan

George A. Stouffer, MD

Ernest and Hazel Craige Distinguished Professor of Medicine

Chief, Division of Cardiology

Physician in Chief, UNC Heart and Vascular Service Line

University of North Carolina at Chapel Hill

Chapel Hill, North Carolina

AUTHORS

Basil Abu-el-Haija, MD

Clinical Cardiac Electrophysiology

Staff Physician, Kaweah Delta Hospital Visalia, California

Tiffanie Aiken, BS MD Candidate 2019

University of South Carolina School of Medicine Greenville Greenville, South Carolina

Sameer Arora, MD

Cardiovascular Disease Fellow

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Matthew S. Baker, MD

Assistant Professor of Medicine

Division of Cardiology

University of North Carolina School of Medicine Chapel Hill, North Carolina

Charles Baggett, MD

Cardiologist

The Harbin Clinic Rome, Georgia

Thomas M. Bashore, MD

Professor of Medicine

Senior Vice Chief, Division of Cardiology

Duke University Medical Center Durham, North Carolina

Sharon Ben-Or, MD

Assistant Professor

Department of Surgery

University of South Carolina at Greenville Greenville, South Carolina

Hannah Bensimhon, MD

Cardiology Fellow

Department of Medicine

University of North Carolina at Chapel Hill School of Medicine

Chapel Hill, North Carolina

Christoph Bode, MD, PhD

Chairman of Internal Medicine

Medical Director, Department of Cardiology and Angiology Albert-Ludwigs-Universität Freiburg Freiburg, Germany

Michael Bode, MD

Cardiovascular Disease Fellow Department of Medicine

Division of Cardiology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Weeranun D. Bode, MD Assistant Professor Department of Medicine Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Mark E. Boulware, MD Interventional Cardiologist University of Colorado Health Heart and Vascular Center Colorado Springs, Colorado

Michael E. Bowdish, MD Director, Mechanical Circulatory Support Assistant Professor of Surgery

Keck School of Medicine of University of Southern California Los Angeles, California

Timothy Brand, MD Cardiothoraic Surgery Resident University of North Carolina Hospitals Chapel Hill, North Carolina

Bruce R. Brodie, MD, FACC Past President, LeBauer Cardiovascular Research Foundation Cone Health Heart and Vascular Center Greensboro, North Carolina

Adam W. Caldwell, MD

Cardiovascular Disease Fellow Division of Cardiology University of North Carolina School of Medicine Chapel Hill, North Carolina

Eric P. Cantey, MD Department of Medicine

Feinberg School of Medicine at Northwestern University Chicago, Illinois

Thomas G. Caranasos, MD

Assistant Professor Department of Surgery

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Wayne E. Cascio, MD

Director

Environmental Public Health Division

National Health and Environmental Effects Research Laboratory Office of Research and Development

U.S. Environmental Protection Agency Chapel Hill, North Carolina

Matthew A. Cavender, MD, MPH

Assistant Professor of Medicine

Department of Medicine

Division of Cardiology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Patricia P. Chang, MD, MHS

Associate Professor of Medicine

Director of Heart Failure and Transplant Program Division of Cardiology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Christopher Chien, MD FACC

Clinical Assistant Professor Division of Cardiology

University of North Carolina Chapel Hill, North Carolina

Medical Director, Heart Failure Clinic UNC-Rex Hospital Raleigh, North Carolina

Christopher D. Chiles, MD

Clinical Assistant Professor of Medicine

Texas A&M Health Science Center

Program Director, Cardiovascular Disease Fellowship

Baylor Scott & White Health/Texas A&M Temple, Texas

Eugene H. Chung, MD

Associate Professor

Cardiac Electrophysiology Service Department of Internal Medicine

Michigan Medicine

University of Michigan Ann Arbor, Michigan

David R. Clemmons, MD

Kenan Professor of Medicine Division of Internal Medicine

University of North Carolina School of Medicine

Chapel Hill, North Carolina

Romulo E. Colindres, MD, MSPH, FACP

Clinical Professor of Medicine

Division of Nephrology and Hypertension Department of Medicine

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Frank L. Conlon, PhD

Professor

Departments of Biology and Genetics

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Jason Crowner, MD

Assistant Professor of Surgery Division of Vascular Surgery

University of North Carolina School of Medicine

Chapel Hill, North Carolina

Xuming Dai, MD, PhD

Assistant Professor of Medicine

Division of Cardiology

University of North Carolina at Chapel Hill

Chapel Hill, North Carolina

Arjun Deb, MD

Associate Professor Department of Medicine (Cardiology) and Molecular, Cell, and Developmental Biology

Broad Stem Cell Research Center

University of California, Los Angeles Los Angeles, California

Cody S. Deen, MD

Assistant Professor of Medicine

Division of Internal Medicine/Cardiology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Gregory J. Dehmer, MD, MACC, MSCAI

Vice President, Medical Director Cardiovascular Services

Baylor Scott & White Health Central Texas Division Temple, Texas

Professor of Medicine

Department of Internal Medicine

Division of Cardiology

Texas A&M College of Medicine Bryan, Texas

John S. Douglas, Jr., MD

Professor of Medicine

Director of Interventional Cardiology Fellowship Program Emory University School of Medicine Atlanta, Georgia

Allison G. Dupont, MD

Interventional Cardiologist

The Heart Center of Northeast George Medical Center Gainesville, Georgia

Fredy H. El Sakr, MD

Fellow in Cardiovascular Medicine

University of Michigan Hospital Ann Arbor, Michigan

Joseph J. Eron, MD

Professor of Medicine

Director, Clinical Core

University of North Carolina Center for AIDS Research Division of Infectious Disease

University of North Carolina School of Medicine

Chapel Hill, North Carolina

Mark A. Farber, MD, FACS

Professor of Radiology and Surgery

Division of Vascular Surgery

Director, Aortic Center

University of North Carolina School of Medicine Chapel Hill, North Carolina

Sunita Juliana Ferns, MD, MRCPCH(UK), FHRS

Assistant Professor of Pediatrics

Director, Pediatric Invasive Electrophysiology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Michelle A. Floris-Moore, MD, MS

Associate Professor Department of Medicine

Division of Infectious Diseases

University of North Carolina School of Medicine Chapel Hill, North Carolina

H. James Ford, MD

University of North Carolina

Division of Pulmonary and Critical Care Chapel Hill, North Carolina

Elizabeth Boger Foreman, MD, FAASM

Sleep Medicine Specialist

Sentara Martha Jefferson Medical and Surgical Associates Charlottesville, Virginia

Elman G. Frantz, MD

Professor of Pediatrics Division of Cardiology

University of North Carolina School of Medicine

Director, Pediatric Cardiac Catheterization Laboratory North Carolina Children’s Hospital

Co-Director, Adult Congenital Heart Disease Program

University of North Carolina Heart and Vascular Center Chapel Hill, North Carolina

Anil K. Gehi, MD

Associate Professor of Medicine Director, Clinical Cardiac Electrophysiology Service Division of Cardiology

University of North Carolina School of Medicine Chapel Hill, North Carolina

Leonard S. Gettes, MD Professor Emeritus Department of Medicine

Division of Cardiology

University of North Carolina at Chapel Hill

Chapel Hill, North Carolina

Olivia N. Gilbert, MD

Advanced Heart Failure and Transplant Cardiologist

Novant Health Forsyth Heart and Wellness

Winston-Salem, North Carolina

Allie E. Goins, MD

Department of Medicine

Emory University

Atlanta, Georgia

Anna Griffith, MD

Clinical Fellow

Division of Hematology and Oncology

Department of Internal Medicine

University of North Carolina Hospitals

Chapel Hill, North Carolina

Thomas R. Griggs, MD

Professor Emeritus Medicine, Pathology, and Laboratory Medicine

University of North Carolina School of Medicine Chapel Hill, North Carolina

Benjamin Haithcock, MD

Associate Professor of Surgery and Anesthesiology

University of North Carolina Hospitals Chapel Hill, North Carolina

Eileen M. Handberg, PhD Professor of Medicine

Department of Medicine

University of Florida Gainesville, Florida

Alan L. Hinderliter, MD

Associate Professor of Medicine Division of Cardiology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Lucius Howell, MD

Asheville Cardiology Associates/Mission Health Asheville, North Carolina

James P. Hummel, MD

Visiting Associate Professor of Medicine

Division of Cardiovascular Medicine

University of Wisconsin School of Medicine and Public Health Madison, Wisconsin

Thomas S. Ivester, MD, MPH

Professor of Maternal Fetal Medicine

Department of Obstetrics and Gynecology

University of North Carolina School of Medicine

Chief Medical Officer and Vice President for Medical Affairs

UNC Health Care Chapel Hill, North Carolina

Brian C. Jensen, MD

Associate Professor of Medicine and Pharmacology

Department of Medicine

Division of Cardiology

University of North Carolina School of Medicine

UNC McAllister Heart Institute Chapel Hill, North Carolina

Beth L. Jonas, MD

Reeves Foundation Distinguished Professor of Medicine Division of Rheumatology, Allergy, and Immunology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Golsa Joodi, MD, MPH

Post-Doctoral Research Fellow Department of Medicine Division of Cardiology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Jason N. Katz, MD, MHS Associate Professor of Medicine Department of Internal Medicine University of North Carolina Chapel Hill, North Carolina

Audrey Khoury, BS, AB Medical Student University of North Carolina School of Medicine Chapel Hill, North Carolina

J. Larry Klein, MD Professor of Medicine and Radiology Department of Cardiology and Radiology University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Martyn Knowles, MD, FACS

Adjunct Assistant Professor of Surgery Division of Vascular Surgery

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

David W. Lee, MD Chief Cardiology Fellow Division of Cardiology

University of North Carolina School of Medicine Chapel Hill, North Carolina

Daniel J. Lenihan, MD, FACC Professor of Medicine Director, Cardio-Oncology Center of Excellence Advanced Heart Failure Clinical Research Cardiovascular Division Washington University St. Louis, Missouri

Fong T. Leong, MBChB, PhD, FRCP, FHRS Consultant, Cardiac Electrophysiologist University Hospital of Wales Cardiff, United Kingdom

Gentian Lluri, MD, PhD Assistant Professor Department of Medicine Division of Cardiology University of California, Los Angeles Los Angeles, California

Robert Mendes, MD, FACS

Adjunct Assistant Professor Division of Vascular of Surgery

University of North Carolina School of Medicine Chapel Hill, North Carolina

Phil Mendys, PharmD Co-Director, Lipid and Prevention Clinic Department of Medicine Division of Cardiology University of North Carolina Healthcare Chapel Hill, North Carolina

Venu Menon, MD, FACC, FAHA Director, Cardiac Intensive Care Unit Director, Cardiovascular Fellowship Associate Director, C5 Research Professor of Medicine Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland, Ohio

Michael R. Mill, MD Professor of Surgery and Pediatrics University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Paula Miller, MD

Clinical Associate Professor of Medicine and Cardiology Department of Medicine Division of Cardiology University of North Carolina School of Medicine Chapel Hill, North Carolina

Timothy A. Mixon, MD, FACC, FSCAI Interventional Cardiologist Baylor Scott & White Health Temple, Texas

Associate Professor of Medicine Department of Internal Medicine Division of Cardiology Texas A&M College of Medicine Bryan, Texas

J. Paul Mounsey, PhD, BSc, BM, BCh Chief of Electrophysiology, East Carolina Heart Institute Professor of Medicine Brody School of Medicine East Carolina University Greenville, North Carolina

E. Magnus Ohman, MD, FRCPI Professor of Medicine Associate Director, Duke Heart Center—Cardiology Clinics Director, Program for Advanced Coronary Disease Duke Clinical Research Institute

Duke University Medical Center Durham, North Carolina

Rikin Patel, DO Cardiovascular Disease Fellow

Baylor Scott & White Health/Texas A&M Temple, Texas

Kristine B. Patterson, MD Associate Professor of Medicine Division of Infectious Disease

Columbia University Medical Center New York, New York

Eric D. Pauley, MD

Cardiovascular Disease Fellow

University of North Carolina Hospitals Chapel Hill, North Carolina

Pamela S. Ro, MD

Associate Professor

Department of Pediatrics University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Rachel D. Romero, MD Fellow

Division of Rheumatology, Allergy, and Immunology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Lisa J. Rose-Jones, MD

Assistant Professor of Medicine

Division of Cardiology

University of North Carolina at Chapel Hill

UNC Center for Heart and Vascular Care Chapel Hill, North Carolina

Richard S. Schofield, MD Professor of Medicine

Division of Cardiovascular Medicine

University of Florida College of Medicine

Department of Veterans Affairs Medical Center Gainesville, Florida

Kristen A. Sell-Dottin, MD

Assistant Professor University of Louisville Louisville, Kentucky

Jay D. Sengupta, MD

Clinical Cardiac Electrophysiologist Minneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis, Minnesota

Faiq Shaikh, MD

Molecular Imaging Physician Consultant Cellsight Technologies, Inc. San Francisco, California

Arif Sheikh, MD

Associate Professor Department of Radiology Columbia University New York, New York

David S. Sheps, MD, MSPH Professor Department of Epidemiology University of Florida Gainesville, Florida

Brett C. Sheridan, MD San Francisco Cardiology San Francisco, California

Ross J. Simpson, Jr., MD, PhD

Director of the Lipid and Prevention Clinic at University of North Carolina

Professor of Medicine and Adjuvant Professor of Epidemiology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Christopher E. Slagle, PhD

Postdoctoral Fellow

Departments of Biology and Genetics

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Sidney C. Smith, Jr., MD, FAHA, FESC, FACP, MACC Professor of Medicine

Department of Medicine/Division of Cardiology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Mark A. Socinski, MD Professor of Medicine

Division of Hematology and Oncology

Multidisciplinary Thoracic Oncology Program

Lineberger Comprehensive Cancer Center University of North Carolina School of Medicine Chapel Hill, North Carolina

Robert D. Stewart, MD, MPH

Staff, Pediatric and Congenital Heart Surgery

Heart and Vascular Institute Cleveland Clinic Cleveland, Ohio

Thomas D. Stuckey, MD, FACC

Medical Director, LeBauer Cardiovascular Research and Education Cone Health Heart and Vascular Center Greensboro, North Carolina

Carla A. Sueta, MD, PhD Professor of Medicine Emerita Division of Cardiology University of North Carolina School of Medicine Chapel Hill, North Carolina

Khola S. Tahir, MD

Cardiovascular Disease Fellow University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Walter A. Tan, MD, MS

Associate Professor of Medicine Director, Cardiac Catheterization Laboratories Wake Forest—Baptist Health Winston-Salem, North Carolina

David A. Tate, MD

Associate Professor of Medicine Emeritus Division of Cardiology University of North Carolina School of Medicine Chapel Hill, North Carolina

Rebecca E. Traub, MD

Assistant Professor Department of Neurology University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Bradley V. Vaughn, MD Professor of Neurology University of North Carolina School of Medicine Chapel Hill, North Carolina

John P. Vavalle, MD, MHS, FACC

Assistant Professor of Medicine Director of Structural Heart Disease

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Anirudh Vinnakota, MS

Case Western Reserve University School of Medicine Department of Thoracic and Cardiovascular Surgery Cleveland, Ohio

Raven A. Voora, MD

Assistant Professor of Medicine Division of Nephrology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Thelsa Thomas Weickert, MD

Assistant Professor Department of Medicine Division of Cardiology

University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Andy Wessels, PhD

Professor and Vice-Chair, Department of Regenerative Medicine and Cell Biology

Co-Director, Cardiovascular Developmental Biology Center

Medical University of South Carolina Charleston, South Carolina

John T. Wilkins, MD, MS

Assistant Professor of Medicine (Cardiology) and Preventive Medicine

Northwestern University Feinberg School of Medicine Chicago, Illinois

Park W. Willis IV, MD

Sarah Graham Kenan Distinguished Professor of Medicine and Pediatrics Emeritus

Director, Cardiac Ultrasound Laboratories

Division of Cardiology

University of North Carolina School of Medicine

Chapel Hill, North Carolina

Eric H. Yang, MD, MBA

Director of Interventional Cardiology and Cardiac Catheterization Laboratories

Department of Cardiovascular Disease

Mayo Clinic Arizona Phoenix, Arizona

Michael Yeung, MD

Assistant Professor of Medicine

University of North Carolina School of Medicine Chapel Hill, North Carolina

Andrew O. Zurick III, MD, MSEd, FACC, FASE

Director of Advanced Cardiovascular Imaging

Cardiovascular Medicine

St. Thomas Heart Nashville, Tennessee

Affiliated Assistant Professor Division of Internal Medicine in the Department of Clinical Medical Education

University of Tennessee Health Science Center, College of Medicine Knoxville, Tennessee

Another random document with no related content on Scribd:

So they went. At first Pooh and Rabbit and Piglet walked together, and Tigger ran round them in circles, and then, when the path got narrower, Rabbit, Piglet and Pooh walked one after another, and Tigger ran round them in oblongs, and by-and-by, when the gorse got very prickly on each side of the path, Tigger ran up and down in front of them, and sometimes he bounced into Rabbit and sometimes he didn't. And as they got higher, the mist got thicker, so that Tigger kept disappearing, and then when you thought he wasn't there, there he was again, saying "I say, come on," and before you could say anything, there he wasn't.

Rabbit turned round and nudged Piglet.

"The next time," he said. "Tell Pooh."

"The next time," said Piglet to Pooh.

"The next what?" said Pooh to Piglet.

Tigger appeared suddenly, bounced into Rabbit, and disappeared again. "Now!" said Rabbit. He jumped into a hollow by the side of the path, and Pooh and Piglet jumped after him. They crouched in the bracken, listening. The Forest was very silent when you stopped and listened to it. They could see nothing and hear nothing.

"H'sh!" said Rabbit.

"I am," said Pooh.

There was a pattering noise ... then silence again.

"Hallo!" said Tigger, and he sounded so close suddenly that Piglet would have jumped if Pooh hadn't accidentally been sitting on most of him.

"Where are you?" called Tigger.

Rabbit nudged Pooh, and Pooh looked about for Piglet to nudge, but couldn't find him, and Piglet went on breathing wet bracken as

quietly as he could, and felt very brave and excited.

"That's funny," said Tigger.

There was a moment's silence, and then they heard him pattering off again. For a little longer they waited, until the Forest had become so still that it almost frightened them, and then Rabbit got up and stretched himself.

"Well?" he whispered proudly. "There we are! Just as I said."

"I've been thinking," said Pooh, "and I think——"

"No," said Rabbit. "Don't. Run. Come on." And they all hurried off, Rabbit leading the way.

"Now," said Rabbit, after they had gone a little way, "we can talk. What were you going to say, Pooh?"

"Nothing much. Why are we going along here?"

"Because it's the way home."

"Oh!" said Pooh.

"I think it's more to the right," said Piglet nervously. "What do you think, Pooh?"

Pooh looked at his two paws. He knew that one of them was the right, and he knew that when you had decided which one of them was the right, then the other one was the left, but he never could remember how to begin.

"Well," he said slowly—— "Come on," said Rabbit. "I know it's this way." They went on. Ten minutes later they stopped again.

"It's very silly," said Rabbit, "but just for the moment I Ah, of course. Come on...."

"Here we are," said Rabbit ten minutes later. "No, we're not...."

"Now," said Rabbit ten minutes later, "I think we ought to be getting —or are we a little bit more to the right than I thought?..."

"It's a funny thing," said Rabbit ten minutes later, "how everything looks the same in a mist. Have you noticed it, Pooh?"

Pooh said that he had.

"Lucky we know the Forest so well, or we might get lost," said Rabbit half an hour later, and he gave the careless laugh which you give when you know the Forest so well that you can't get lost.

Piglet sidled up to Pooh from behind. "Pooh!" he whispered.

"Yes, Piglet?"

"Nothing," said Piglet, taking Pooh's paw. "I just wanted to be sure of you."

When Tigger had finished waiting for the others to catch him up, and they hadn't, and when he had got tired of having nobody to say, "I say, come on" to, he thought he would go home. So he trotted back; and the first thing Kanga said when she saw him was "There's a good Tigger. You're just in time for your Strengthening Medicine," and she poured it out for him. Roo said proudly, "I've hadmine," and Tigger swallowed his and said, "So have I," and then he and Roo pushed each other about in a friendly way, and Tigger accidentally knocked over one or two chairs by accident, and Roo accidentally knocked over one on purpose, and Kanga said, "Now then, run along."

"Where shall we run along to?" asked Roo.

"You can go and collect some fir-cones for me," said Kanga, giving them a basket.

So they went to the Six Pine Trees, and threw fir-cones at each other until they had forgotten what they came for, and they left the basket

under the trees and went back to dinner. And it was just as they were finishing dinner that Christopher Robin put his head in at the door.

"Where's Pooh?" he asked.

"Tigger dear, where's Pooh?" said Kanga. Tigger explained what had happened at the same time that Roo was explaining about his Biscuit Cough and Kanga was telling them not both to talk at once, so it was some time before Christopher Robin guessed that Pooh and Piglet and Rabbit were all lost in the mist on the top of the Forest.

"It's a funny thing about Tiggers," whispered Tigger to Roo, "how Tiggers neverget lost."

"Why don't they, Tigger?"

"They just don't," explained Tigger. "That's how it is."

"Well," said Christopher Robin, "we shall have to go and find them, that's all. Come on, Tigger."

"I shall have to go and find them," explained Tigger to Roo.

"May I find them too?" asked Roo eagerly.

"I think not today, dear," said Kanga. "Another day."

"Well, if they're lost tomorrow, may I find them?"

"We'll see," said Kanga, and Roo, who knew what that meant, went into a corner, and practised jumping out at himself, partly because he wanted to practise this, and partly because he didn't want Christopher Robin and Tigger to think that he minded when they went off without him.

"The fact is," said Rabbit, "we've missed our way somehow."

They were having a rest in a small sand-pit on the top of the Forest. Pooh was getting rather tired of that sand-pit, and suspected it of following them about, because whichever direction they started in,

they always ended up at it, and each time, as it came through the mist at them, Rabbit said triumphantly, "Now I know where we are!" and Pooh said sadly, "So do I," and Piglet said nothing. He had tried to think of something to say, but the only thing he could think of was, "Help, help!" and it seemed silly to say that, when he had Pooh and Rabbit with him.

"Well," said Rabbit, after a long silence in which nobody thanked him for the nice walk they were having, "we'd better get on, I suppose. Which way shall we try?"

"How would it be," said Pooh slowly, "if, as soon as we're out of sight of this Pit, we try to find it again?"

"What's the good of that?" said Rabbit.

"Well," said Pooh, "we keep looking for Home and not finding it, so I thought that if we looked for this Pit, we'd be sure not to find it, which would be a Good Thing, because then we might find something that we weren'tlooking for, which might be just what we werelooking for, really."

"I don't see much sense in that," said Rabbit.

"No," said Pooh humbly, "there isn't. But there was goingto be when I began it. It's just that something happened to it on the way."

"If I walked away from this Pit, and then walked back to it, of course I should find it."

"Well, I thought perhaps you wouldn't," said Pooh. "I just thought."

"Try," said Piglet suddenly. "We'll wait here for you."

Rabbit gave a laugh to show how silly Piglet was, and walked into the mist. After he had gone a hundred yards, he turned and walked back again ... and after Pooh and Piglet had waited twenty minutes for him, Pooh got up.

"I just thought," said Pooh. "Now then, Piglet, let's go home."

"But, Pooh," cried Piglet, all excited, "do you know the way?"

"No," said Pooh. "But there are twelve pots of honey in my cupboard, and they've been calling to me for hours. I couldn't hear them properly before, because Rabbit would talk, but if nobody says anything except those twelve pots, I think, Piglet, I shall know where they're calling from. Come on."

They walked off together; and for a long time Piglet said nothing, so as not to interrupt the pots; and then suddenly he made a squeaky noise ... and an oo-noise ... because now he began to know where he was; but he still didn't dare to say so out loud, in case he wasn't. And just when he was getting so sure of himself that it didn't matter whether the pots went on calling or not, there was a shout from in front of them, and out of the mist came Christopher Robin.

"Oh, there you are," said Christopher Robin carelessly, trying to pretend that he hadn't been Anxious.

"Here we are," said Pooh.

"Where's Rabbit?"

"I don't know," said Pooh.

"Oh—well, I expect Tigger will find him. He's sort of looking for you all."

"Well," said Pooh, "I've got to go home for something, and so has Piglet, because we haven't had it yet, and——"

"I'll come and watch you," said Christopher Robin.

So he went home with Pooh, and watched him for quite a long time ... and all the time he was watching, Tigger was tearing round the Forest making loud yapping noises for Rabbit. And at last a very Small and Sorry Rabbit heard him. And the Small and Sorry Rabbit rushed through the mist at the noise, and it suddenly turned into Tigger; a Friendly Tigger, a Grand Tigger, a Large and Helpful Tigger, a Tigger who bounced, if he bounced at all, in just the beautiful way a Tigger ought to bounce.

"Oh, Tigger, I amglad to see you," cried Rabbit.

CHAPTER VIII

IN WHICH PigletDoesaVeryGrandThing

Half way between Pooh's house and Piglet's house was a Thoughtful Spot where they met sometimes when they had decided to go and see each other, and as it was warm and out of the wind they would sit down there for a little and wonder what they would do now that they hadseen each other. One day when they had decided not to do anything, Pooh made up a verse about it, so that everybody should know what the place was for.

This warm and sunny Spot Belongs to Pooh.

And here he wonders what He's going to do.

Oh, bother, I forgot It's Piglet's too.

Now one autumn morning when the wind had blown all the leaves off the trees in the night, and was trying to blow the branches off, Pooh and Piglet were sitting in the Thoughtful Spot and wondering.

"What Ithink," said Pooh, "is I think we'll go to Pooh Corner and see Eeyore, because perhaps his house has been blown down, and perhaps he'd like us to build it again."

"What I think," said Piglet, "is I think we'll go and see Christopher Robin, only he won't be there, so we can't."

"Let's go and see everybody," said Pooh. "Because when you've been walking in the wind for miles, and you suddenly go into somebody's house, and he says, 'Hallo, Pooh, you're just in time for a little smackerel of something,' and you are, then it's what I call a Friendly Day."

Piglet thought that they ought to have a Reason for going to see everybody, like Looking for Small or Organizing an Expotition, if Pooh could think of something. Pooh could.

"We'll go because it's Thursday," he said, "and we'll go to wish everybody a Very Happy Thursday. Come on, Piglet."

They got up; and when Piglet had sat down again, because he didn't know the wind was so strong, and had been helped up by Pooh, they started off. They went to Pooh's house first, and luckily Pooh was at home just as they got there, so he asked them in, and they had some, and then they went on to Kanga's house, holding on to each other, and shouting "Isn't it?" and "What?" and "I can't hear." By the time they got to Kanga's house they were so buffeted that they stayed to lunch. Just at first it seemed rather cold outside afterwards, so they pushed on to Rabbit's as quickly as they could.

"We've come to wish you a Very Happy Thursday," said Pooh, when he had gone in and out once or twice just to make sure that he could get out again.

"Why, what's going to happen on Thursday?" asked Rabbit, and when Pooh had explained, and Rabbit, whose life was made up of Important Things, said, "Oh, I thought you'd really come about something," they sat down for a little ... and by-and-by Pooh and Piglet went on again. The wind was behind them now, so they didn't have to shout.

"Rabbit's clever," said Pooh thoughtfully.

"Yes," said Piglet, "Rabbit's clever."

"And he has Brain."

"Yes," said Piglet, "Rabbit has Brain."

There was a long silence.

"I suppose," said Pooh, "that that's why he never understands anything."

Christopher Robin was at home by this time, because it was the afternoon, and he was so glad to see them that they stayed there until very nearly tea-time, and then they had a Very Nearly tea, which is one you forget about afterwards, and hurried on to Pooh Corner, so as to see Eeyore before it was too late to have a Proper Tea with Owl.

"Hallo, Eeyore," they called out cheerfully.

"Ah!" said Eeyore. "Lost your way?"

"We just came to see you," said Piglet. "And to see how your house was. Look, Pooh, it's still standing!"

"I know," said Eeyore. "Very odd. Somebody ought to have come down and pushed it over."

"We wondered whether the wind would blow it down," said Pooh.

"Ah, that's why nobody's bothered, I suppose. I thought perhaps they'd forgotten."

"Well, we're very glad to see you, Eeyore, and now we're going on to see Owl."

"That's right. You'll like Owl. He flew past a day or two ago and noticed me. He didn't actually say anything, mind you, but he knew it was me. Very friendly of him, I thought. Encouraging."

Pooh and Piglet shuffled about a little and said, "Well, good-bye, Eeyore" as lingeringly as they could, but they had a long way to go, and wanted to be getting on.

"Good-bye," said Eeyore. "Mind you don't get blown away, little Piglet. You'd be missed. People would say 'Where's little Piglet been blown to?'—really wanting to know. Well, good-bye. And thank you for happening to pass me."

"Good-bye," said Pooh and Piglet for the last time, and they pushed on to Owl's house.

The wind was against them now, and Piglet's ears streamed behind him like banners as he fought his way along, and it seemed hours before he got them into the shelter of the Hundred Acre Wood and they stood up straight again, to listen, a little nervously, to the roaring of the gale among the tree-tops.

"Supposing a tree fell down, Pooh, when we were underneath it?"

"Supposing it didn't," said Pooh after careful thought.

Piglet was comforted by this, and in a little while they were knocking and ringing very cheerfully at Owl's door.

"Hallo, Owl," said Pooh. "I hope we're not too late for I mean, how are you, Owl? Piglet and I just came to see how you were, because it's Thursday."

"Sit down, Pooh, sit down, Piglet," said Owl kindly. "Make yourselves comfortable."

They thanked him, and made themselves as comfortable as they could.

"Because, you see, Owl," said Pooh, "we've been hurrying, so as to be in time for—so as to see you before we went away again."

Owl nodded solemnly.

"Correct me if I am wrong," he said, "but am I right in supposing that it is a very Blusterous day outside?"

"Very," said Piglet, who was quietly thawing his ears, and wishing that he was safely back in his own house.

"I thought so," said Owl. "It was on just such a blusterous day as this that my Uncle Robert, a portrait of whom you see upon the wall on your right, Piglet, while returning in the late forenoon from a—— What's that?"

There was a loud cracking noise.

"Look out!" cried Pooh. "Mind the clock! Out of the way, Piglet! Piglet, I'm falling on you!"

"Help!" cried Piglet.

Pooh's side of the room was slowly tilting upwards and his chair began sliding down on Piglet's. The clock slithered gently along the mantelpiece, collecting vases on the way, until they all crashed together on to what had once been the floor, but was now trying to see what it looked like as a wall. Uncle Robert, who was going to be the new hearth-rug, and was bringing the rest of his wall with him as carpet, met Piglet's chair just as Piglet was expecting to leave it, and for a little while it became very difficult to remember which was really the north. Then there was another loud crack ... Owl's room collected itself feverishly ... and there was silence.

In a corner of the room, the tablecloth began to wriggle.

Then it wrapped itself into a ball and rolled across the room.

Then it jumped up and down once or twice, and put out two ears. It rolled across the room again, and unwound itself.

"Pooh," said Piglet nervously.

"Yes?" said one of the chairs.

"Where are we?"

"I'm not quite sure," said the chair.

"Are we—are we in Owl's House?"

"I think so, because we were just going to have tea, and we hadn't had it."

"Oh!" said Piglet. "Well, did Owl always have a letter-box in his ceiling?"

"Has he?"

"Yes, look."

"I can't," said Pooh. "I'm face downwards under something, and that, Piglet, is a very bad position for looking at ceilings."

"Well, he has, Pooh."

"Perhaps he's changed it," said Pooh. "Just for a change."

There was a disturbance behind the table in the other corner of the room, and Owl was with them again.

"Ah, Piglet," said Owl, looking very much annoyed; "where's Pooh?"

"I'm not quite sure," said Pooh.

Owl turned at his voice, and frowned at as much of Pooh as he could see.

"Pooh," said Owl severely, "did youdo that?"

"No," said Pooh humbly. "I don't thinkso."

"Then who did?"

"I think it was the wind," said Piglet. "I think your house has blown down."

"Oh, is that it? I thought it was Pooh."

"No," said Pooh.

"If it was the wind," said Owl, considering the matter, "then it wasn't Pooh's fault. No blame can be attached to him." With these kind words he flew up to look at his new ceiling.

"Piglet!" called Pooh in a loud whisper.

Piglet leant down to him.

"Yes, Pooh?"

"Whatdid he say was attached to me?"

"He said he didn't blame you."

"Oh! I thought he meant—Oh, I see."

"Owl," said Piglet, "come down and help Pooh."

Owl, who was admiring his letter-box, flew down again. Together they pushed and pulled at the arm-chair, and in a little while Pooh came out from underneath, and was able to look round him again.

"Well!" said Owl. "This is a nice state of things!"

"What are we going to do, Pooh? Can you think of anything?" asked Piglet.

"Well, I had just thought of something," said Pooh. "It was just a little thing I thought of." And he began to sing:

I lay on my chest

And I thought it best

To pretend I was having an evening rest; I lay on my tum

And I tried to hum

But nothing particular seemed to come. My face was flat

On the floor, and that Is all very well for an acrobat;

But it doesn't seem fair

To a Friendly Bear

To stiffen him out with a basket-chair.

And a sort of sqoze

Which grows and grows Is not too nice for his poor old nose, And a sort of squch Is much too much

For his neck and his mouth and his ears and such.

"That was all," said Pooh.

Owl coughed in an unadmiring sort of way, and said that, if Pooh was sure that was all, they could now give their minds to the Problem of Escape.

"Because," said Owl, "we can't go out by what used to be the front door. Something's fallen on it."

"But how else canyou go out?" asked Piglet anxiously.

"That is the Problem, Piglet, to which I am asking Pooh to give his mind."

Pooh sat on the floor which had once been a wall, and gazed up at the ceiling which had once been another wall, with a front door in it

which had once been a front door, and tried to give his mind to it.

"Could you fly up to the letter-box with Piglet on your back?" he asked.

"No," said Piglet quickly. "He couldn't."

Owl explained about the Necessary Dorsal Muscles. He had explained this to Pooh and Christopher Robin once before, and had been waiting ever since for a chance to do it again, because it is a thing which you can easily explain twice before anybody knows what you are talking about.

"Because you see, Owl, if we could get Piglet into the letter-box, he might squeeze through the place where the letters come, and climb down the tree and run for help."

Piglet said hurriedly that he had been getting bigger lately, and couldn't possibly, much as he would like to, and Owl said that he had had his letter-box made bigger lately in case he got bigger letters, so perhaps Piglet might, and Piglet said, "But you said the necessary you-know-whats wouldn't," and Owl said, "No, they won't, so it's no good thinking about it," and Piglet said "Then we'd better think of something else," and began to at once.

But Pooh's mind had gone back to the day when he had saved Piglet from the flood, and everybody had admired him so much; and as that didn't often happen he thought he would like it to happen again. And suddenly, just as it had come before, an idea came to him.

"Owl," said Pooh, "I have thought of something."

"Astute and Helpful Bear," said Owl.

Pooh looked proud at being called a stout and helpful bear, and said modestly that he just happened to think of it. You tied a piece of string to Piglet, and you flew up to the letter-box with the other end in your beak, and you pushed it through the wire and brought it down to the floor, and you and Pooh pulled hard at this end, and Piglet went slowly up at the other end. And there you were.

"And there Piglet is," said Owl. "If the string doesn't break."

"Supposing it does?" asked Piglet, wanting to know.

"Then we try another piece of string."

This was not very comforting to Piglet, because however many pieces of string they tried pulling up with, it would always be the same him coming down; but still, it did seem the only thing to do. So with one last look back in his mind at all the happy hours he had spent in the Forest not being pulled up to the ceiling by a piece of string, Piglet nodded bravely at Pooh and said that it was a Very Clever pup-puppup Clever pup-pup Plan.

"It won't break," whispered Pooh comfortingly, "because you're a Small Animal, and I'll stand underneath, and if you save us all, it will be a Very Grand Thing to talk about afterwards, and perhaps I'll make up a Song, and people will say 'It was so grand what Piglet did that a Respectful Pooh Song was made about it."

Piglet felt much better after this, and when everything was ready, and he found himself slowly going up to the ceiling, he was so proud that he would have called out "Look at me!" if he hadn't been afraid that Pooh and Owl would let go of their end of the string and look at him.

"Up we go!" said Pooh cheerfully.

"The ascent is proceeding as expected," said Owl helpfully. Soon it was over. Piglet opened the letter-box and climbed in. Then, having untied himself, he began to squeeze into the slit, through which in the old days when front doors werefront doors, many an unexpected letter that WOL had written to himself, had come slipping.

He squeezed and he squoze, and then with one last sqooze he was out. Happy and excited he turned round to squeak a last message to the prisoners.

Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.