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Bedside cardiology
Book reviews
The Conduction System of the Heart. Structure, Function and Clinical Implications. Edited by H. J. J. Wellens, M.D., K. I. Lie, M.D., and M. J. Janse, M.D., Philadelphia, 1976, Lea & Febiger, Publishers, 708 pages.
each chapter definitely reflects the respective author's opinions and approach to these complex cardiotogic problems. The book is highly recommended to all physicians who manage cardiac disease.
Obviously the conduction system of the heart is an extremely important structure of the heart. An intact normal functioning conduction system is necessary for proper function of the cardiac pump. Proper timing Of the contraction of each chamber and all parts of each chamber is necessary for normal cardiac function. The book is dedicated to Dr. Dirk Durrer and is based upon a workshop conducted in the spring of 1975 in Amsterdam. The many contributors from several nations of the world discuss anatomy and electrophysiology of the conduction system, impulse formation, the sinus node and atz~ium, the A-V junction and bundle branches and ventricle, the WPW syndrome, and myocardial infarction. The many papers should interest all cardiologists because of the importance of the role of disturbances in cardiac rhythm in cardiac disease. These many presentations review the common problems of disturbances in function of the conduction system. This is a good book edited b y outstanding cardiologists of Amsterdam. Dr. Durrer should feel honored to have the book dedicated to him.
Bedside Cardiology, ed. 2. Jules Constant, M.D., Boston, 1976, Little, Brown & Company, 443 pages.
Intensive Care. Edited by John Joakim Skillman, M.D., Boston, 1973, Little, Brown & Company, 609 pages. Intensive-care centers exist in practically all hospitals of the world. They are no better than the people who are responsible for theft" operation. This book edited by Skillman is an excellent source for study of intensive care of seriously ill patients. It is surgically oriented. Most books on this subject have been medically directed. The SICU is extremely important in the care of the patient who undergoes complex cardiac surgical operations and patients with cardiac disease subjected to major surgical operations. The importance of teamwork is emphasized as well as a thorough knowledge of pathophysiology and management of disturbances in physiology. The book should interest all cardiologists as well as all surgeons, not only cardiac surgeons. The book is worth owning. It is practical and clearly written. Clinical Cardiovascular Physiology. Edited by Herbert J. Levine, New York, 1976, Grune & Stratton, Inc., 945 pages. $52.5O. This book of about 1,000 pages edited by Dr. Herbert Levine contains a rather extensive review of the common pathophysiologic problems in clinical cardiology. The discussions are clearly presented and each chapter contains a fairly extensive selected bibliography. The contributors tend to present the pathophysiologic disturbances in fair detail but always with clinical implications in view. The 24 chapters include a review of electrophysiology, hemodynamic phenomena in the normal and failing heart, contraction of heart muscle as related to its structure, renal function in congestive heart failure, digitalis, and cardiomyopathy. The book contains an enormous amount of information that is useful to clinicians who manage a large number of patients with heart disease. Students, house staff, and trainees in cardiology will find this to be a useful and thought-provoking book. It must be studied critically since
540
This book emphasizes the need for better training in bedside cardiology. But, when one refers, as on the top ofp. 267, to the "shape" of a murmur, then the reader is forced to wonder how "bedside" this presentation is. Further, as is evident, the author is referring in this instance to the phonocardiographic recording and the time course of the pressure gradient across the mitral valve orifice, but the explanation falls short of a clear explanation or reference to the recorded phonocardiogram which is not a routine bedside or office procedure. The book consists of questions and answers concerning the bedside study of the patient. A check list is presented for detailed history taking. The questions related to the physical signs such as sounds, arterial pulse, etc., do raise interesting ideas and thoughts. The illustrations are simple and well selected. Readers will find this book to be useful, thought provoking, and concerned with important bedside and office approaches to the study of the heart and circulation of patients. The Hemiblocks in Myocardial Infarction. By Agustin Castellanos, Jr., and Robert J. Myerburg, New York, 1976, Appleton-Century-Crofts, 158 pages. $11.75. This is a short book on hemiblocks, a conduction disturbance which apparently has caused considerable confusion in ECG laboratories throughout the U. S. A. An ECG diagnosis of hemibloCk is too frequently made. The ECG shown in Fig. 12, p. 21, of this book is a good example. It would be difficult to differentiate this ECG from that of left axis deviation due to other causes such as a transverse heart with counterclockwise rotation along the longitudinal axis of the heart or from left ventricular hypertrophy. The fidelity of direct ECG recorders is so poor that an error of 1 to 2 msec. can readily occur in a QRS complex of the conventionally clinically recorded ECG. This book consists of the authors' concepts of the hemiblock as the syndromes are observed and diagnosed in patients with myocardial infarction. The strict and reliable criteria for diagnosis, pathogenesis, and clinical significance of the hemiblock are yet to be defined. This book does stimulate interest in the problems related to hemiblock, but this reviewer cautions the reader to study this book critically and to employ the authors' diagnostic criteria cautiously. There is a need to study in detail more of the hearts at autopsy to learn if the diagnosis so frequently made by ECG is actually due to hemiblock or to some other cause. This book is difficult to follow because of the numerous abbreviations, many not generally used in other institutions. Some criteria for diagnosis seem to be arbitrary, e.g., the degree of left axis deviation of the QRS complex that indicates left anterior hemiblock (see p. 5). Pharmacologie Clinique des Medicaments Anti-Angineux. Paris, Decembre 12-13, 1974, Hopital Tenon. Published by Sandoz Editions.
April, 1977, Vol. 93, No. 4
The Conduction System of the Heart. Structure, Function and Clinical Implications. Edited by H. J. J. Wellens, M.D., K. I. Lie, M.D., and M. J. Janse, M.D., Philadelphia, 1976, Lea & Febiger, Publishers, 708 pages.
each chapter definitely reflects the respective author's opinions and approach to these complex cardiotogic problems. The book is highly recommended to all physicians who manage cardiac disease.
Obviously the conduction system of the heart is an extremely important structure of the heart. An intact normal functioning conduction system is necessary for proper function of the cardiac pump. Proper timing Of the contraction of each chamber and all parts of each chamber is necessary for normal cardiac function. The book is dedicated to Dr. Dirk Durrer and is based upon a workshop conducted in the spring of 1975 in Amsterdam. The many contributors from several nations of the world discuss anatomy and electrophysiology of the conduction system, impulse formation, the sinus node and atz~ium, the A-V junction and bundle branches and ventricle, the WPW syndrome, and myocardial infarction. The many papers should interest all cardiologists because of the importance of the role of disturbances in cardiac rhythm in cardiac disease. These many presentations review the common problems of disturbances in function of the conduction system. This is a good book edited b y outstanding cardiologists of Amsterdam. Dr. Durrer should feel honored to have the book dedicated to him.
Bedside Cardiology, ed. 2. Jules Constant, M.D., Boston, 1976, Little, Brown & Company, 443 pages.
Intensive Care. Edited by John Joakim Skillman, M.D., Boston, 1973, Little, Brown & Company, 609 pages. Intensive-care centers exist in practically all hospitals of the world. They are no better than the people who are responsible for theft" operation. This book edited by Skillman is an excellent source for study of intensive care of seriously ill patients. It is surgically oriented. Most books on this subject have been medically directed. The SICU is extremely important in the care of the patient who undergoes complex cardiac surgical operations and patients with cardiac disease subjected to major surgical operations. The importance of teamwork is emphasized as well as a thorough knowledge of pathophysiology and management of disturbances in physiology. The book should interest all cardiologists as well as all surgeons, not only cardiac surgeons. The book is worth owning. It is practical and clearly written. Clinical Cardiovascular Physiology. Edited by Herbert J. Levine, New York, 1976, Grune & Stratton, Inc., 945 pages. $52.5O. This book of about 1,000 pages edited by Dr. Herbert Levine contains a rather extensive review of the common pathophysiologic problems in clinical cardiology. The discussions are clearly presented and each chapter contains a fairly extensive selected bibliography. The contributors tend to present the pathophysiologic disturbances in fair detail but always with clinical implications in view. The 24 chapters include a review of electrophysiology, hemodynamic phenomena in the normal and failing heart, contraction of heart muscle as related to its structure, renal function in congestive heart failure, digitalis, and cardiomyopathy. The book contains an enormous amount of information that is useful to clinicians who manage a large number of patients with heart disease. Students, house staff, and trainees in cardiology will find this to be a useful and thought-provoking book. It must be studied critically since
540
This book emphasizes the need for better training in bedside cardiology. But, when one refers, as on the top ofp. 267, to the "shape" of a murmur, then the reader is forced to wonder how "bedside" this presentation is. Further, as is evident, the author is referring in this instance to the phonocardiographic recording and the time course of the pressure gradient across the mitral valve orifice, but the explanation falls short of a clear explanation or reference to the recorded phonocardiogram which is not a routine bedside or office procedure. The book consists of questions and answers concerning the bedside study of the patient. A check list is presented for detailed history taking. The questions related to the physical signs such as sounds, arterial pulse, etc., do raise interesting ideas and thoughts. The illustrations are simple and well selected. Readers will find this book to be useful, thought provoking, and concerned with important bedside and office approaches to the study of the heart and circulation of patients. The Hemiblocks in Myocardial Infarction. By Agustin Castellanos, Jr., and Robert J. Myerburg, New York, 1976, Appleton-Century-Crofts, 158 pages. $11.75. This is a short book on hemiblocks, a conduction disturbance which apparently has caused considerable confusion in ECG laboratories throughout the U. S. A. An ECG diagnosis of hemibloCk is too frequently made. The ECG shown in Fig. 12, p. 21, of this book is a good example. It would be difficult to differentiate this ECG from that of left axis deviation due to other causes such as a transverse heart with counterclockwise rotation along the longitudinal axis of the heart or from left ventricular hypertrophy. The fidelity of direct ECG recorders is so poor that an error of 1 to 2 msec. can readily occur in a QRS complex of the conventionally clinically recorded ECG. This book consists of the authors' concepts of the hemiblock as the syndromes are observed and diagnosed in patients with myocardial infarction. The strict and reliable criteria for diagnosis, pathogenesis, and clinical significance of the hemiblock are yet to be defined. This book does stimulate interest in the problems related to hemiblock, but this reviewer cautions the reader to study this book critically and to employ the authors' diagnostic criteria cautiously. There is a need to study in detail more of the hearts at autopsy to learn if the diagnosis so frequently made by ECG is actually due to hemiblock or to some other cause. This book is difficult to follow because of the numerous abbreviations, many not generally used in other institutions. Some criteria for diagnosis seem to be arbitrary, e.g., the degree of left axis deviation of the QRS complex that indicates left anterior hemiblock (see p. 5). Pharmacologie Clinique des Medicaments Anti-Angineux. Paris, Decembre 12-13, 1974, Hopital Tenon. Published by Sandoz Editions.
April, 1977, Vol. 93, No. 4