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Congestive cardiac failure: Pathophysiology and treatment
ELSEVIER SCIENCE lREL,NI,
International
Journal
of Cardiology
44
I 1994)
105- 108
Book reviews
Congestive Cardiac Failure: Pathophysiology and Treatment D.B. Barnett, H. Pouleur, G.S. Francis Marcel Dekker, New York, NY, 1993; 448 pp.; USSl35.00; ISBN O-8247-882 l-4 This book begins with an intriguing paradox; why, if mortality from coronary artery disease and stroke is falling, which some have attributed to the more effective control of blood pressure in the community, is the incidence of and mortality due to heart failure increasing, a condition which is closely linked to hypertension in many epidemiological studies? The easy answer is to blame the increase in heart failure on the ageing of the population, but Garg and Yusuf point out that even after adjusting for age the number of deaths due to heart failure appears to have doubled in the last 20 years. This increase remains to be explained. Heart failure is already numerically the single commonest clinical problem in in-patient practice in industrialised societies. A book on the epidemiology. pathophysiology and management of heart failure should be required reading for all general physicians. physicians for the care of the elderly and cardiologists. For the non-expert the present book will fill most important gaps in knowledge. However, it is almost impossible for text-books to keep pace with the rate at which new clinically relevant information is being acquired. Some of the chapters are already sadly out of date, for instance the chapter on digoxin which had obviously been submitted and accepted before publication of the most recent of the ACE inhibitor trials and the still more recent RADIANCE trial of digoxin. Other chapters, for instance those on vasodilator therapy, beta-blockers and on ACE inhibitors contained all the available information at the time of press but are no longer up to-date. The results of several major trials including PROFILE, MDC. CIBIS, AIRE, ISIS-4 and GISSI-3 have been announced within 6 months of this book being published.
Less major criticisms include the failure to discuss the accuracy of the clinical diagnosis of heart failure and the impact this might have on the epidemiological data and to discuss simple clinical factors dictating prognosis such as the arterial pressure or serum sodium concentration The chapter on sympathetic activation still asserts that the sympathetic response to exercise, as measured by the rise in plasma noradrenaline, is increased in heart failure, whereas the converse has been demonstrated on numerous occasions since Chidsey’s original publication. The rise in plasma noradrenaline that occurs with age, reaching levels found in heart failure patients even in normal elderly subjects is also not discussed. There are over 100 pages dealing with modulation of adrenergic and dopaminergic receptors in heart failure but only 25 on ACE inhibitors which seems disproportionate. Another notable omission is the lack of any real discussion of digoxin toxicity. The only surgical option discussed is transplantation; contributions on revascularisation, valve surgery, cardiomyoplasty and the operative risks for non-heart failure related surgery would all have been helpful. Nonetheless, this book is a valuable primer for those with a limited knowledge of the subject. Senior Lecturer in Medicine (Cardiology) Hammersmith Hospital London. UK and British Cardiac Society Fitzroy Square London. UK
Dr John,
G.F. Cleland
SSDI 0167-5273(93)01941-P
Duplex Scanning in Vascular Disorders D. Eugene Strandness, Jr. Raven Press, New York, NY. 1993: 343 pp.; US$l20.00; ISBN O-78 17-0014-o
International
Journal
of Cardiology
44
I 1994)
105- 108
Book reviews
Congestive Cardiac Failure: Pathophysiology and Treatment D.B. Barnett, H. Pouleur, G.S. Francis Marcel Dekker, New York, NY, 1993; 448 pp.; USSl35.00; ISBN O-8247-882 l-4 This book begins with an intriguing paradox; why, if mortality from coronary artery disease and stroke is falling, which some have attributed to the more effective control of blood pressure in the community, is the incidence of and mortality due to heart failure increasing, a condition which is closely linked to hypertension in many epidemiological studies? The easy answer is to blame the increase in heart failure on the ageing of the population, but Garg and Yusuf point out that even after adjusting for age the number of deaths due to heart failure appears to have doubled in the last 20 years. This increase remains to be explained. Heart failure is already numerically the single commonest clinical problem in in-patient practice in industrialised societies. A book on the epidemiology. pathophysiology and management of heart failure should be required reading for all general physicians. physicians for the care of the elderly and cardiologists. For the non-expert the present book will fill most important gaps in knowledge. However, it is almost impossible for text-books to keep pace with the rate at which new clinically relevant information is being acquired. Some of the chapters are already sadly out of date, for instance the chapter on digoxin which had obviously been submitted and accepted before publication of the most recent of the ACE inhibitor trials and the still more recent RADIANCE trial of digoxin. Other chapters, for instance those on vasodilator therapy, beta-blockers and on ACE inhibitors contained all the available information at the time of press but are no longer up to-date. The results of several major trials including PROFILE, MDC. CIBIS, AIRE, ISIS-4 and GISSI-3 have been announced within 6 months of this book being published.
Less major criticisms include the failure to discuss the accuracy of the clinical diagnosis of heart failure and the impact this might have on the epidemiological data and to discuss simple clinical factors dictating prognosis such as the arterial pressure or serum sodium concentration The chapter on sympathetic activation still asserts that the sympathetic response to exercise, as measured by the rise in plasma noradrenaline, is increased in heart failure, whereas the converse has been demonstrated on numerous occasions since Chidsey’s original publication. The rise in plasma noradrenaline that occurs with age, reaching levels found in heart failure patients even in normal elderly subjects is also not discussed. There are over 100 pages dealing with modulation of adrenergic and dopaminergic receptors in heart failure but only 25 on ACE inhibitors which seems disproportionate. Another notable omission is the lack of any real discussion of digoxin toxicity. The only surgical option discussed is transplantation; contributions on revascularisation, valve surgery, cardiomyoplasty and the operative risks for non-heart failure related surgery would all have been helpful. Nonetheless, this book is a valuable primer for those with a limited knowledge of the subject. Senior Lecturer in Medicine (Cardiology) Hammersmith Hospital London. UK and British Cardiac Society Fitzroy Square London. UK
Dr John,
G.F. Cleland
SSDI 0167-5273(93)01941-P
Duplex Scanning in Vascular Disorders D. Eugene Strandness, Jr. Raven Press, New York, NY. 1993: 343 pp.; US$l20.00; ISBN O-78 17-0014-o