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Differentiation between normal and abnormal in electrocardiography
Book
reviews
\~ECTORCARDIOGRBPHY. By Hugon and Zolia Kowarzykowie. With the assistance of L. Giec, M. Gieron-Zasadzien, L. Hirnle, A. Kustrzycki, S. Lukasik, Z. Pvlorawska, J. Ostrowska, and L. Sedziwy. New York, 1961, Pergamon Press, Ltd., 254 pages. Price $12.50. SPATIAL
This monograph, written in English, is an excellent review of Polish studies in spatial vectorcardiography. The book consists mainly of illustrations, with very few pages of narrative material. The illustrations are clear and well presented. They include electrocardiograms, original recordings of spatial vectorcardiograms, and wire models and descriptions and illustrations of use of the axonocardiograph. The monograph includes a fairly complete and well-organized bibliography of the published papers of the Polish authors. This book is highly recommended to those who are interested in vectorcardiography and electrocardiography.
KORON~RVEKSCHLUSS. ;~TIOLOGIE UND
KLINISCHE PATHOGENESE.
BEITR~E
ZUR
By
Priv.-Doz. Dr. Horstdorken, U’issenschlaftlicher Assistent der 1 Medizinischen Universitsts-Klinik, Hamburg. Mit einem Geleitwort von Prof. Dr. H. H. Berg. Stuttgart, 1961, Georg Thieme lTerlag, 169 pages. Price $16.50 of this monograph is composed of 17-l Tl le bulk diligently collected case reports selected from over 3,000 records of patients with coronary heart disease, in order to bring out some possible factors which precipitate an acute coronary occlusion. The case reports include instances of coronary occlusion in patients with serum sickness, a variety of allergic reactions to drugs and foreign proteins, Herxheimer’s reactions, insulin reactions, overdosage of thyroid extract and digitalis, and after the administration of quinidine, steroids, ganglionic blocking agents, and hydralazine. In addition, the author incriminates urtiraria, eczema, dermatitis, furunculosis, and also burns and many surgical procedures, particularly operations on the extremities, genitourinary tract, larynx, and eyes, and dental manipulations. The occurrence of coronary occlusion after perforation or bleeding of a peptic ulcer, and during the course of acute gall-bladder or pancreas disease is also illustrated by case reborts. Another short section of the monograph deals with Dossible Dsvchic factors which are suspected i1; several ‘patients who developed a coronary occlusion concomitantly with an attempted suicide. The same point is also supported by an analysis of the incidence of acute vascular accidents on various days of the week; this revealed a statistically significant increase on Saturdays, Sundays, and Mondays as compared to the other days of the week. The final chapter is devoted to the analysis of certain factors which might have precipitated a coronary occlusion in 50 women below the age of 52, and here an early 577
menopause and excessive smoking emerge as possible culprits. This array of “precipitating factors” obviously includes many well-documented clinical situations, such as hypotension, hypoglycemia, hemorrhage, vasculitis, or an early menopause. However, the occurrence of a large number of syndromes and diseases preceding the coronary occlusion in this material appears, to the reviewer, to be rather coincidental because of the relatively small number of cases in each category, and also because many of the patients were elderly individuals with severe generalized coronary artery disease. Proof that a certain condition precipitates a coronary occlusion would require an extensive statistical treatment, but this is lacking in this monograph, with one or two exceptions. Thus, the author’s purpose to convince the reader that the factors listed have “precipitated” the coronary occlusion has not been accomplished. However, the monograph contains an extensive European and American bibliography, with a comprehensive review of numerous reports of coronary occlusions, other vascular accidents, and certain types of myocarditis precipitated by conditions which the author has singled out. Thus, a student of coronary arterv disease or of sudden cardiac death might find in the bibliography and in the author’s case reports a useful source of references. The prospective reader of this monograph would be helped by a title which describes the content of the book more precisely. Otherwise, he may be disappointed in not being able to find more than a recital of case reports suggesting various unrelated, assumed, proved, and nonproved factors which might precipitate an acute coronary occlusion.
DIFFERENTIATION BETWEEK IN ELECTROCARDIOGIIAPHY.
NORMALANDABKORMAL
By Ernst Simonson, M.D., Professor of Physiological Hygiene, University of Minnesota, Minneapolis, Minn.; Consultant in Electrocardiography, Mt. Sinai Hospital and Veterans Administration Hospital, Minneapolis, Mimi. St. Louis, 1961, The C. V. Mosby Company, 328 pages. Price $13.50. One
of the major requirements for further improvement of diagnostic electrocardiography is quantitative description of the normal electrocardiogram. The difficulty of such description is indicated by the fact that it has not been adequately accomplished in more than 50 years of clinical electrocardiography. This book reports the most complete effort to date to define the normal electrocardiogram. The most immediately useful information in the volume is the tabular presentation of upper and lower limits for a variety of electrocardiographic measurements. The relation of age, body weight, and other factors to these limits is presented. These data concern the conventional 12lead electrocardiogram and apply to an adult population only. This information is preceded
578
Book reviews
by a review of present electrocardiographic standards in which the inadequacy of these standards is documented. Of less immediate use but of even greater eventual importance is an excellent discussion of the sources of variability in the electrocardiogram. Knowledge of these sources has always been of great importance in electrocardiography but will become essential as more rigorous quantitative analyses are applied. This is not a text of electrocardiographic theory. The author states his intent that this be a supplement to texts in which the theory of electrocardiography and the differentiation of various abnormalities are considered. This book is specifically concerned with the recognition of the normal electrocardiogram. The information contained is not available from any other source and should be accessible to all those who interpret clinical electrocardiograms. For the most part, the volume is excellently organized. The foreword by Dr. Charles Kossmann describes the importance of the work and places it in perspective with reference to previous attempts to define the normal electrocardiogram. The introduction by Dr. Ancel Keys is an eloquent statement concerning the role of modern statistical methods in medical research. The text itself begins with a clear statement of the scope and objectives of the book and a chapter on principal considerations in determining normal electrocardiographic limits. A review of present standards is followed by three chapters on sources of variability in the electrocardiogram. The presentation of these sources is admirably organized under the headings of technical and biologic variability, with the latter divided into physio-
Ant. Hearr J. Afwil, 1962
logic and constitutional variables. New normal standards are then presented, and a separate chapter concerns the normal day-to-day variability of the electrocardiogram. The chapter entitled “Distribution of Elec-trocardiographic Patterns” is written from the controversial point of view that scalar leads from any point on the body surface are projections of the spatial vectorcardiogram. This chapter will be of interest to research workers but of less interest to the clinical electrocardiographer. Chapters on the ventricular gradient, stress tolerance tests, and minor electrocardiographic changes are appropriate supplements to the material on the range of normal variation. The last chapter concerning vectorcardiography has little to do with the major thesis of normal standards for the 12-lead electrocardiogram. In its own right this chapter is an able review of the subject. This chapter inevitably contains some controversial material. There is, for example, a statement that the vectorcardiogram is an approach to true quantitation. This statement is especially surprising in a volume largely devoted to quantitative standards for the electrocardiogram, since a major limitation of the vectorcardiogram is the difficulty one has in applying practical quantitative methods to the record. A short discussion entitled “Some Biophysical Bases of Electrocardiographic Analysis,” by Dr. 0. H. Schmitt, is included. In summary, this book goes far toward filling an extremely important and practical need in electrocardiography. It should be available to all those who interpret electrocardiograms for diagnostic purposes.
Announcement The deadline for receipt of applications for the AMERICAN BOARD OF PEDIATRICS EXAMINATION in the subspecialty of PEDIATRIC CARDIOLOGY is April 15, 1962. The written examination will be held in June, 1962, and the oral examination in October, 1962. The exact dates have not yet been set.
reviews
\~ECTORCARDIOGRBPHY. By Hugon and Zolia Kowarzykowie. With the assistance of L. Giec, M. Gieron-Zasadzien, L. Hirnle, A. Kustrzycki, S. Lukasik, Z. Pvlorawska, J. Ostrowska, and L. Sedziwy. New York, 1961, Pergamon Press, Ltd., 254 pages. Price $12.50. SPATIAL
This monograph, written in English, is an excellent review of Polish studies in spatial vectorcardiography. The book consists mainly of illustrations, with very few pages of narrative material. The illustrations are clear and well presented. They include electrocardiograms, original recordings of spatial vectorcardiograms, and wire models and descriptions and illustrations of use of the axonocardiograph. The monograph includes a fairly complete and well-organized bibliography of the published papers of the Polish authors. This book is highly recommended to those who are interested in vectorcardiography and electrocardiography.
KORON~RVEKSCHLUSS. ;~TIOLOGIE UND
KLINISCHE PATHOGENESE.
BEITR~E
ZUR
By
Priv.-Doz. Dr. Horstdorken, U’issenschlaftlicher Assistent der 1 Medizinischen Universitsts-Klinik, Hamburg. Mit einem Geleitwort von Prof. Dr. H. H. Berg. Stuttgart, 1961, Georg Thieme lTerlag, 169 pages. Price $16.50 of this monograph is composed of 17-l Tl le bulk diligently collected case reports selected from over 3,000 records of patients with coronary heart disease, in order to bring out some possible factors which precipitate an acute coronary occlusion. The case reports include instances of coronary occlusion in patients with serum sickness, a variety of allergic reactions to drugs and foreign proteins, Herxheimer’s reactions, insulin reactions, overdosage of thyroid extract and digitalis, and after the administration of quinidine, steroids, ganglionic blocking agents, and hydralazine. In addition, the author incriminates urtiraria, eczema, dermatitis, furunculosis, and also burns and many surgical procedures, particularly operations on the extremities, genitourinary tract, larynx, and eyes, and dental manipulations. The occurrence of coronary occlusion after perforation or bleeding of a peptic ulcer, and during the course of acute gall-bladder or pancreas disease is also illustrated by case reborts. Another short section of the monograph deals with Dossible Dsvchic factors which are suspected i1; several ‘patients who developed a coronary occlusion concomitantly with an attempted suicide. The same point is also supported by an analysis of the incidence of acute vascular accidents on various days of the week; this revealed a statistically significant increase on Saturdays, Sundays, and Mondays as compared to the other days of the week. The final chapter is devoted to the analysis of certain factors which might have precipitated a coronary occlusion in 50 women below the age of 52, and here an early 577
menopause and excessive smoking emerge as possible culprits. This array of “precipitating factors” obviously includes many well-documented clinical situations, such as hypotension, hypoglycemia, hemorrhage, vasculitis, or an early menopause. However, the occurrence of a large number of syndromes and diseases preceding the coronary occlusion in this material appears, to the reviewer, to be rather coincidental because of the relatively small number of cases in each category, and also because many of the patients were elderly individuals with severe generalized coronary artery disease. Proof that a certain condition precipitates a coronary occlusion would require an extensive statistical treatment, but this is lacking in this monograph, with one or two exceptions. Thus, the author’s purpose to convince the reader that the factors listed have “precipitated” the coronary occlusion has not been accomplished. However, the monograph contains an extensive European and American bibliography, with a comprehensive review of numerous reports of coronary occlusions, other vascular accidents, and certain types of myocarditis precipitated by conditions which the author has singled out. Thus, a student of coronary arterv disease or of sudden cardiac death might find in the bibliography and in the author’s case reports a useful source of references. The prospective reader of this monograph would be helped by a title which describes the content of the book more precisely. Otherwise, he may be disappointed in not being able to find more than a recital of case reports suggesting various unrelated, assumed, proved, and nonproved factors which might precipitate an acute coronary occlusion.
DIFFERENTIATION BETWEEK IN ELECTROCARDIOGIIAPHY.
NORMALANDABKORMAL
By Ernst Simonson, M.D., Professor of Physiological Hygiene, University of Minnesota, Minneapolis, Minn.; Consultant in Electrocardiography, Mt. Sinai Hospital and Veterans Administration Hospital, Minneapolis, Mimi. St. Louis, 1961, The C. V. Mosby Company, 328 pages. Price $13.50. One
of the major requirements for further improvement of diagnostic electrocardiography is quantitative description of the normal electrocardiogram. The difficulty of such description is indicated by the fact that it has not been adequately accomplished in more than 50 years of clinical electrocardiography. This book reports the most complete effort to date to define the normal electrocardiogram. The most immediately useful information in the volume is the tabular presentation of upper and lower limits for a variety of electrocardiographic measurements. The relation of age, body weight, and other factors to these limits is presented. These data concern the conventional 12lead electrocardiogram and apply to an adult population only. This information is preceded
578
Book reviews
by a review of present electrocardiographic standards in which the inadequacy of these standards is documented. Of less immediate use but of even greater eventual importance is an excellent discussion of the sources of variability in the electrocardiogram. Knowledge of these sources has always been of great importance in electrocardiography but will become essential as more rigorous quantitative analyses are applied. This is not a text of electrocardiographic theory. The author states his intent that this be a supplement to texts in which the theory of electrocardiography and the differentiation of various abnormalities are considered. This book is specifically concerned with the recognition of the normal electrocardiogram. The information contained is not available from any other source and should be accessible to all those who interpret clinical electrocardiograms. For the most part, the volume is excellently organized. The foreword by Dr. Charles Kossmann describes the importance of the work and places it in perspective with reference to previous attempts to define the normal electrocardiogram. The introduction by Dr. Ancel Keys is an eloquent statement concerning the role of modern statistical methods in medical research. The text itself begins with a clear statement of the scope and objectives of the book and a chapter on principal considerations in determining normal electrocardiographic limits. A review of present standards is followed by three chapters on sources of variability in the electrocardiogram. The presentation of these sources is admirably organized under the headings of technical and biologic variability, with the latter divided into physio-
Ant. Hearr J. Afwil, 1962
logic and constitutional variables. New normal standards are then presented, and a separate chapter concerns the normal day-to-day variability of the electrocardiogram. The chapter entitled “Distribution of Elec-trocardiographic Patterns” is written from the controversial point of view that scalar leads from any point on the body surface are projections of the spatial vectorcardiogram. This chapter will be of interest to research workers but of less interest to the clinical electrocardiographer. Chapters on the ventricular gradient, stress tolerance tests, and minor electrocardiographic changes are appropriate supplements to the material on the range of normal variation. The last chapter concerning vectorcardiography has little to do with the major thesis of normal standards for the 12-lead electrocardiogram. In its own right this chapter is an able review of the subject. This chapter inevitably contains some controversial material. There is, for example, a statement that the vectorcardiogram is an approach to true quantitation. This statement is especially surprising in a volume largely devoted to quantitative standards for the electrocardiogram, since a major limitation of the vectorcardiogram is the difficulty one has in applying practical quantitative methods to the record. A short discussion entitled “Some Biophysical Bases of Electrocardiographic Analysis,” by Dr. 0. H. Schmitt, is included. In summary, this book goes far toward filling an extremely important and practical need in electrocardiography. It should be available to all those who interpret electrocardiograms for diagnostic purposes.
Announcement The deadline for receipt of applications for the AMERICAN BOARD OF PEDIATRICS EXAMINATION in the subspecialty of PEDIATRIC CARDIOLOGY is April 15, 1962. The written examination will be held in June, 1962, and the oral examination in October, 1962. The exact dates have not yet been set.