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New horizons in cardiovascular practice
Book reviews
Stress Testing: Principles and Practice. B y Myrvin H. Ellestad, M.D., Philadelphia, 1975, F. A. Davis Company, 296 pages. This publication comes at a time of great interest in treadmill exercise testing of cardiac function throughout the U.S.A. Ellestad has had considerable experience with the procedures of stress testing. The apparatus, methods, and interpretation of data are clearly described. However, stress testing has not only its limitations b u t it. is potentially hazardous. If the procedure were not hazardous, there would be no need for standby drugs, defibrillators, well-trained nurses and doctors. Those precautions are necessary and reflect the dangers of the procedures. Even the Master's twostep test is not without risk to the patient with heart disease. The physician must consider seriously the extent of liberties he has with his patients' lives. The interpretation of records are difficult, for example, in regard to the magnitude of ST segment depression which is abnormal. In spite of such problems, the interest in stress exercise testing is constantly increasing. The use of stress testing is well described in this publication for those who are using the procedure or who plan to enter the program of stress exercise. Nevertheless, this reviewer advises the "readers to read the book critically and cautiously, especially with regard to some statements which could be challenged. Treadmill stress testing is a new diagnostic procedure which cannot replace clinical bedside cardiology. Its value, indications for use, and interpretation of recordings as advocated by Dr. Ellestad are clearly indicated in his book.
The Conduction of the Cardiac Impulse. By Paul F. Cranefield, M.D., Ph.D., M o u n t Kisco, N. Y., 1975, Futura Publishing Company, 404 pages. Cranefield has written an excellent book on an important aspect of cardiology. T h a t he is an expert on the subject is well recognized by all who work in the field of cardiology. The discussions are concerned with fundamental principles of impulse transmission in the heart, principles important in clinical practice. Physicians must know the physiology of conduction of impulses in the heart in order to manage cardiac arrhythmias logically. The priniciples in electrophysiology presented in this book are of practical nature and form the background for understanding drug action and clinical manifestations of disturbances in cardiac rhythm. The book is highly recommended.
Cardiovascular Physiology. Edited by James V. Warren, M.D., Stroudsburg, Pa., 1975, Halsted Press, 441 pages. Dr. Warren has gathered several publications t h a t he considers of historic importance in cardiology. This is acceptable and reflects his own opinion. However, others have their ideas of what was important. Omissions can cause great difficulties. For example, Sir Thomas Lewis' contributions to clinical and experimental electrocardiography were outstanding, b u t only one publication was included in the book. The role of anatomists and electron microscopists such as Huxley, Keith, and Flack, who provided the fundamental background for physiologic studies are not included. The original experiments of Stephen Hales, A. N. Richard, Wittering, and many others are also not included. The reader will find this book interesting in large part for the subjects and people selected. Warren attempted to limit publications related to man
American Heart J o u r n a l
himself which decidedly influenced the selection of papers included.
Diagnostic Methods in Cardiology. Edited by Nobel O, Fowler, M.D., Philadelphia, 1975, F. A. Davis Company, 455 pages. This issue of Cardiovascular Clinics reviews methods in diagnosis in cardiology. Like previous issues, it is designed for the practicing physician. Gallop rhythm, auscultation in general, arterial and venous wave forms, exercise electrocardiography, computer analysis of the electrocardiogram, ambulatory monitoring of the arrhythmias, His bundle recordings, and vectorcardiography are among the many subjects discussed. The contributors in their respective subjects attempted to indicate the practical aspects of the problems. Those in a busy practice should study the various chapters of the book carefully. For example, the chapter on coronary angiography ~s summarized to indicate its usefulness in clinical practice, b u t the hazardous nature of the procedure indicated by the tables is not adequately emphasized. Where some laboratories report a mortality rate of over 2 per cent, the author fails to be convincing t h a t such a diagnostic procedure is worth the risk. Then the operative risk must be added to those who survive the diagnostic procedure itself. Some of the diagnostic procedures are expensive for the information derived, e.g., vectorcardiography. Regardless, the reader will find a great deal of interesting information in this publication and the opinions of the respective contributors is evident from their discussions.
The Physiology of Physical Stress: A Selective Bibliography. By Carleton B. Chapman, M.D., and Elinor C. Reinmiller, Cambridge, Mass., 1975, Harvard University Press, 369 pages. The title of this publication adequately describes its contents. The value of this book is certainly challenged by the tremendous bibliographic services offered by the National Library of Medicine and its various ancillary services. Physiologists and cardiologists with special interest in physical stress will find this book useful. The book should interest at least some people, particularly in t h a t the bibliography does indicate to contemporary investigators t h a t much of the work done today was already done very well many years ago.
New Horizons in Cardiovascular Practice. Edited by Henry I. Russek, M.D., Baltimore, 1975, University Park Press, 521 pages. Price $34.50. This publication of the papers presented at the symposium on cardiovascular practice held in New York City during December, 1973, is, as usual, a valuable collection. This a n n u a l symposium conducted by Dr. Russek is one of the outstanding meetings held in the U.S.A. in the field of cardiology. The contributors are leaders in cardiology and the subjects discussed include the most important problems of the year. This publication consists of presentations on bedside management of cardiovascular diseases, advances in diagnostic methods, ischemic heart disease, medical and surgical management of angina pectoris and myocardial infarction, management of hypertension, disorders of cardiac rhythm, microcirculatory disease, and others. This book is highly recommended as a source of review of these many clinic~lproblems for those who were unable to attend the sessions.
135
Stress Testing: Principles and Practice. B y Myrvin H. Ellestad, M.D., Philadelphia, 1975, F. A. Davis Company, 296 pages. This publication comes at a time of great interest in treadmill exercise testing of cardiac function throughout the U.S.A. Ellestad has had considerable experience with the procedures of stress testing. The apparatus, methods, and interpretation of data are clearly described. However, stress testing has not only its limitations b u t it. is potentially hazardous. If the procedure were not hazardous, there would be no need for standby drugs, defibrillators, well-trained nurses and doctors. Those precautions are necessary and reflect the dangers of the procedures. Even the Master's twostep test is not without risk to the patient with heart disease. The physician must consider seriously the extent of liberties he has with his patients' lives. The interpretation of records are difficult, for example, in regard to the magnitude of ST segment depression which is abnormal. In spite of such problems, the interest in stress exercise testing is constantly increasing. The use of stress testing is well described in this publication for those who are using the procedure or who plan to enter the program of stress exercise. Nevertheless, this reviewer advises the "readers to read the book critically and cautiously, especially with regard to some statements which could be challenged. Treadmill stress testing is a new diagnostic procedure which cannot replace clinical bedside cardiology. Its value, indications for use, and interpretation of recordings as advocated by Dr. Ellestad are clearly indicated in his book.
The Conduction of the Cardiac Impulse. By Paul F. Cranefield, M.D., Ph.D., M o u n t Kisco, N. Y., 1975, Futura Publishing Company, 404 pages. Cranefield has written an excellent book on an important aspect of cardiology. T h a t he is an expert on the subject is well recognized by all who work in the field of cardiology. The discussions are concerned with fundamental principles of impulse transmission in the heart, principles important in clinical practice. Physicians must know the physiology of conduction of impulses in the heart in order to manage cardiac arrhythmias logically. The priniciples in electrophysiology presented in this book are of practical nature and form the background for understanding drug action and clinical manifestations of disturbances in cardiac rhythm. The book is highly recommended.
Cardiovascular Physiology. Edited by James V. Warren, M.D., Stroudsburg, Pa., 1975, Halsted Press, 441 pages. Dr. Warren has gathered several publications t h a t he considers of historic importance in cardiology. This is acceptable and reflects his own opinion. However, others have their ideas of what was important. Omissions can cause great difficulties. For example, Sir Thomas Lewis' contributions to clinical and experimental electrocardiography were outstanding, b u t only one publication was included in the book. The role of anatomists and electron microscopists such as Huxley, Keith, and Flack, who provided the fundamental background for physiologic studies are not included. The original experiments of Stephen Hales, A. N. Richard, Wittering, and many others are also not included. The reader will find this book interesting in large part for the subjects and people selected. Warren attempted to limit publications related to man
American Heart J o u r n a l
himself which decidedly influenced the selection of papers included.
Diagnostic Methods in Cardiology. Edited by Nobel O, Fowler, M.D., Philadelphia, 1975, F. A. Davis Company, 455 pages. This issue of Cardiovascular Clinics reviews methods in diagnosis in cardiology. Like previous issues, it is designed for the practicing physician. Gallop rhythm, auscultation in general, arterial and venous wave forms, exercise electrocardiography, computer analysis of the electrocardiogram, ambulatory monitoring of the arrhythmias, His bundle recordings, and vectorcardiography are among the many subjects discussed. The contributors in their respective subjects attempted to indicate the practical aspects of the problems. Those in a busy practice should study the various chapters of the book carefully. For example, the chapter on coronary angiography ~s summarized to indicate its usefulness in clinical practice, b u t the hazardous nature of the procedure indicated by the tables is not adequately emphasized. Where some laboratories report a mortality rate of over 2 per cent, the author fails to be convincing t h a t such a diagnostic procedure is worth the risk. Then the operative risk must be added to those who survive the diagnostic procedure itself. Some of the diagnostic procedures are expensive for the information derived, e.g., vectorcardiography. Regardless, the reader will find a great deal of interesting information in this publication and the opinions of the respective contributors is evident from their discussions.
The Physiology of Physical Stress: A Selective Bibliography. By Carleton B. Chapman, M.D., and Elinor C. Reinmiller, Cambridge, Mass., 1975, Harvard University Press, 369 pages. The title of this publication adequately describes its contents. The value of this book is certainly challenged by the tremendous bibliographic services offered by the National Library of Medicine and its various ancillary services. Physiologists and cardiologists with special interest in physical stress will find this book useful. The book should interest at least some people, particularly in t h a t the bibliography does indicate to contemporary investigators t h a t much of the work done today was already done very well many years ago.
New Horizons in Cardiovascular Practice. Edited by Henry I. Russek, M.D., Baltimore, 1975, University Park Press, 521 pages. Price $34.50. This publication of the papers presented at the symposium on cardiovascular practice held in New York City during December, 1973, is, as usual, a valuable collection. This a n n u a l symposium conducted by Dr. Russek is one of the outstanding meetings held in the U.S.A. in the field of cardiology. The contributors are leaders in cardiology and the subjects discussed include the most important problems of the year. This publication consists of presentations on bedside management of cardiovascular diseases, advances in diagnostic methods, ischemic heart disease, medical and surgical management of angina pectoris and myocardial infarction, management of hypertension, disorders of cardiac rhythm, microcirculatory disease, and others. This book is highly recommended as a source of review of these many clinic~lproblems for those who were unable to attend the sessions.
135