POCKET COMPANION TO TEXTBOOK OF CRITICAL CARE

the bookshelf ACUTE CORONARY CARE. Robert M. Califf, Daniel B. Mark, and Galen S. Wager, eds. St. Louis: Mosby-Year Book, 1995, 964 pp, $95 This book is an excellent and long-awaited update of the first edition, published in 1988. Since then, the era of thrombolytic therapy has progressed from youth to maturity, changing many aspects of acute coronary care. Reflecting this, the current edition has enlarged from compact to full textbook size, adding 22 chapters to its original 49, and expanding the list of contributors from 69 to 140. The first edition’s single chapter on coronary pathophysiology has expanded into an excellent six-chapter section. A new six-chapter section on research methodology will interest those with academic tastes. New chapters on cost containment and medicolegal issues are fascinating reading, even for the busy clinician with only a few minutes to spare. Acute Coronary Care is organized into six sections. “Basic Concepts” describes the pathophysiology of acute coronary syndromes and research methodology. The section on prehospital and ER care includes strategies for patient selection and decreasing time to treatment with thrombolytic therapy. The “Hospital Phase” discusses all aspects of acute care for myocardial infarction and unstable angina patients, including lytic therapy, catheter reperfusion techniques, and treatment of complications of acute myocardial infarction. Sections on predischarge evaluation and rehabilitation discuss functional testing (exercise echocardiography is omitted) and coronary risk factor modification. This book is authoritative; many of the authors are the acknowledged experts on the topics on which they write, and the list of contributors reads like a “Who’s Who” of acute coronary care. The book is practical; its authors are also skilled practitioners who infuse their clinical experience into their writing. The editors took special efforts to ensure that the book would be relevant and useful to practitioners by sending drafts of each chapter to a member of the Duke University Clinical Cardiology Society for review. Perhaps as a result, this book provides more practical guidance on specific clinical problems than does the average textbook. For example, it includes many specific treatment protocols, examples of sample admission orders, an emergency department thrombolytic flowsheet, and an example of a critical pathway (CareMap) for acute myocardial infarction. Acute Coronary Care has several limitations. First, its subject is acute coronary care, not acute cardiac care. It does not cover noncoronary problems such as digitalis toxicity, nonischemic pulmonary edema, or nonischemic arrhythmias. Second, as the authors note, “the book represents an attempt to hit a moving target.” Final drafts were revised to include results of just-released clinical trials, but inevitably, significant advances have been reported since publication. (The authors hint that some future edition may be available on the internet.) Finally, when different authors cover different topics, they may not fit together seamlessly. For example, streptokinase and tPA are discussed in different chapters, but there is no thorough discussion on their relative merits in general or in different patient subgroups. In summary, this book represents an excellent, comprehensive, but practical analysis of acute coronary care in 1995. It will be useful to students and clinicians who care for patients with acute coronary syndromes, and for the investigators who study them. Its greatest value may be for those of us who have neither the time nor the perspective to integrate into everyday practice the results of the hundreds of clinical trials from the past decade. James C. Blankenship, MD, FACC Danville, PA POCKET COMPANION TO TEXTBOOK OF CRITICAL CARE. William C. Shoemaker, Ake Grenvik, Stephen M. Ayres, and Peter R. Holbrook, eds. Philadelphia: W. B. Saunders Company, 1996, 844 pp, $39.95 The unwieldy nature of a comprehensive medical textbook reduces its usefulness as a bedside information source. Thus, a recent trend in book publishing is the complementary issuance of an abridged, usually paperback, companion version that is designed to be portable and used as a fingertip reference. The publishers of the 3rd edition of the Textbook of Critical Care, edited by WC Shoemaker, et al, are following that trend with the release of the Pocket Companion to Textbook of Critical Care. Designed to slip into a lab coat pocket, this book is organized in the order of the chapters of the parent textbook. It also includes a separate chapter at the end for pediatric critical care, which is written in outline form and is filled with tables and algorithms. References are not listed at

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the end of the chapters, specifically sacrificed by the authors in keeping with the goals of small size and portability. Overall, this book attains an appropriate mix of content and brevity. The chapter summaries are nicely written in a concise yet flowing textual style. The meaning of each chapter is clear, such that a reader can use this book independent from and without constantly referring to the main textbook. Most of the pertinent tables, algorithms, and diagrams are replicated from the original. Over 10% of the pages of this book are dedicated to a quite comprehensive index. Two minor quibbles: (1) the statement on the back cover that the “companion is fully cross-referenced” to the main text is an exaggeration; and (2) although configured to be a “pocket guide,” its 844 pages make this book a bit heavy to carry around constantly. In summary, Pocket Companion to Textbook of Critical Care fulfills its goal as a useful quick bedside reference guide for busy house officers and other critical care practitioners. Marc J. Popovich, MD Cleveland, Ohio

ATRIAL ARRHYTHMIAS: State of the Art. John P. Dimarco, MD, PhD, Eric N. Prytowsky, MD, eds. New York: Futura Publishing, 1995, 432 pp, $70 Atrial arrhythmias remain the most challenging of arrhythmias from all view points. From mechanism to management there exists a significant debate, which is constantly evolving. The arrhythmia, though not life threatening, results in significant morbidity and a significant usage of health care resources at a world-wide level. This book covers all aspects from epidemiology to newer management strategies. It also covers very important mechanistic information that is critical for the refinement of existing management strategies and the development of newer ones. Each chapter dealing with these issues is followed by succinct editorial comments that put together data from existing and ongoing research on the topic laying out a clear message. There are many chapters that merit individual attention. Epidemiology of atrial arrhythmias has outlined data from the Framingham study, the CASS registry, and the Cardiovascular Health Study. This has been put together very clearly and comprehensively. It emphasizes the rapid need for efficient management strategies for the arrhythmia. The effect of autonomic nervous system modulation on the atria and the AV node has been given important consideration. This is a topic which is very often not well delineated in current literature. “Tachycardia—Induced Tachycardia” is a very interesting account on the basis for the conversion of one supraventricular arrhythmia to another. This is a very common clinical occurrence and is a very important diagnostic clue but not as well understood. The basic underlying mechanism of arrhythmia initiation and maintenance is essential for the evolution of different management modalities. The chapters on anisotropic coupling in reentrant arrhythmias, animal models of atrial arrhythmias, and sodium and potassium channels in electrogenesis give a very detailed review on the work in these areas covering arrhythmogenesis from cell to clinical mapping studies. The underlying electrophysiological abnormalities, ie the arrhythmogenic substrate for atrial fibrillation, has been meticulously dealt with. These chapters dealing with basic electrophysiology are the strengths of the book. The management of AF has rapidly evolved from the traditional rate control to a rhythm control strategy. The chapter on Surgical intervention illustrates very well on the various surgical techniques which have been utilized for a ‘cure’ from the arrhythmia. The chapters on nonpharmacological management of AF have discussed on some of the recent treatment modalities such as the concept of an atrial defibrillator and atrial pacing. This chapter possibly reflects the authors’ personal views on a more conventional treatment strategy as opposed to AF prevention with multisite atrial pacing, atrial defibrillator, and ablative strategies. The combination of atrial pacing and defibrillation may become the management modality of choice. The stroke prevention chapters have summarized very well on the very important issue of the risks and the benefits of anticoagulation in patients with AF. The major multicenter AF Anticoagulation studies have been discussed in detail. On the whole, the book provides a very exhaustive review of current literature regarding atrial fibrillation, which is accompanied by very useful editorial comments from leading experts in the fields of cardiology and electrophysiology. It would be very useful reading material to both an academic electrophysiologist and a clinical cardiologist, or indeed to any physician with an interest in the field of arrhythmology. Atul Prakash, MD, MRCP Millburn, NJ