Book Review

Treatment of Heart Diseases

N Engl J Med 1993; 329:738September 2, 1993

Article

Treatment of Heart Diseases
Edited by James T. Willerson. Approximately 500 pp,. illustrated. New York, Gower Medical, 1992. $159.50. (Distributed in the U.S. by Raven Press, New York.) ISBN: 0-397-44695-0

This oversized, magnificently produced book is a major publishing event. The distinguished editor has assembled nine contributors to produce seven sections, all but one by a single eminent author. It is unusual for every contributor to a multiauthored book to perform outstandingly, but these chapters range from excellent to superb. It is an understatement to say that this book is lavishly illustrated -- the abundant, high-quality illustrations are themselves worth the price of the book.

The editor has written the first chapter, on coronary disease, covering every aspect and complication and including useful algorithms for treatment of stable angina and management after an infarction. I would carp only about the use of indomethacin to treat infarct pericarditis, because that drug reduces coronary flow. The electrocardiogram shown is technically imperfect and not typical of infarct pericarditis, which almost never produces the ubiquitous changes of generalized pericarditis. Moreover, the histologic section included among the illustrations appears to show an uncharacteristically aggressive and advanced process. Certainly more representative illustrations should abound in Willerson's own large medical center in Houston.

The chapter on heart failure by Milton Packer is a book within a book, written with its author's customary clarity and comprehensiveness. Recent concepts are given appropriate emphasis: the loose correlation between clinical response and the positive inotropic effects of digitalis; that drug's opposition to neurohormonal activation; its effects on cardiac baroreceptors; favorable effects of angiotensin-converting-enzyme inhibitors; and potentially deleterious effects of “first generation” calcium-channel blockers. The management of arrhythmias and conduction abnormalities forms the subject of another mini-textbook (74 pages). After the customary synopsis of anatomical, electrophysiologic, and pharmacologic features, there follows a veritable atlas of arrhythmias, their mechanisms, and their management, including nonpharmacologic (e.g., ablative and surgical) treatments. Curiously, torsade de pointes is discussed without being compared with other polymorphous ventricular tachycardias of similar appearance. Hyperlipidemias are discussed with imaginative illustrations of their chemical and metabolic aspects; this is a field in which the nonexpert (and I suspect some experts) can barely survive without the kind of pictorial guide for the perplexed that is provided here. The chapter “Percutaneous Transluminal Coronary Angioplasty and Newer Treatments for Coronary Disease” presents interventional cardiology in a nutshell. The only multiauthored chapter, on the surgical treatment of heart diseases, includes transplantation and introduces nonsurgeons to technical details, giving them spectacular views at the operating table but somehow omitting discussion of postoperative complications and surgery for congenital heart disease and the pericardium. A third mini-textbook, “Etiologies and Treatment of Systemic Arterial Hypertension” (106 pages), beautifully integrates theory and practice.

This book is monumental. The few flaws enumerated here had to be dredged from this uniformly excellent treasury of the best that contemporary cardiology has to offer.

David H. Spodick, M.D., D.Sc.
St. Vincent Hospital, Worcester, MA 01604