Book Review

Classic Teachings in Clinical Cardiology: A tribute to W. Proctor Harvey

N Engl J Med 1996; 335:678-679August 29, 1996

Article

Classic Teachings in Clinical Cardiology: A tribute to W. Proctor Harvey
Edited by Michael A. Chizner. 1526 pp. in two volumes, illustrated. Cedar Grove, N.J., Laennec, 1996. $145. ISBN: 1-886128-06-5

Between about 1850 and 1950, the Festschrift (a collection of papers by the pupils or colleagues of an esteemed teacher or researcher) was a popular means of celebrating the career and contributions of a mentor. This two-volume work is of that genre. It honors W. Proctor Harvey, an internationally known teacher, author, and cardiologist whose main interest is cardiac diagnosis. During the past half-century, Harvey has taught thousands of medical students and physicians at the bedside and has taught thousands more through his books and audiotapes of heart sounds and murmurs.

Fifty-four authors contributed to this large book, which includes 62 chapters in 12 sections covering clinical evaluation of the patient with cardiac disease; normal and abnormal structure and circulatory function; clinical electrophysiology; coronary heart disease; valvular heart disease; myocardial, pericardial, and endocardial disease; congenital heart disease; hypertension; cardiovascular pharmacology; geriatric cardiology; and miscellaneous topics.

The chapters are generally well written and up to date. They contain some types of information that set this book apart from other contemporary cardiology textbooks. Many chapters contain a brief section on the natural history of the disorder under consideration, which provides a useful perspective. Cost effectiveness is a recurrent theme. Recent developments and advances are discussed in detail, but there is unusual emphasis on the value of the history and physical examination.

Harvey has long advocated what he terms the “five-finger approach” to cardiac diagnosis. The physician can learn much about a patient's cardiovascular system by taking a detailed history, performing a thorough cardiovascular physical examination, studying the electrocardiogram and chest film, and (if necessary) requesting or performing specialized laboratory tests. Clearly, the editor instructed the contributors to emphasize the usefulness of the five-finger approach. Reflecting Harvey's interest in cardiac diagnosis, 150 pages are devoted to physical examination of the cardiovascular system. The chapter on M-mode echocardiographic and phonocardiographic correlations is welcome; this valuable teaching tool is no longer available in most medical centers.

An unusual aspect of the book is the inclusion of several hundred “cardiac pearls” from Harvey's rich clinical experience. His pearls are written in a straightforward, even folksy style. A few of them, however, involve recommendations that are dated. For example, a college athlete with recurrent episodes of “paroxysmal atrial tachycardia” at a rate of 250 beats per minute was given medical clearance, because the only symptom was an awareness of rapid heart action. Harvey made the diagnosis clinically and did not believe that further evaluation or treatment was necessary, because the episodes lasted just one or two minutes and occurred only during practice, not during competition. There was no mention of the small risk of sudden death or of the potential role of radio-frequency ablation. Although most of Harvey's pearls can be admired because of their timeless beauty, some must be placed in a contemporary context that reflects new knowledge and techniques.

Many chapters include tables that will be especially useful to medical students and trainees. The sources of the information in the tables are rarely cited, however. Each chapter includes pertinent illustrations and a list of selected readings. Unfortunately, the quality of the images is highly variable. Many of the illustrations are indistinct, especially those reproduced from other published material. Despite captions that suggest otherwise, most of the color-flow Doppler images were printed in black and white. I was surprised to find that the index is incomplete.

It is a challenge to avoid redundancy in a multiauthored textbook, and the editor was only partially successful in minimizing it. Redundancy is especially evident in the chapters on acute myocardial infarction and its complications and on coronary heart disease and new treatment techniques. Most of the topics addressed in the chapter on heart disease in the elderly are discussed more thoroughly in other chapters on those topics.

Despite these reservations, this is a useful book that complements other current cardiology textbooks.

W. Bruce Fye, M.D.
Marshfield Clinic, Marshfield, WI 54449