Book Review

Ischemic Heart Disease: A rational basis for clinical practise and clinical research

N Engl J Med 1997; 336:384-385January 30, 1997

Article

Ischemic Heart Disease: A rational basis for clinical practise and clinical research
By Attilio Maseri. 713 pp., illustrated. New York, Churchill Livingstone, 1996. $115. ISBN: 0-443-07910-2

Ischemic Heart Disease is a major achievement for its sole author, Professor Attilio Maseri. It is the most comprehensive book published on this subject, with chapters on topics ranging from the biology of the myocyte to the management of acute myocardial infarction. Every chapter uses background sections on pathophysiologic principles to explain clinical phenomena. There are superb figures, many of which were made specifically to enhance this book, and not just reproduced from other sources. The breadth of subjects covered in Ischemic Heart Disease reflects the author's skill and vast experience as a cardiovascular physiologist and a clinician. One noteworthy feature of the book is its organization, with major conclusions or concepts indented and highlighted for ease of comprehension.

One of the best early chapters, “Regulation of Coronary Vasomotor Tone,” reflects Maseri's long-standing interest in the role of vasoconstriction and spasm in the pathogenesis of myocardial ischemia. The section on neural influences on coronary vasomotor tone is particularly well referenced, as is the one on the contribution of coronary endothelial abnormalities to coronary vasoconstriction in coronary artery disease. The role of the coronary microcirculation in ischemic heart disease is covered in great depth. Perhaps the most intriguing chapter is the one on syndrome X and microvascular angina — subjects that Maseri and his group have studied extensively. He convincingly discusses how prearteriolar microvascular dysfunction could cause syndrome X, which could be related either to structural abnormalities in vessels (such as medial hypertrophy) or to functional vascular abnormalities (such as defective endothelial production of nitric oxide or an enhanced response of smooth muscle to physiologic constrictor stimuli). The chapter entitled “Mechanisms of Ischemic Cardiac Pain and the Significance of Pain in Ischemic Syndromes” is well illustrated and gives a persuasive discussion of how adenosine could mediate ischemic pain by stimulating afferent nerve fibers. There are noteworthy reviews of determinants of prognosis in ischemic heart disease, silent myocardial ischemia, unstable angina, and risk factors for coronary artery disease. To acquire state-of-the-art knowledge of the myriad aspects of ischemic heart disease, one should read this book from cover to cover.

George A. Beller, M.D.
University of Virginia Health Sciences Center, Charlottesville, VA 22908