Book Review

Medical Management of Heart Disease

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

Article

Medical Management of Heart Disease
(Clinical Guides to Medical Management.) Edited by Burton E. Sobel, with Michael E. Cain and Paul R. Eisenberg. 566 pp. New York, Marcel Dekker, 1996. $99.75. ISBN: 0-8247-9315-3

The care of patients with cardiovascular diseases has changed dramatically as new therapeutic options and improved classifications have evolved from clinical, epidemiologic, and experimental investigations. Numerous outstanding textbooks on cardiovascular conditions are available, and a number of handbooks clarify and focus a vast amount of information into workable guidelines. The book by Sobel and 36 experienced contributors aims to be a practical and concise synopsis for a broad audience of physicians. As a “clinician's consultant,” this book attempts to provide only the essential details.

The book has five major sections covering cardiac symptoms, cardiac signs, cardiac treatment, heart disease in special settings, and medications. The degree of detail in several chapters, such as those on hypertension, the management of acute myocardial infarction, and the management of ventricular arrhythmias, will undoubtedly facilitate patient care. The bibliographies vary: some chapters have substantial ones (chapter 7, on hypertension), and some have none at all (chapter 8, on shock; chapter 9, on routine tests; and chapter 30, on common therapeutic medications). The section on the management of arrhythmia is very well done. The effort to cross-reference between chapters is helpful.

This book may be useful as a quick, general check on therapeutic directions; however, particular details essential for the management of several disorders are not provided. Physicians would need to seek more information to meet the therapeutic responsibilities outlined in this handbook. The management of anticoagulant therapy and coagulopathies is described in a small section in the chapter on chest pain; this subject warrants additional attention. There are no chapters dealing with the care of patients with prosthetic devices, apart from a mention of infective endocarditis on prosthetic valves. There is no information on allografts, cardiac or otherwise, and nothing on cardiovascular disease in the elderly. The chapter on therapeutics seems to replicate information found in other sources, and the absence of references in this chapter is discomforting, considering that the therapeutic guidelines it sets forth may be individual preferences and not broadly based. The book could be improved by the addition of more decision trees or critical pathways for therapeutic decision making. Although somewhat uneven and selective, the information in this book may be valuable to clinicians looking for general guidance on cardiovascular diseases.

Bruce McManus, M.D., Ph.D.
University of British Columbia, Vancouver, BC V6Z 1Y6, Canada