Management of Complex Cardiovascular Problems. The Consultant’s Approach
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* Philip J. Garber

MANAGEMENT OF COMPLEX CARDIOVASCULAR PROBLEMS. THE CONSULTANT’S APPROACH. 2nd edition. Edited by Thach N. Nguyen, Dayi Hu, Shigeru Saito, Vijay Dave and Cindy L. Grines with a foreword by Eugene Braunwald. 409 pp. Illust. Futura Publishing Company, Inc., Armonk, NY. 2002. Soft cover. $US54. ISBN 0-87993-493-X

In this book many of the significant clinical issues that cardiologists encounter on a day-to-day basis are discussed. Although the chapters are relatively small, the topics are discussed in very elaborate detail and include the most recernt advances in therapy and research. The majority of the pertinent points are referenced. The book is refreshing in that it discusses various patient subgroups in relation to clinical problems, i.e., diabetic patients and the elderly. It also discusses gender issues. The various tables and graphs throughout ther text are easy to understand and further illustrate the pertinent points.

The topic areas include common problems such as atrial fibrillation, acute coronary syndromes, arrhythmias, congestive heart failure and syncope. In addition, less common but no less important clinical scenarios are covered, such as cardiogenic shock, thrombolysis for acute stroke and congenital heart disease in adults.

The chapter on acute coronary syndromes includes the pathophysiology of unstable coronary syndromes. it gives a thorough review of the mechanisms involved, and it provides a meticulous dissection of the literature, a large part of which is recent. The authors have made an extremely complex topic area appear understandable. The chapter on management of ST elevation acute myocardial infarction once again is a superb summary of all the relevant trials and treatment modalities available.

A disappointment was the chapter on hypotension and cardiogenic shock in acute myocardial infarction, in which mechanisms of shock were discussed, but very little was mentioned of one of the most important treatment modalities — the intra-aortic balloon pump and its potential mechanisms of benefit. As well, a more-detailed discussion of the SHOCK trial would have been beneficial.

There are other minor faults such as the discussion of bretylium for arrhythmias, which has fallen into disuse, the odd table that is impossible to understand (e.g., in the chapter on hypertension the legend is uninterpretable), the notable absence of important topic areas in valvular heart disease, such as mitral stenosis and aortic stenosis, and the omission of certain classes of drugs for hypertension and congestive heart failure that appear promising (i.e., vasopeptidase inhibitors).

Despite these shortcomings this text provides a very good overview of the practice of modern-day cardiology and its associated area, the investigation and therapy for peripheral vascular disease and cerebrovascular disease, and illustrates ongoing research that may change the practice of cardiology in the future.

Overall, this text is extremely thorough and contains areas of interest for the novice cardiology trainee as well as for the consultant cardiologist. This book would also be of interest to those in the surgical field in the daily management of acute cardiac medical problems that are of relevance to their practice.

In summary, this book is topical, interesting and comprehensive, and provides quality reading for all those associated with the cardiovascular field.