(Circulation. 1999;100:567.)
© 1999 American Heart Association, Inc.
Book Reviews |
Clinical Electrocardiography
Antoni Bayés de Luna. 398 pp. Armonk, NY: Futura Publishing Co;1997. $125.00. ISBN 0–87993-682–7.
Heart Lung Institute, University Medical Center, Utrecht, the Netherlands
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Introduction |
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 Top Introduction |
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Despite the introduction of several sophisticated noninvasive imaging techniques in clinical cardiology, the ECG has remained the most widely used laboratory technique for the evaluation of the patient with known or suspected heart disease. This position is explained by its wide applicability and its role as a safe and cheap tool for initial screening. The ECG is the gold standard for the diagnosis of cardiac arrhythmias and conduction disturbances (type A statements) and serves as a source of useful information for the evaluation of structural and some functional cardiac abnormalities, as well as the effects of systemic derangements on the electrical activity of the heart (type B statements). In addition, it provides independent prognostic information on the risk of subsequent cardiac events in a variety of cardiac conditions. Unfortunately, ECG criteria are frequently insensitive and/or nonspecific (particularly in type B statements), and their predictive accuracy, in addition, depends on the prevalence of that particular disease. Proper interpretation of the ECG therefore requires that its findings be evaluated in the context of all relevant clinical data. Failure to do so may lead to either false reassurance or stigmatization of the patient or to more costly and even risky additional diagnostic procedures. These limitations may explain why the young generation of cardiologists—the teachers of tomorrow—do not appear to feel very much at ease with the ECG and rapidly seek refuge in the more expensive imaging techniques or even cardiac catheterization and coronary angiography.
There is thus a strong need for good textbooks on electrocardiography that cover more than only pattern recognition.
The second updated edition of Clinical Electrocardiography by Dr Antoni Bayés de Luna is an example of a well-balanced, up-to-date text that puts the ECG in clinical context. The book has been subdivided into 4 sections and an appendix. Each section is amply illustrated to highlight the discussion. The first part deals with the normal ECG, the second with abnormal ECG patterns and their diagnostic criteria, the third with arrhythmias, and finally, in part IV, the clinical usefulness of electrocardiography is authoritatively discussed, with separate chapters on the diagnostic value of ECG abnormalities, ECG findings in different forms of heart disease, and the role of other diagnostic techniques. The appendix provides normal values of ECG waves, as well as a brief introduction into other ECG techniques, such as vectorcardiography, exercise testing, and Holter monitoring. Throughout the text, Dr Bayés de Luna has stressed the utility as well as the limitations of the ECG and provided personal as well as literature data on the sensitivity, specificity, and predictive value of various ECG criteria. In sections I through III, it is the ECG teacher in Dr Bayés de Luna who is speaking, whereas in section IV—the most enjoyable one—it is the experienced clinician.
The book contains a wealth of information, presented in a informal, pleasant style. Unfortunately, the translation from Spanish into English is suboptimal, and some disturbing typographical errors have crept in that should be corrected in a subsequent edition.
The terminology in several areas is unusual, at least for the Angloamerican and most European countries. Examples include the terms global ventricular block instead of bundle-branch block and hyperactive and hypoactive arrhythmias instead of tachyarrhythmias and bradyarrhythmias, respectively. Also, the discussion early in the text of differential diagnostic considerations, when these items have not yet been explained in their own context, may be confusing to the beginner. To overcome this problem, the author has provided extensive cross-references throughout the text, which I find very useful. Finally, the quality of some of the figures could be improved. This would further increase the attractiveness of the book.
I do not hesitate to warmly recommend this authoritative book to all cardiologists, internists, anesthetists, and trainees in these specialities, as well as experienced nurses working in intensive care and coronary care units. I look forward to the third edition.
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