(Circulation. 1998;98:1040-1041.)
© 1998 American Heart Association, Inc.
The New Living Heart
Michael E. DeBakey, MD, Antonio M. Gotto, Jr, MD, DPhil. 495 pp.Holbrook, Mass: Adams Media Corp; 1997. $17.95. ISBN 1-55850-722-1.
Lori Mosca, MD, PhD
Division of Cardiology
Ralph Mosca, MD
Section of Thoracic Surgery,
University of Michigan,
Ann Arbor, Mich
The end of this millennium will be remembered for many things.
Chief among them will be that this was the era of the consumer, whose
needs helped to ignite and continue to fuel an explosive information
age. Slogans such as "An educated consumer is our best customer"
epitomize the paradigm shift from gullery to tutelage in
contemporary marketing, although some may view the latter as simply a
more sophisticated form of mendacity. In part, the new strategy is a
response to advances in communication technology coupled with the
compulsions of discerning consumers. Parallel transitions have occurred
in medicine, now known as the healthcare industry, in which the term
client has become synonymous with patient, the concept of population
served has been replaced by the number of lives covered, and in which a
practice may not survive without an elaborate Web site or home page.
The patient is now the commodity. The buyer's market in medicine has
stimulated efforts at outreach and information transfer at
unprecedented levels.
Medical consumers have become efficient search engines. They can access
the latest medical information on-line, they are intrigued by watching
live operations on the Nova channel, and they are able to read the
results of research studies in the New York Times, often
long before medical journals ever hit our "in" boxes. With all of
this, the demand for a lay reference book on heart disease might be
challenged. In reality, though, the need has never been greater. The
exponential increase in availability of medical data, the abundance of
opinions from self-proclaimed experts, and the barrage of press
releases from pharmaceutical companies with a vested interest in
selling their products have left the public confused and
frustrated. Not unlike the reaction of children with too many choices,
many of our patients are experiencing sensory overload and would
significantly benefit from clarification and guidance. There is a
cogent need for our patients to have access to a truly authoritative
treatise that describes the nature of heart disease and presents
current options for its treatment and prevention. The New Living
Heart fills this gap. It is targeted for the layperson and is a
revised and updated version of The Living Heart, written by
Drs DeBakey and Gotto almost 20 years ago.
The New Living Heart is a comprehensive lay reference with
28 chapters and an extensive glossary of medical terms. The
introduction includes a fascinating description of the origin of our
knowledge of the heart. Anyone interested in the history of medicine
would enjoy the exploration into the insights of ancient physicians
such as Hippocrates and Galen and how the rejection of their theories
by Renaissance thinkers shaped medical knowledge. Following this, the
book flows from a description of the normal structure and function of
the heart and vascular system to a narrative of the
diagnostic tools available to detect disease, including the
physical examination and invasive and noninvasive procedures. The
initial section is followed by an account of risk factors for heart
disease with ensuing chapters dedicated to specific disease entities. A
broad range of conditions are covered, including heart failure,
arrhythmias, venous disease, atherosclerosis,
congenital heart disease, acquired heart disease, and noncardiac
vascular disease, including stroke and peripheral
arterial disease. The basic pathophysiology and clinical
sequelae of each are chronicled. Therapeutic modalities and surgical
options for the featured disease process are integrated into each
discussion or illustrated in more detail in subsequent chapters. The
book includes a section on special issues facing women with heart
disease and concludes with chapters on lifestyle, rehabilitation, and
cardiac medications.
The purpose of the book is to provide the general (although fairly
well-educated) reader with a better understanding of heart disease, and
it certainly achieves that goal. The work is an ambitious attempt to
provide an in-depth proviso of the major forms of heart and vascular
disease with an emphasis on therapeutic and preventive strategies. The
writing is clear, well organized, factual, and nonjudgmental, in the
spirit of a true reference book. There are occasional and welcomed
deviations from this style in which the reader is engaged with
questions. This is illustrated in a section on smoking cessation. The
question, "Does it really make a difference?" is asked and then
followed with a list of the chronological benefits of quitting smoking.
The tone of the book is supportive, yet alarming when appropriate.
Because of the level of detail provided and the breadth of the book's
content, it is unlikely that this book will be read cover to cover.
Several related chapters can be readily consumed, though, and a
substantial portion of the book is relevant to all, particularly the
sections on risk factors, lifestyle, and prevention.
The authors succeed in providing unbiased and accurate information
about an array of cardiac disorders. This is a monumental task and
speaks to the true authority of Drs DeBakey and Gotto, the
complementary nature of their work, and the synergy of their
contributions to the book. A few minor errors may be identified by
healthcare professionals, but these are usually due to simplification
of complex procedures rather than mistakes. Despite the rapidly
changing field of cardiovascular medicine, the book is
notably current. In a few spots, the material or recommendations are
outdated. For example, in the section on congenital heart surgery, the
expressed ideal age of elective repair of coarctation is 3 to 7 years,
but this is now recognized to be 6 months to 1 year in many larger
centers. The potential danger of a book like this is that
recommendations will be generalized, and the reader will wonder why his
or her treatment plan was different. The authors do an excellent job of
avoiding this by focusing on the treatment itself and not how it was
chosen. Some readers might find this frustrating, but it is certainly
in the broader interest of patient care to avoid specific
recommendations without individual information.
In summary, this is an excellent medical reference for the layperson.
Physicians will also find it a nice companion to facilitate the
communication process with patients. The book is replete with diagrams
that illustrate the basic anatomy, pathology, and
interventional and surgical procedures of the
cardiovascular system. Although it is no substitute for
the physician's traditional method of informing patients about their
disease and their options for treatment, it could serve as an
extraordinary adjunct to the process. The New Living Heart
is an important contribution in an era when the medical consumer's
need for detailed information is heightened, and the time available for
physicians to instruct and counsel patients is at a premium.
