(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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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