Textbook of Cardiovascular Medicine
Eric Topol. 2760 pp. Philadelphia, Pa: Lippincott Raven; 1997. $125.00. ISBN 0–397-51592–8.
Dr Topol’s Textbook of Cardiovascular Medicine is an excellent embodiment of the current era of evidence-based medicine. The editor, Dr Eric Topol, is a leader in the field of clinical trials in cardiovascular medicine, and this approach comes through in his textbook. As he states in the preface, his purpose is to bring forth currently available information from clinical trials to guide the management of cardiac patients. This textbook is an up-to-the-minute compendium of the new data available from clinical trials in cardiology today. Indeed, many of the figures included are from articles still in press or from trials that have been presented but not yet published.
The presentation of the data is very clear and again is based on the trials. There are numerous figures and tables (between 20 and 40 per chapter) that help illustrate the data being discussed and also allow readers to quickly review the data in each chapter. For example, in the chapter on congestive heart failure treatment, the authors have compiled the mortality curves from the 20 major trials and plotted them all on the same scale to show on 1 page both the relative and absolute amounts of benefit of the various treatments (eg, ACE inhibitors, β-blockers).
The structure of the text is excellent: it is divided into 8 sections, each with a world-renowned section editor. The 8 sections are very natural subcategories of cardiology and thus become very useful minitextbooks. First, there is a 12-chapter review of Preventive Cardiology. This begins a useful pathophysiological approach to cardiology, beginning with the risk factors for development of cardiovascular disease. It also helps highlight this important subspecialty of cardiology. The next section, Clinical Cardiology, with Robert Califf as section editor, includes several excellent chapters on acute coronary syndromes, as well as chapters on valvular and congenital heart disease and other miscellaneous topics (eg, endocarditis, venous thromboembolism, cost-effectiveness). The third section is on Cardiac Imaging, with concise chapters reviewing each of the techniques with numerous clinically useful and illustrative images (eg, 69 chest radiographs). The next sections are on Electrophysiology, Invasive Cardiology (including cardiac surgery), and Heart Failure and Transplantation. The final 2 sections are on 2 very important emerging fields in cardiology: Molecular Cardiology and Vascular Biology and Medicine. The following is a review of several of the chapters.
The hypertension chapter is a very good one. Beginning with a historical perspective, it then describes the pathophysiology of hypertension, including the many predisposing factors. The section Establishing a Diagnosis and Risk Profile walks the reader through the optimal assessment plan for the initial history, physical examination, and laboratory tests to perform, all described in a series of tables. Similarly, the approach to secondary hypertension is well described in a single table. Unfortunately, there is no information about the new class of drugs, the angiotensin II receptor antagonists, despite the approval in 1995 of the first agent in this class, losartan. The index referred me to a 1-page summary of the emerging data on this class of drugs in congestive heart failure, which included an overview of the ELITE trial. Dr Topol already has a series of “Updates” to his textbook, including 1 on this topic by Gibbons and Pfeffer, thus keeping the textbook “up-to-the-minute.”
The sections on unstable angina and acute myocardial infarction (MI) are outstanding. Harvey White’s chapter on unstable angina is one of the best I’ve ever seen, covering very concisely the topics of diagnosis, risk stratification, and medical and interventional treatment. There are 3 chapters on acute MI: acute management, complications, and post-MI care; each is excellent and again, they are based strongly on the trial data supporting current management strategies. The chapter on ventricular tachycardia (VT) had a review of general mechanisms (also covered in a separate chapter on mechanisms) and different types of VT. The summary of treatment was brief, with the details on the various treatment modalities covered in separate concise and very informative chapters. In the congestive heart failure section, as noted above, the management section reviews the medications and their mechanisms of action, followed by an overview of all the important clinical trial data. Finally, the section on molecular cardiology is superb. Although it would not be immediately relevant to day-to-day clinical practice, it is a terrific primer on the subject for busy clinicians and investigators.
In summary, this is an outstanding textbook that helps keep the reader apprised of what is new in cardiology.
- Copyright © 1999 by American Heart Association