Aleksandar N. Neskovic, Frank A. Flachskampf, Michael H. Picard, eds.
187 pp. London, UK: Taylor and Francis; 2005. $139.00. ISBN 1-84184-392-X.
Because of its portability, versatility, relative ease of use, and ability to deliver immediate real-time structural and functional information, echocardiography has become a vital imaging tool in the rapid diagnosis and accurate management of acute cardiovascular conditions. The textbook Emergency Echocardiography is a timely publication that reviews the role of ultrasound imaging in the management of a wide range of cardiovascular emergencies frequently encountered in clinical practice. The book is not a comprehensive text of general echocardiography; rather, it focuses on specific topics in cardiac emergencies, thereby filling an important niche within the echocardiography literature currently available. As such, it addresses a wide readership of both experienced healthcare providers and trainees while straddling multiple specialties that include cardiology, anesthesiology, and emergency medicine.
The 181-page textbook consists of 17 easy-to-read and clearly organized chapters dedicated to broad topics, including echocardiography in acute coronary syndromes, cardiac tamponade, chest trauma, acute native and prosthetic valve dysfunction, cardiac arrest, cardiogenic shock, pulmonary embolism, aortic dissection, portable echocardiography in the emergency setting, and intraoperative imaging. The chapters are fluent and written by a cadre of international contributors from 8 different countries spanning 3 continents who are experts in their respective fields. Each section focuses on the role of echocardiography in topic-specific diagnostic and management algorithms. Most chapters are case based, are fact filled with easy-to-understand images and illustrations, and encompass a sizable number of useful references highlighting the diagnostic and prognostic power of echocardiography. Care is taken to provide predominantly evidence-based management suggestions based on published guidelines and key publication references. Both transthoracic and transesophageal images are incorporated into the textbook, and the potential advantages and limitations of each methodology in specific clinical situations are broadly addressed. The textbook is probably geared toward individuals who already have some basic fundamental understanding of echocardiographic imaging and interpretation and would not serve as an introductory technical book on how to perform echocardiograms.
Overall, I enjoyed reading this textbook, which was clearly written and easy to understand. I read it in its entirety and learned many facts. Most of the sections provided illustrations that are “classic” examples of commonly encountered cardiac emergencies such as tamponade, aortic dissection, and papillary muscle rupture while providing current knowledge and clinical pearls that are certain to be useful at the bedside. The “key points” tables at the beginning of each chapter were excellent and provided a quick glimpse of the take-home messages from each chapter. Carefully selected echocardiographic images, illustrations, and tables complemented the text information well. Most images were of good quality, although a handful were technically limited, likely owing to acquisition methods under acute challenging situations, as acknowledged by the authors. As is inevitable in any multiauthor book, particularly with international authors, there was some heterogeneity in the length, depth, language, and quality of each chapter. For example, chapter 1 on acute aortic insufficiency is limited to 5 pages with 23 references, while chapter 14 on acute myocardial infarction provided 17 pages of information with 140 references. Several chapters, especially in the later portions of the book, were particularly well organized, comprehensive, yet concise without extensive reviews of the literature that are available in more standard echocardiographic texts. Chapters on cardiogenic shock, tamponade, acute aortic dissection, acute myocardial infarction, cardiac source of embolism, and prosthetic valve dysfunction were excellent with succinct case examples, clinical pearls, clear illustrations, and useful tables. Pitfalls and limitations of echocardiography such as “blind spots” of transesophageal echocardiography in acute aortic dissection were appropriately mentioned with acknowledgement that complementary imaging studies such as CT and MRI may also provide useful information in some settings. There was some repetition in topics such as acute mitral regurgitation and tamponade across different chapters, although this is unavoidable given the nature of these clinical presentations that span several acute emergency settings.
A couple of the chapters addressed new and emerging areas in echocardiography, although they appeared somewhat superficial and only scratched the surface of their full potential. For example, the 6-page chapter on portable echocardiography in the emergency room focused primarily on the different types of commercially available portable machines and the level of training recommended for their proper use. More specific case examples and broader discussion highlighting the role of portable echocardiography at the bedside would have strengthened the section. Assessment of microvascular perfusion with myocardial contrast echocardiography in the setting of percutaneous coronary intervention is certainly a growing area of interest. This technique is not widely available in most echocardiography laboratories, where it remains primarily a research tool at the present time, particularly in the emergency setting. Although a handful of illustrations were scattered across some sections, a chapter specifically dedicated to native and prosthetic valve endocarditis with additional case examples of associated complications such as abscesses, fistulas, leaflet perforation, and embolism may have added to the textbook. Finally, because echocardiography is a dynamic imaging tool, a companion CD with animations and multimedia real-time projections to complement static textbook images could be an excellent source for teaching.
Overall, this easy-to-read textbook concisely addresses a wide variety of critical topics and provides many excellent chapters. It represents a valuable contribution to the imaging bookshelf for both trainees and specialists and is a fine investment for residents, practitioners, and educators alike in the field of echocardiography.