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.
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healthcare industry, in which the term client has become synonymous with patient, the concept of population served has been replaced by the number of lives covered, and in which a practice may not survive without an elaborate Web site or home page.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.
- Copyright © 1998 by American Heart Association