Time for more than heartfelt sympathy

The Cardiovascular System - Cardiology - Specialist Training in Cardiology
February 24, 2006

In the late 20th century, medicine was transformed from a profession based on clinical diagnosis where compassion was often the only therapy, to one where lives are saved by treatment guided by accurate investigation - and nowhere was the revolution more powerful than in cardiology. Forty years ago, a heart attack was seen as an act of God for which no treatment was possible; nor could much be done for angina, heart failure or rhythm disturbances.

In the early 21st century, all that has changed. As a consequence, it has never been more exciting to be a cardiologist. Not only has treatment improved dramatically, but much heart disease can be prevented. Indeed, we learn in Specialist Training in Cardiology , edited by Henry Purcell of the Royal Brompton Hospital and Paul Kalra of Portsmouth Hospitals National Health Service Trust, that age-specific coronary heart disease mortality has fallen by 50 per cent in recent years, with 60 per cent of that reduction due to less smoking and 40 per cent due to better treatments.

Yet despite impressive age-specific reductions in coronary disease, with an ageing population, cardiovascular disease continues to cause half the deaths in the developed world, and by 2010 will cause half the deaths in the developing world as well. Never has there been a greater need for large numbers of well-trained cardiologists. In this context, what are we to make of three new textbooks of cardiology? They are aimed at trainees at different stages of training. The Cardiovascular System: Basic Science and Clinical Conditions , by Alan Noble et al, is aimed at the more junior medical student; Cardiology: An Illustrated Colour Text , by David Newby and Neil Grubb, is a lavishly illustrated monograph aimed at middling to senior medical students; Specialist Training in Cardiology , edited by Purcell and Kalra, is aimed at the more senior (or enthusiastic) medical student, along with junior hospital doctors.

The Cardiovascular System proclaims itself a "textbook for those medical courses that combine organisation by body system with much earlier contact with patients". This is the sort of teaching much promoted by the General Medical Council and other organisations distant from, and ignorant of, the coalface. The authors aim to include "anatomy, physiology, pharmacology and pathology"; in reality, this book provides an important link between cardiovascular physiology and clinical problems. It is well written and goes into enough detail to be interesting yet not so much as to overload. It is excellently illustrated with clear and pertinent graphs and diagrams.

The problems that students might experience in learning are delightfully anticipated, and the text is leavened with humour. The flow of ideas is neatly presented, with key historical facts and dates mentioned. In short, it is an excellent introduction to the physiology and medicine of the cardiovascular system. Many (indeed, most) practising cardiologists would benefit from revisiting the physiological principles outlined within it.

Newby and Grubb's text feels the newest of the three - it is published on glossy paper, lavishly illustrated, with many clear full-colour diagrams and numerous actual investigations, along with boxed tables. It feels Scottish: dry, matter-of-fact, even austere. It provides an accurate description of how modern cardiologists practice. Each chapter is confined to a double-page spread - an excellent device for ensuring brevity and clarity. All aspects of modern adult cardiology are well covered. This book relays a lot of data in an attractive fashion to the medical student. Given how much difficulty students have with turning symptoms into a diagnosis, there are perhaps too few chapters on this aspect.

Purcell and Kalra's Specialist Training in Cardiology is a more traditional form of book. It is multi-authored, which leads to the usual strengths of chapters written authoritatively by experts - but, thanks to firm editorial control, without the usual weaknesses of differing textual style and repetition. Most conditions are crisply defined, and there are separate sections on the aetiology, pathophysiology, symptoms, signs, investigations and treatment of diseases. Prognosis has no separate heading, but is usually well described. The epidemiology of disease, a grossly neglected area in most books, is often excellent. The diagrams and ECGs are extraordinarily clear because they are pertinent and, unusually, very large. Most diseases are well covered, with the section on congenital heart disease in adults - an area in which few cardiology trainees have specific training - being particularly good.

The historical perspective, while not central to this book, is sufficient to entertain, while at the same time, informative - few know that George II died of an aortic dissection! In short, this book sets a high standard and can be wholeheartedly recommended.

Patrick Davey is an interventional cardiologist, working at Northampton General Hospital and John Radcliffe Hospital, Oxford, and author of several medical texts.

The Cardiovascular System: Basic Science and Clinical Conditions

Author - Alan Noble, Robert Johnson, Alan Thomas and Paul Bass
Publisher - Churchill Livingstone
Pages - 211
Price - £19.99
ISBN - 0 443 07308 2

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