1340 Cardiology Explained 3 - O ELETROCARDIOGRAMA

[Pages:257]EXPLAINED SERIES

Cardiology explained

Euan A Ashley and Josef Niebauer

Cardiology explained

Remedica explained series

ISSN 1472-4138 Also available Anal and rectal diseases explained Interventional radiology explained Forthcoming Common spinal disorders explained

Published by Remedica 32?38 Osnaburgh Street, London, NW1 3ND, UK Civic Opera Building, 20 North Wacker Drive, Suite 1642, Chicago, IL 60606, USA Email: info@ Publisher: Andrew Ward In-house editors: Tonya Berthoud, Helen James, Roisin O'Brien, & Cath Harris Design: AS&K Skylight Creative Services ? 2004 Remedica While every effort is made by the publisher to see that no inaccurate or misleading data, opinions, or statements appear in this book, they wish to make it clear that the material contained in the publication represents a summary of the independent evaluations and opinions of the authors. As a consequence, the authors, publisher, and any sponsoring company accept no responsibility for the consequences of any inaccurate or misleading data or statements. Neither do they endorse the content of the publication or the use of any drug or device in a way that lies outside its current licensed application in any territory. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher. Remedica is a member of the AS&K Media Partnership. ISBN 1 901346 22 6 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library.

Cardiology explained

Euan A Ashley and Josef Niebauer

Euan A Ashley Division of Cardiovascular Medicine Stanford University School of Medicine Falk CVRC, 300 Pasteur Drive Palo Alto, California 94305 USA

Josef Niebauer Privatdozent and Consultant Cardiologist Department of Internal Medicine and Cardiology University of Leipzig ? Heart Center Str?mpellstr. 39 04289 Leipzig Germany

Foreword

Cardiology is a rapidly changing field. New technologies such as drug-eluting stents, left ventricular assist devices, and novel inflammatory markers, and imaging modalities such as magnetic resonance imaging and three-dimensional echocardiography, offer us an unprecedented view of the function of the heart in health and an unparalleled scope of therapies with which to treat disease. Yet, although we cardiologists like to think that we are more innovative and pioneering than our colleagues in other specialties, it seems at least possible that there are equally exciting changes in other fields, too. All of this leaves the generalist as the patient's primary advocate, as the integrator of all these specialist opinions, trying at once to learn enough of the new advances to communicate with both patient and specialist, but not so much as to lose the big picture in amongst the details.

What the generalist needs is a concise, well written, beautifully illustrated guide to cardiology. And fortunately, if you're reading this, you've already found it! The authors have recognized that generalists need help in staying up-to-date with specialist advances in a way that journals can rarely provide: a comprehensive, yet highly digestible update to cardiology that can jog the memory in a tactful but not patronizing way. Further, it is organized not in the didactic way in which many such textbooks are written, but in a way that will make sense to the practicing clinician who needs the facts quickly to hand. Clear yet detailed explanations of what cardiologists do can be found within these pages. Specific guides to understanding cardiological tests and writing good referral letters are two of the unusual, yet extremely useful places where this book differs from others you might have read. All recommendations are, of course, consistent with the latest guidelines from the European Society of Cardiology, the American Heart Association, and the American College of Cardiology. Meanwhile, the historical nuggets remind us from where we have come and just how lucky we are to make it this far (intact!). Together, these things serve to make this book a unique and invaluable resource for generalists and other subspecialists, both in hospital and in the community. I highly commend you for picking it up!

Alan Yeung Professor of Medicine (Cardiovascular), Stanford University Medical Center, USA

Preface

We may not be the most impartial commentators, but it seems to us that the heart is the most interesting organ in the body. It beats in a tightly regulated, finely coordinated, gracefully rhythmic fashion to distribute blood and oxygen to all the other organs. It does this more than 2 billion times in the lifetime of an average human. It can accelerate to power an Olympic athlete for 26 miles in a little over 2 hours, and it can weaken to hold your 86-year-old patient hostage in her favorite chair.

Yet the heart, so central to the metaphors of our language, has not revealed its secrets readily. This may be because until relatively recently, it was believed the heart was the only organ that could not be cut (heart surgery was unthinkable from the time of Aristotle until the late 1800s). But this reflects the heart's eternal mystique. Since the invention of the stethoscope we have used technology to reveal the innermost workings of the heart. In recent times, technological advance has been ever more rapid. Indeed, the rapidity of this technological advance is what led us to writing this book. Meanwhile, the bulk of cardiovascular disease remains the realm of the generalists. From whose perspective, knowing when to make use of specialists and knowing how to view their input in the context of the whole patient is increasingly important, yet increasingly difficult. So this is the aim of our book: to sit beside you when you wonder, "Should I refer this patient to a cardiologist"; to look over your shoulder when you receive the cardiology clinic letter; to whisper in your ear the normal left ventricular internal diameter. In short, if our book can be your partner in working with your cardiologist then it has been successful. If it can answer questions the answers to which you once knew, it has been valuable. If it can explain the answers to questions you didn't know you wanted to ask, then it has been worth our while and worth your money. We care deeply that this book fulfils your needs and welcome any feedback on its content, explanatory style, or level of detail.

Many people have made this book possible. Too many to mention in these pages. We would like to thank our wives Fiona and D?rte who have been patient and understanding during the long nights and early mornings. Many cardiologists and generalists gave advice and read chapters and we would like to thank them all here. Finally, we'd like to thank Cath Harris, Andrew Ward, and all the team at Remedica who coaxed and cajoled us, encouraged and enlivened our text, and heroically rescued our diagrams from obscurity.

Euan A Ashley and Josef Niebauer

To Angus Ashley, the best doctor I know

EAA

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