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Cardiology Core Curriculum—A Problem-based Approach.
  1. N Pegge
  1. University Hospital of Wales, Cardiff, UK; nicholas.peggebtopenworld.com

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    Edited by John D Rutherford. (Pp 596; £45.) BMJ Books, 2003. ISBN 0-7279-1690-4.

    At 596 pages, this new textbook neither fits into a white coat pocket, nor possesses encyclopaedic exhaustiveness. Nevertheless, the chapter structure of text followed by clinical case based questions promotes immediate revision of new learning for the student, and criterion based self assessment for the more advanced trainee. The authors are all American; for the British trainee, the approach to clinical decision making whereby most investigations are performed to exclude unlikely diagnoses, not to confirm clinical judgment, will be unfamiliar though perhaps challenging. The chapter dealing with history and examination paradoxically discusses investigations at length, even though later chapters are dedicated to such investigations.

    The paragraphs are usually long, and much information buried in text could have been presented diagrammatically. The referencing of didactic pronouncements, such as percentage point specific risks of cardiac complications of non-cardiac surgery, is patchy.

    Discussion of risk factors for coronary artery disease excludes any mention of homocysteine, low birth weight, or socioeconomic factors. Risk assessment of the acute coronary syndromes excludes some of the newer biomarkers—for example, C-reactive protein and soluble CD-40 ligand. Similarly, the chapters dealing with arrhythmia management do not reflect recent literature clarifying the indications for implantable cardioverter/defibrillator therapy, or focal pulmonary vein ablation for atrial fibrillation. The role of device based cardiac resynchronisation therapy for heart failure is not discussed, neither the concept of diastolic ventricular interaction.

    In contrast, the chapter dealing with pulmonary embolism and pulmonary hypertension presents elegant decision making algorithms and is admirably concise.

    Discussion of cardiovascular pharmacology is entirely case based. A strategy based on the statement “If it is difficult to decide whether a ‘wide-complex’ tachycardia is VT or SVT with aberrancy, then procainamide is an appropriate antiarrhythmic to consider using” is not one that I would recommend to the target audience for this textbook in the UK. There is no discussion of low molecular weight heparin versus unfractionated.

    In summary, this textbook lacks coverage of the scientific context of some “bread and butter” management dilemmas relevant to district general hospital practice, but does contain detailed equations for calculating regurgitant volumes, stenotic gradients, and transvascular resistance by echo or catheter techniques.

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