Bedside Cardiology

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Author: Jules Constant
Published: July 1999
Publisher: Lippincott Williams & Wilkins
ISBN: 0781721687
Paperback Book
Number of Pages: 342

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Bedside Cardiology

This book provides a detailed review of physical diagnosis and history-taking as they relate to the cardiovascular system. This fourth edition includes new information obtained from advances in echocardiography and phonocardiography that have occurred since the 1985 edition. The stated purpose is to help physicians balance advances in technology by increasing their skills in diagnosing cardiovascular disorders through history-taking and physical examination. The author hopes the development of cost-effective clinical skills will help clinicians choose which tests to order and better evaluate the results of tests. Although it may or may not succeed in promoting cost-containment, it will certainly increase the cognitive and diagnostic skills of its readers. The stated target audience is cardiologists, fellows, and internists with a special interest in cardiology. Family practitioners, internists, and pediatricians are referred by the author to another "simplified text." This book, however, has much to offer noncardiologists and is certainly not beyond the scope of primary care physicians, residents, and even senior medical students. Chapters are devoted to detailed cardiac history, arterial and venous pulsations, inspection and auscultation of the chest, and heart sounds and murmurs. The unique question-and-answer format reminds one of stimulating bedside rounds with a master cardiologist of the old school. At about 350 pages, the book is comprehensive without being voluminous. Questions are organized under clear topical headings and subheadings. The black-and-white illustrations are a nice mix of photographs (which, unfortunately, appear somewhat dated), schematic drawings, line diagrams,and illustrative tracings. They are generally of good quality and of sufficient quantity. The majority of references predate the 1985 edition, but more than 50 more recent references have been included, especially in chapters related to murmurs. An extensive and well-organized index makes the search for an individual topic an easy task. Above all, this book strives to teach. The author writes in a straightforward and clear style. The question-and-answer format takes some getting used to, but it accomplishes the goal of prompting thinking by the reader. The book will be useful to physicians with a strong interest in cardiology, to cardiology fellows, to faculty physicians who teach physical diagnosis to residents and medical students, and to any physician with an ambulatory practice who must rely on history and physical examination rather than technology to make the diagnosis in a majority of patients. The advanced cardiologist will find it a refreshing review of a vanishing art. This book is now in the fifth edition and continues to be the benchmark of cardiology texts on the Socratic method of teaching cardiac history and physical exams. The goal is straightforward in that the author means to teach the diagnostic skills required to assess patients with cardiac disorders. He does so by history and physical exam skills. These are not only worthy but essential objectives and the author achieves them better than anyone in the field. What is unique about this book is that it can be used at all levels of training from the beginning student to the cardiac subspecialist. Whether the book has been read once or one hundred times, there are always new data to be gleaned. The author is an extremely credible authority in the subject matter as evidenced by this fifth edition. The art of cardiac clues from physical exam and the section on arterial pulse and pressure are exceedingly well done. Again, the Socratic method is the major strength of the book and there are more pearls to be gleaned that can be retained on a single reading. The text is a quick reference to answer clinical questions as they arise. One major limitation is that some of the figures and photographs are old; perhaps in the next edition they could be updated with higher detail and closer evaluation to better bring out the teaching point. This is the core textbook for cardiac history and exam. There is no other one like it and no other author that masterfully uses the Socratic method of learning. This is a valuable text and should be available from the medical student level on to the board certified cardiologist.

Table of Contents
Preface
1 The Evolving Checklist in History Taking 1
2 Cardiac Clues from Physical Appearance 16
3 Arterial Pulses and Pressures 30
4 Jugular Pressure and Pulsations 67
5 Inspection, Palpation, and Auscultation of the Chest 94
6 The Stethoscope 119
7 Diagraming and Grading Heart Sounds and Murmurs (The Auscultogram) 123
8 The First Heart Sound (S[subscript 1]) 127
l9 The Second Heart Sound (S[subscript 2]) 143
10 The Opening Snap (OS) 171
11 The Third Heart Sound (S[subscript 3]) 181
12 The Fourth Heart Sound (S[subscript 4]) 195
13 Ejection Murmurs 208
14 Systolic Regurgitant Murmurs 238
15 Diastolic Murmurs 283
16 Abdominal Murmurs 313
17 Prosthetic Valve Sounds 315
18 Systolic Time Intervals 317
Subject Index 325

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