Strengths: Very good review of the pathogenesis and management of heart failure
Weaknesses: Appendix is repetitive and not designed for primary care practitioners
Audience: Primary care practitioners
The definition given of heart failure -- an inadequate output for the demands of the body -- is the standard one, but it does not recognize that the clinical findings are due to compensatory mechanisms. The discussion of the pathogenesis of heart failure is particularly good; pressure and volume overload, remodelling and changes in neurohormonal mechanisms are clearly described. However, I do not agree with the authors that all patients should undergo an echocardiogram to exclude a surgically correctable condition.
The chapter on treatment is excellent, although I would challenge the advice to consider sotalol, calcium-channel antagonists such as diltiazem, or amiodarone to treat patients with atrial fibrillation and a rapid ventricular rate. I also disagree with the advice to stop treatment with digoxin after finding low serum levels in patients with sinus rhythm.
The appendix, which constitutes almost half of the book, repeats the rest of the text, but in considerably more detail. It is very test oriented, providing recommendations for echocardiographic, nuclear and electrophysiologic tests. It contains an excessively detailed diagram of the pathophysiologic process involved in heart failure and a two-page table summarizing the major published trials concerning heart failure and left ventricular dysfunction. It also discusses heart transplantation and the management of heart failure in children. This appendix is not designed for primary care physicians and adds little to what has been so clearly stated in the body.
The body of this book provides an excellent and concise discussion of heart failure for its intended audience. It should have stood alone, without the reproduction of the proceedings of the consensus conference in the appendix.
John H. Burgess, CM, MD, FRCPC
Professor of medicine
McGill University
Senior cardiologist
Montreal General Hospital
Montreal, Que.