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Braunwalds Heart Disease:
A Textbook of
Cardiovascular Medicine
7th Edition. Edited by Douglas P. Zipes, MD,
Peter Libby, MD, Robert Bonow, MD,
and Eugene Braunwald, MD, MD (hon),
ScD (hon), FRCP
2183 pages. Philadelphia, PA; Elsevier
Saunders; 2004
$189. ISBN 0721605095
How does one
review a 2183-
page, 4.5-kg, 21
6.828-cm text?
I placed it on my
desk where its bulk
kept it always in
sight and its mass
resisted movement.
It was used to answer questions of my
own and of house officers and students,
to additionally test the index, too often
a weak part of even outstanding text-
books (it proved to be adequate). Out of
personal interest, I read a few chapters
closely and spot read others.
The cover has a striking holograph
of the heart, which can be viewed in
systole and diastole. Four distinguished
editors have co-opted 122 contributors
to produce 87 chapters, including 36
new chapters since the sixth edition
(2001). Most contributors are house-
hold words among cardiologists. Apart
from the material I digested, spot read-
ing and question answering suggest only
good and better chapters; I found no bad
ones. For updating the text, there is an
electronic edition, which will be kept au
courant weekly and from which illustra-
tions can be downloaded to PowerPoint
for slides from the plethora of figures
and tables that are uniformly clear, fre-
quently in color, and of high quality.
I gave special attention to the chap-
ters covering electrocardiography, espe-
cially chapter 32, Specific Arrhythmias:
Diagnosis and Treatmenta thorough
book reviews
Congestive Heart Failure (ISSN 1527-5299) is published bimonthly (Feb., April, June, Aug., Oct., Dec.) by CHF, Inc., Three Parklands Drive, Darien, CT 06820-3652. Copyright 2005 by CHF, Inc. All rights reserved. No part of this publication may be
reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publishers. The opinions and ideas
expressed in Congestive Heart Failure do not necessarily reflect those of the Editor and Publisher. For copies in excess of 25 or for commercial purposes, please contact Sarah Howell at showell@lejacq.com or 203.656.1711 x106.
BOOK REVIEWS
Marrick L. Kukin, MD
Editor
presentation in which strategic use of
fine print permits the authors to wax
encyclopedic over such subjects as
supraventricular arrhythmias. Yet, as
with many other textbooks, this chapter
and others more or less skimp on P wave
information. Description of left atrial
abnormality includes, left shift of the
P axis to between 30 degrees to +45
degrees (perhaps a typographic error);
left atrial abnormality does not require P
axis shift. Pure restrictive (fibrotic) lung
disease without heart disease has such
horizontal and leftward P axes. (Normal
P axis is usually between zero and +90
degrees.) Neglect of the P wave is also
seen in the material (chapters nine
and 37) on chronic obstructive lung
disease in which emphysema vertical-
izes the P axis to over +60 degrees (a
high sensitivity and specificity screening
test for chronic obstructive lung disease
in adults). The wide, usually notched
P waves of interatrial block have,
for some reason, been designated P
mitrale. The former P is usually of rela-
tively low to very low voltage, whereas
the latter is of normal to increased
voltage. Moreover, P mitrale is rare and
becoming more rare, and interatrial
block is common and becoming more
common as the population ages. Its P is
more appropriately P-sinistrocardiale.
Personal interest led me to Pericardial
Diseases. Although the senior author is
a distinguished researcher, the chapter
received only 24 pages, whereas in the
sixth edition the pericardium required 54
pages, including considerable fine print.
With this constraint, the authors were
unable to wax encyclopedic (a cardinal
sin for some panjandrums of cardiology);
however, the chapter is nicely written
and reads easily with much very good
material. Strangely, the authors consider
the left atrium largely extrapericardial.
I have not observed that in the operat-
ing room or at autopsies and I could not
find it in four anatomy books, including
Grays. If it were true, the large and high
pressure pericardial effusions that force
their way posterior to the left atrium in
echocardiograms would be self-draining.
(Indeed, on page 1765, increasing peri-
cardial fluid is described as behind the
left atrium, certainly retained there by
the pericardium.) The chapter handles
pericardial macrophysiology in relation
to cardiac function concisely, and the
association of pathophysiology has been
presented in a practical manner. Yet, the
rich pericardial microphysiology (a veri-
table chemical factory) is not seriously
considered. A relatively minor but sig-
nificant omission: electric alternation is
said to be of the QRS. Although QRS
alternation is most common, this ignores
the many tamponade publications with
P-QRS and sometimes T alternans and
a recent one showing every wave and
every interval of the electrocardiogram to
alternate. (Indeed, whereas QRS alter-
nans can occur in a variety of conditions,
P-QRS alternation alone has long been
considered virtually pathognomonic of
tamponade.) Finally, a pericardial window
does not reliably eliminate futuretam-
ponade. Pericardial windows ultimately
close and some of them close early
enough for tamponade to recur during
the same admission. Despite these few
points, which can be corrected elec-
tronically, the chapter will be helpful
to almost all cardiologists, internists,
and surgeons. Moreover, this chapter
is light years ahead of Braunwalds first
edition (1980), with pericardial cov-
erage by the infamous John Darsee,
who digested some 435 references and
cobbled a 65-page chapter that was, at
best, pedestrian.
Despite its few flaws, this is a mag-
nificent textbook, which is hard on the
heels of cardiologys venerable bible,
now in its eleventh edition, Hursts
The HeartDavid H. Spodick, MD,
DSc, University of Massachusetts Medical
School, Worcester, MA
november . december 2005 339