Cardiovascular Pathophysiology

Cardiovascular Pathophysiology

327 above the textbook of Kirklin textbook of thoracic surgery. and Barratt-Boyes is the inclusion within Cardiothoracic Institute Brompton Hospi...

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above the textbook of Kirklin textbook of thoracic surgery.

and Barratt-Boyes

is the inclusion


Cardiothoracic Institute Brompton Hospital London, U.K.

Cardiovascular Robert The





N. Levy St. Louis/Washington,



278 pp.;








and Matthew Company,



H. Anderson


Physiology, 5th ed.

M. Berne


the “International”

G. Ahumada Press,




278 pp.;





Written by distinguished authors for students, the two books clearly declare their aim in the preface. “Cardiovascular Physiology” is presented with an attempt to place emphasis more on general concepts than isolated facts. The general and local circulatory systems and their control are considered in 12 chapters using simplified models and ample illustrations, and each chapter includes a list of some papers and review articles. In this pursuit, any disadvantages arising from apparent pedagogism or assumptions resulting from simplifications, are acknowledged. The text suggests other disadvantages. The reflex systems are used to simplify the control of heart rate and circulation, such that the mention of their operation is incomplete and often ambiguous relative to the available knowledge. For example, there is a scarce mention of the result of activating ventricular or aortic chemoreceptors and reflexes related to them. Emphasis is placed on the so-called “cardiopulmonary receptors” and the function of their reflex system; this label includes several reflex systems, each involving different groups of receptors the function of some of which is yet to be demonstrated. To its credit, however, the book contains clear illustrations on almost every page, which should draw the attention of students to the complexity of the subject. In contrast, the second book considers pathophysiology and aims to direct the reader towards essential facts, concepts and major mechanisms involved. The chosen subjects are covered in 13 chapters, each with a selected list of references for further reading. The majority of chapters deal with a variety of aspects related to cardiovascular diseases, including aetiology, epidemiology, diagnosis, therapeutics and their outcome. In such a small book it is difficult to present adequately a complete account of facts and mechanisms, particularly when these involve more than one explanation. At the level of basic physiology, reflex responses attributed to atria1 receptors and aortic baroreceptors are different from those previously documented. Some students may find use for these books. The simplified version of “Cardiovascular Physiology” would serve as an introduction to larger and more detailed accounts. Regarding

* European


International Journal of Cardiology


the chosen subjects of “Pathophysiology”, arguably these would be accessible through basic sciences syllabi, although the book might provide an early appreciation of some of their implications.

Department of Cardiovascular Studies The University Leeds LS2 9JT. U.K.

David A.S.G. Mary *

Drugs for Heart Disease, 2nd ed.

Editor: J. Hamer Chapman & Hall, London, 1987; 395 pp.; 235.00; ISBN 0-412-26540-O

This book aims to be a comprehensive review of modern cardiovascular pharmacotherapy. It is attractively presented. One of the inherent risks with such works is that the publication process and delays involved may render parts obs&escent or dated. This work is no exception. For example, the section on calcium antagonists only mentions briefly nicardipine, the most recently marketed member, despite the fact that there are three published supplements of cardiovascular journals and dozens of papers on this compqund. Little emphasis is placed on the possible application of the selectivity of new calcium channel blockers or concurrent use with beta-blockers in cardiovascular pharmacotherapy. There is no mention of the “vasodilator” beta-blockers, one of which is already marketed in Europe. Recent mortality data on heart failure and balanced vasodilation or ACE inhibitors in improving heart failure mortality does not figure. With the recent interest in positive inotropic drugs for heart failure, it is somewhat disappointing to find 40 pages devoted to digitalis and only 10 to many other inotropic agents. The positive inotropic chapter is probably the most disappointing, being merely a cataloguing of compounds with very little expert interpretation. On the other hand, the nitrate section is comprehensive and has anticipated current developments; the need for intermittency of application of therapy is stressed. The thrombolytic section was somewhat dismissive of the role of thrombolysis in myocardial infarction with subsequent coronary angioplasty. It may be inappropriate in a book directed at the international audience to dwell so heavily on the English context. There are interesting_seciions on blood level measurements of cardiac drugs, prostaglandins, ACE inhibitors, diuretics, vasodilator therapy, beta and slow calcium channel blockers. Despite some reservations, which I think are inevitable in work which sets out to be comprehensive, this is a broadly based and useful review of cardiovascular pharmacotherapy which should have general appeal to physician and cardiologist alike. Department of Medical Cardiology The General Infirmary Leeds, U.K.

* Member of the Editorial Board, International Journal of Cardiology.

Bernard Silke