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Bedside Cardiac Diagnosis
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Henry J. L. Marriott. 291 pages. Philadelphia: J. B. Lippincott Company; 1992. $49.95.
Marriott, well known as a master explicator of the mysteries of the electrocardiogram, returns to his roots with this textbook devoted to the clinical examination of patients. In this age of technology, such an approach and emphasis is timely and welcome. Lip service is widely paid to the knowledge that most diagnoses can be made from a careful history and physical examination. In practice, there is a rush to the laboratory.
The first and most successful part of the book describes cardiac examination in the classic manner. A brief section on the history is followed by several more detailed chapters on the techniques of physical examination and a description of auscultatory findings. Their causes, significance, and differential diagnosis are included. The last half of the book describes major valvular and congenital abnormalities. The text suffers somewhat by considering the bedside findings out of broader context, but this is a minor complaint. A short historical paragraph at the beginning of most sections is a welcome touch. A short bibliography is appended to each chapter.
There are cavils, as with any text. "Exuberant" blood flow is a colorful term, but hardly accurate. The cause of gastrointestinal bleeding in aortic stenosis is no longer unknown as it was in the 1961 reference cited; arteriovenous malformations have been shown to be the cause. Hypertrophic cardiomyopathy is not always congenital. These and other minor problems, however, do not detract from the overall excellence.
The book is well written and at times is almost conversational. It is quite dense with facts. As with a rich meal, if a reasonable number of small bites are taken at a time, they may be incorporated into one's body of knowledge; otherwise indigestion (or "undigestion") may result.
The intended readership is not stated. Residents and practicing internists would profit by spending a few minutes a day with this text. Cardiologists should be expected to be masters of all the information contained in this book.
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