HURST'S THE HEART, Ninth Edition
Alexander RW, Schlant RC, Fuster V (editors)
McGraw-Hill, New York, 1998
Reviewed by Barry J. Goldlist, MD, FRCPC, FACP
The latest edition of Hurst's The Heart is a massive tome, comprised of 2602 pages of text, and an index of 96 pages. Clearly this is not a book that is meant to be read at once from cover to cover! My first task was to check the list of authors. There are 181 contributors, and they are truly an outstanding group. However, as is common in American texts, only six of these are from outside the USA (one from Belgium, Germany, South Africa and Canada, and two from the United Kingdom). This could be a weakness as the pattern of delivery of cardiac care, especially advanced cardiac care, may differ from country to country. The table of contents mirrors the goals of the text, which are to provide a comprehensive reference source. However, there are a number of topics that could have been added. Part 1, "Basic Foundations of Cardiology", could have included a chapter on how to interpret the burgeoning cardiovascular literature. Although the principles of critical appraisal span all disciplines, the specifics (e.g. methodological pitfalls, appropriate outcome measures, meaning of clinical significance) vary widely from specialty to specialty. Issues concerning coronary artery disease in women are incorporated into various chapters. Considering the huge challenges this area creates for clinicians, it would have been preferable to have a separate chapter on the topic. There is a chapter entitled "Geriatric Considerations in Cardiovascular Therapy", but it focuses exclusively on pharmacology. Topics such as altered presentation, difficulties in diagnosis, and under-treatment are not addressed.
The book itself is well designed. The typeface is clear and crisp, and there are large numbers of excellent and appropriate illustrations. The use of charts to highlight important information is excellent. As in all multi-authored texts, the quality varies somewhat from chapter to chapter, but generally the content is excellent. The chapter on history, physical examination and cardiac auscultation is superb. The chapter on diagnosis and management of heart failure exhibits the major difficulty that textbooks face. It is very well written, but there is nothing in the references more recent than 1997, and thus the authors do not mention the survival benefits of spironolactone, and are less "bullish" on beta-blockers than they would have been today because more evidence has been accumulated.
In summary, this is an excellent text that covers virtually all aspects of cardiovascular disease, and is a first rate reference. However, the fast pace of change in cardiovascular medicine means that clinicians will have to use additional more current sources of information when they manage individual patients.
