Challenging Concepts in Cardiovascular Medicine: Cases with Expert Commentary

289 Pages·2011·5.043 MB·English

by  Aung Myat, Shouvik Haldar, Simon Redwood

Challenging Concepts in Cardiovascular Medicine:
A Case-Based Approach with Expert Commentary
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Challenging Concepts in
Cardiovascular Medicine:
A Case-Based Approach
with Expert Commentary
Edited by
Aung Myat
SpR Cardiology and NIHR Clinical Research Fellow
West Midlands Deanery and The Rayne Institute, St Thomas’ Hospital,
King’s College London, UK
Shouvik Haldar
SpR Cardiology and Electrophysiology Research Fellow
London Deanery and The National Heart & Lung Institute, Royal Brompton Hospital,
Imperial College London, UK
Simon Redwood
Professor of Interventional Cardiology and Honorary Consultant Cardiologist
King’s College London and Guy’s and St Thomas’
NHS Foundation Trust London, UK
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FOREWORD
The authors are to be congratulated on producing an innovative and informative text
on the management of common cardiovascular conditions. By presenting facts through
the vehicle of a series of case presentations the text comes alive and has relevance and
immediacy for anyone having to deal with patients with heart disease. Rather than cite
references to publications in the conventional way, the authors provide up to date
commentaries on the published evidence with additional, personalized opinions from
an impressive array of distinguished specialists from around the UK with each case
representing a virtual ‘grand round’ on a particular topic.
Although not exhaustive, the book covers most of the clinical presentations that are
likely to be encountered by a trainee in their day-to-day practice, whether in the A & E
department, on the wards or in the catheterization laboratory. Not only does it provide
invaluable reading for the relatively inexperienced cardiologist, it also serves as a
highly palatable update for those of us who have been around somewhat longer.
In a modern clinical practice setting dominated by guidelines, protocols and direc-
tives it is refreshing to encounter a text that brings all aspects of case management
together in such an informative and entertaining way.
I can thoroughly recommend it to all cardiologists, whether established or in training,
as well as any healthcare professional wishing to keep abreast of modern, evidence-
based management of heart disease.
Professor Peter Weissberg
Medical Director, British Heart Foundation
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A REVIEW FROM THE BRITISH
CARDIOVASCULAR SOCIETY
There are many books published in cardiovascular medicine but few that offer a practi-
cal patient based approach. The authors should be congratulated for producing a highly
readable, unique, and memorable educational experience suitable for a wide audience:
medical students, trainees, trained cardiologists, allied professionals, and GPs.
This book presents 25 ‘real world’ cases of the common, and some not so common,
cardiac diagnoses. Each scenario, written by a Specialist Registrar, follows the patient
pathway through their presenting complaint, history, examination fi ndings, investiga-
tion and treatment options. Along the way, there are highlighted sections of ‘clinical
tips’ to aid the diagnosis and ‘learning points’. These ‘learning points’ range from basic
facts to the ever important evidence base and this is where this book excels. With the
growing evidence base from clinical trials, with all their acronyms to remember, and
increasing number of clinical guidelines, the authors pick out, and summarise, those
relevant to the case in hand. This information becomes far easier to remember simply
by association with the case. In addition a distinguished expert in the relevant fi eld
adds an ‘expert commentary’ and a ‘fi nal word’ after the case discussion to complete
the tutorial. I am sure the information held in each of these case scenarios will be
recalled frequently in clinical practice and beyond.
The British Cardiovascular Society, through its education strategy, supports the
delivery of high quality education and this book, through its knowledge based learn-
ing, certainly provides that. It comes highly recommended by the Society.
Dr Sarah Clarke
Vice President Education and Research
British Cardiovascular Society
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PREFACE
Cardiovascular medicine in the 21st Century continues to be a dynamic and continu-
ally evolving landscape with high impact journals rapaciously churning out trial after
landmark trial, alongside the emergence of novel translational techniques and discov-
eries at the cellular level. We as healthcare professionals must critically appraise and
selectively plunder this evidence base and apply it to everyday clinical practice so that
we can give our patients the very best possible care biomedical science will allow.
Local, national and international guidelines help, as do the expert consensus of opin-
ion leaders and the advice of our colleagues and peers on the ground. We have tried
to encapsulate this contemporary scheme of patient-focussed care, with its foundation
supported by guidelines and an evidence base, in this publication.
We present 25 real-world clinical scenarios, each aiming to provide the reader with
an holistic approach to dealing with a variety of challenging concepts in cardiovascu-
lar medicine. It has been our deliberate intention to include detailed reviews centred
around individual cases which we may all encounter either in the emergency depart-
ment, outpatient clinic, catheterisation laboratory or on the coronary care unit. Indeed
we have tried to avoid presenting a compendium of the rare, weird or wonderful. Each
case has been written by a UK Specialty Trainee(s) and is punctuated by “Learning
Points”, “Clinical Tips,” and “Landmark Trial Summaries”. These highlighted boxes
are embedded in the main body of the case text and should help to aid memory and
provoke thought. We have then sought the peer review of an internationally-renowned
Expert for each of the clinical scenarios and have asked them to provide a narrative as
the case proceeds in the form of “Expert Comments” boxes. These should provide the
reader with a unique insight into how today’s opinion leaders deal with the very same
clinical scenarios we all manage day in and day out.
We very much hope this text will appeal, fi rst and foremost, to all specialty trainees
in cardiology and to some degree those in acute and general internal medicine. Allied
to this our aim has been to make this book stimulating, transferable, and accessible to
all those with an interest in cardiovascular medicine so in that respect general practi-
tioners (particularly those with a specialist interest in cardiology), clinical electro-
physiologists, specialist cardiac nurses and physicians’ assistants may all fi nd the
content applicable to their everyday practice. It is now standard practice to explore the
management of clinical scenarios both in specialist training post interviews and fel-
lowship exams. We would therefore expect our junior colleagues preparing to navigate
these career milestones to fi nd this text particularly relevant too.
We, the Editors, very much hope you enjoy the read.
Aung Myat
Shouvik Haldar
Simon Redwood