Practical Echocardiography and Doppler

Echocardiography is one of the grandest techniques of this century. It does no harm to the patient, it can be repeated many times, it is relatively inexpensive, and the amount of information that we can derive from it is extraordinarily useful to the everyday practice of cardiology. Practical Echocardiography and Doppler is a handsome, clearly written text with good illustrations; however, there are quite a few items omitted which could have made it a better book. For example, as this book is written for the novice, I do not believe there was enough emphasis placed on the technique of echocardiography. The author should have pointed out that it is sometimes difficult to get a good study. This problem is true not only for the patients with chronic lung disease, as he does tell us, but sometimes for patients with sunken chests. In the case of chronic pulmonary disease, simply rolling the patient over on his left side, bringing the heart closer to the chest wall, is sometimes more useful than breath holding to obtain a good study. In the chapter on endocarditis, the author would have done well to remind us that vegetations are sometimes confused under mitral valve with myxoma degeneration, and it can be impossible to differentiate between the two. The coronary artery chapter was slim. It should have discussed the importance of stress echocardiography and the role that it plays in diagnosing coronary artery disease. Dr. Harvey Feigenbaum [1] has already pointed out that with a stress test the septum may decrease motion, and this process can be reversed with nitroglycerin. There is a chapter on mitral valve prolapse, which is a common disorder. The author neglects to mention that sometimes in thin people the position of the transducer can create a small prolapse where none exists. In the chapter on aortic regurgitation, the author fails to discuss the important diagnostic role echocardiography plays in conjunction with the electrocardiogram (EKG). By demonstrating early closure of the mitral valve with the AC point occurring before the Q-wave on the EKG, as we sometimes see in acute endocarditis, the echocardiogram may help us to determine the severity of the valve destruction and the need to intervene. The treatment of congestive heart failure (CHF) depends greatly on left ventricular ejection fraction. A greater emphasis in the chapter on CHF could be made on the abilities of the two-dimensional echocardiogram to determine ejection fraction. This finding can guide us in choosing the best drug treatment regimen. A chapter on echocardiographic findings of the aging heart is appropriate at this time. The aging heart can show decreased mitral valve motion, calcifications of the annulus, and left atrial enlargement. Such a chapter is lacking from this book. The chapter on doppler echocardiography was well done. I do believe that any textbook should have a bibliography; one was conspicuously absent from this text. In spite of its limitations, this volume would be a good