HOT OFF THE PRESS!
Originally published as an update to Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine
11th edition
Debra L. Beck
Eugene Braunwald, MD
Date Published: October 19, 2018
Traditionally, the four pillars of bedside physical examination are inspection, palpation, percussion, and auscultation. In this paper, Drs. Narula, Chandrashekhar and Braunwald propose adding a fifth element—bedside ultrasound (or insonation). This is timely for several reasons, including that current physical examination skills in new trainees are often suboptimal and efforts to improve examination skills during medical training have not been particularly successful. Also, point-of-care handheld ultrasound systems are now available that make bedside insonation imminently feasible. The newest devices are handheld, in some cases wireless, compatible with smartphone technologies, and, in one case, costing less than $2000.
Detractors of bedside insonation have argued that it will diminish the primacy of physical examination even further. However, said the authors, “bedside imaging should not be thought of as replacing or even displacing current practice of physical examination but additive for understanding physiology and pathology and an internal validation of physical findings.” It should be considered “a complement to our senses” to aid in establishing a correct diagnosis rapidly and inexpensively. A further argument for bedside technology is that it may help with the patient-physician relationship in that it keeps the physician at the bedside for longer, and in direct contact with the patient.
In conclusion, said the authors, “We believe that the most practical enhancement to bedside physical examination could be provided by incorporating handheld ultrasound devices.”
The investigators concluded that many patients with severe asymptomatic primary MR may remain free of indications for surgery for long periods of time and can be actively monitored by experienced practitioners. In such patients, “active surveillance was associated with a favorable prognosis, resulting in timely referral to surgery, excellent long-term survival, and good surgical outcomes.” A randomized trial comparing active surveillance and early elective surgery is warranted.
Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine features a unique update program by Dr. Braunwald, creating a “living textbook” by featuring weekly Hot off the Press, periodic Late-Breaking Clinical Trials (including links to authors’ presentation slides), and monthly Focused Reviews.
Learn more about Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 11th Edition. Download a free chapter here.
Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 11th Edition
ISBN: 9780323463423
Pub Date: 2/22/2018
Reviewed by: Ronald Chong-Yik, MD, MPH (Ochsner Clinic Foundation)
Description
This is the eleventh edition of the definitive, comprehensive reference for cardiovascular medicine. This edition has been updated with a multitude of additional chapters. It also offers an enhanced ebook version for use on mobile devices (iOS and Android), PCs, and Macs.
Purpose
The purpose is to provide the most comprehensive and up-to-date reference in cardiovascular medicine.
Audience
The audience is anyone learning or practicing cardiovascular medicine, including trainees, midlevel providers, and practicing physicians. The comprehensive nature of this reference presents learning opportunities for providers at any level.
Features
The book is organized into 99 chapters subdivided into 11 unique parts that cover a wide variety of topics ranging from stable ischemic heart disease to emerging and evolving areas such as cardio-oncology. There are over a dozen new chapters including ones on chronic lung disorders and cardiovascular disease, the approach to the patient with cardiac arrhythmias, and transcatheter treatment of congenital heart disease. The presentation is comprehensive and encompasses everything from basic science concepts behind cardiovascular disease to the public health burden of cardiovascular diseases to the latest and greatest in clinical treatment options.
Assessment
This is the gold standard of references for anyone learning or practicing cardiovascular medicine. The authors and contributors continue to update and add new information in this ever-changing field. This book should be in the library of anyone who sees and treats patients with cardiovascular disease.
Doody’s Review Service Weighted Numerical Score: 93 — 4 Stars!
