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For the past 40 years Dr J. Willis Hurst has been among the leaders of a discipline that has grown from a small and exclusive club of academic clinicians to the largest subspecialty of internal medicine, with several independent tracks of technically demanding diagnostic and therapeutic procedures. Retiring from administrative duties and relinquishing the chief editorship of the classic textbook The Heart has freed Dr Hurst to do what he does best, dividing a full day's work into the consulting practice of cardiology, teaching, and professional and journalistic writing. The 46 pieces assembled in the collection Essays from the Heart , and ranging in length from a single paragraph to several pages, represent mostly modified excerpts from previously published articles, addresses, and position papers. The subjects break down roughly into two groups, medical autobiography and the basic philosophy of teaching medicine to students and physicians. In 1955, Dr Hurst was the

In response to the criticism aimed at the massive weight of the first edition, the editors have split the 2219 pages of the second edition of the "Mayo Clinic textbook" into two volumes, which are still only slightly less bulky than some of the single-volume cardiology texts on the market. The edition is handsome, with excellent though sometimes diminutive figures, but the small print is near the limits of comfortable reading and is somewhat of an eyestrain when it comes to tables and legends. For a textbook, this is not a major drawback. Common to all multiauthor texts is a gap of two to three years separating the publication date from the dates of the most recent references. The time lag and constraints of space make it impossible for any textbook to provide as much detailed, up-to-date information on a particular subject as a recent comprehensive review article or a

The multiauthor textbook has become the most convenient way of collating a comprehensive body of new information. Elkayam and Gleicher state that their purpose is to acquaint the adult and pediatric cardiologist with the developing field of fetal cardiology and to offer the obstetrician an understanding of maternal cardiology. The two editors, a cardiologist and an obstetrician, have accomplished both goals in their collaborative effort. They have written, either alone or together, about one third of the 49 chapters of the text and delegated the remainder to about 60 of their colleagues with established expertise in cardiology, pediatrics, obstetrics, surgery, anesthesiology, and pertinent basic sciences. The second edition has maintained the original organization, which combines in a single volume two loosely related surveys of maternal and fetal cardiology. Several chapters have been added, and some of the older ones have been updated or rewritten, but only a few of the

Judging from the rate at which new entries invade the medical book market, the subject of electrocardiography appears to have an unusually strong appeal to textbook writers. The greatest concentration of books about electrocardiography resides within the category of primers and introductory texts for beginners. At the more advanced level, the choices become scantier, while a search for a truly comprehensive single-author textbook, if one excludes books on arrhythmias, takes us some 30 years back to Lepeschkin in the United States and Holzmann in Europe. The Fundamentals by E. M. McLachlan (who, we learn in the preface, has spent most of his professional life in a small town in New Zealand) is intended for use by medical students, house staff, nurses, and technicians. From the large pack of similarly targeted volumes arriving from English-speaking countries or in translation, this particular textbook has a good chance of moving into a winning

Electrophysiology of the Heart by B. Hoffman and P. Cranefield is already 15 years old but as yet no successors or competitors have challenged the dominant role of this basic textbook. The new Cranefield makes no pretense to alter this status by serving as an updated comprehensive textbook of cardiac electrophysiology a la Hoffman and Cranefield. The new text is more limited in scope, more probing, and much more similar to a monograph. Hoffman's absence does not mean the dissolution of the productive partnership because Hoffman did play an active role in the initial phase of experiments that form the background of this book. Wit and others also collaborated in these studies, which were begun in the late sixties, with an aim to create new models of experimental arrhythmias. These experiments revealed many previously unobserved phenomena and brought to light some puzzling meanderings of cardiac impulse through fragments of depressed

When I reviewed the 1967 textbook of clinical vectorcardiography by Drs Te-Chuan Chou and Robert A. Helm (JAMA, Jan 15,1968), I referred to it as a "remarkable specimen of superb teaching and clear writing." I felt that the book provided convincing evidence that the vectorcardiogram constructed from corrected orthogonal leads was more than occasionally superior to the electrocardiogram in the diagnosis of myocardial infarction, hypertrophy, and various intraventricular conduction disturbances.From this, one might have predicted a bright future for orthogonal vectorcardiography, particularly when popularized by such masters as Chou and Helm. Yet, a visit to a randomly selected medical center or hospital in this country is likely to reveal that, in today's clinical practice, vectorcardiography is threatened with extinction. Whereas the symmetry of the corrected orthogonal leads and the precision of time markings in the vector loop are no less appealing today than 20 years ago, they are rarely

Electrocardiography seems to offer the novice a wider choice of primers, synopses, introductions, and elementary texts than any other segment of medical literature. Stiff competition and uncertain acceptance are likely to face the newcomers to such a crowded market. The newest competitor, however, probably does not need to worry about the prospect of insufficient recognition by the public. Learning Electrocardiography may best be described as a rather practical "how to do it" approach, with questions and answers in a "Socratic method." The method may not be superior to either a purely narrative, or to a strictly programmed textbook, but this particular volume happens to contain good questions and good answers. The reader encounters a dedicated and sensitive teacher—an apparent veteran of many successful and stimulating dialogues with generations of students and house officers. He understands what they wish to know and why they may have difficulties in grasping certain problems

FOR MANY YEARS it has been recognized that specific sensory stimuli can precipitate convulsive attacks in susceptible individuals. Such reflex or sensory precipitated epilepsy (SPE) is uncommon and is found in only 5% to 7% of patients with epilepsy.1,2The following communication describes an unusual type of SPE in which seizures were initiated by the periodic discharge of an implanted cardiac pacemaker. To our knowledge, this is the first reported case of pacemaker-induced epilepsy. Report of a Case A 72-year-old white woman was admitted to the University of Kentucky Hospital on Nov 25, 1964, with a history of seizures which had begun three days prior to admission. The attacks occurred several times a day and were accompanied by tonic and clonic contractions, tongue biting, and unconsciousness. They were preceded by an aura of bright lights and noises and left the patient feeling dizzy and tired. Although she reported frequent

Physical training improves the performance of the heart. Recent studies of Sjostrand and other Swedish physiologists have shown that training increases the stroke volume and the volume of the heart. This implies that a small but healthy heart functions inefficiently, and that a certain amount of cardiac dilatation and hypertrophy, induced by training, may be beneficial. Reindell and his colleagues from Heidelberg conclude that cardiac performance during strenuous exercise is a function of the heart volume. Therefore, they have correlated the heart volume with the blood pressure, heart rate, electrocardiogram, ventilation, and oxygen uptake per beat during exercise in a large number of healthy individuals and in cardiac patients. The monograph contains a large number of tables and graphs with the detailed results of these correlations in men and women of various ages. The authors estimate the heart volume at rest from the supine, anteroposterior, and lateral x-ray films of

In 1954, Burch and co-workers identified a specific electrocardiographic pattern peculiar to certain patients with cerebrovascular accident (CVA).1In the series of Burch et al, 14 of 17 patients with this pattern had an intracranial hemorrhage. Subsequently, other investigators found the same pattern in patients with nonvascular intracranial lesions. However, in all studies the pattern was most frequently observed in patients with intracranial hemorrhage. The "CVA pattern" is characterized by wide T waves of large amplitude ("giant" T waves). These wide T waves are usually inverted in the standard limb and in the left precordial leads and upright in the right precordial leads. Sometimes, the wide T waves of large amplitude are upright in the three standard limb leads and in the leads V1through V6. The QTcinterval is usually prolonged by up to 60% above normal. In many cases, the wide T wave cannot

This short textbook, devoid of references, is directed primarily at students, interns, and surgical residents. The author correlates cardiac anatomy and pathophysiology with clinical electrocardiographic and roentgenologic findings in patients with operable heart disease. In the preface he states that his presentation has evolved from experience in teaching medical students and house officers, but the book does not successfully transform effective classroom teaching into an effective writing. The lines separating the virtues of effective oral presentation from the sins of sloppy writing have been too frequently transgressed. As a result, brevity has become an omission of important information, and simplicity an over-simplification. The bits of information selected for presentation are mostly of elementary nature. Nevertheless, not all definitions are precise and not all statements are accurate. Most of my colleagues—cardiologists—will not agree that in ventricular septal defect the harsh pansystolic murmur is loudest over the left second interspace; that in