556
Family Practice—an international journal
This slim booklet is a commendable attempt to produce
an overview of a difficult, and at times contentious, area
of practice. The authors summarize evidence for current practice, discuss the organization of preventive
services and offer specific chapters on the management
of myocardial infarction, guidelines for the diagnosis
and management of angina and rehabilitation after an
infarction. The book is aimed squarely at the family
practitioner and is a challenge to improve the services
provided at an individual and a population level. The
readers will include practice nurses and managers
interested in the role of the primary care team in the
management of coronary artery disease.
Unfortunately, this type of book will date rapidly.
The advice it contains is based on up-to-date studies,
for example it refers to the Scandinavian Simvastatin
study, but inevitably new work will modify practice and
alter the detailed recommendations that make up much
of this book.
Detailed advice about the management of coronary
heart disease is widely available from a wide variety
of sources. This one comes from a reputable group of
authors and is published by the Royal College of General
Practitioners, although there is no endorsement of the
contents by the College. An alternative model for the
production of guidelines is to conduct a detailed and
systematic literature review, assemble a panel to review
the evidence and then ask a wider group to review the
detailed recommendations, whilst making arrangements
for regular updating. For example, the recent 'North
of England guidelines on the management of angina'
were assembled by a group with a strong general practice representation and widely disseminated in the British
Medical Journal.
The strength of this book lies in its breadth of
coverage and its primary care focus. It should therefore
be actively considered by family practitioners, those in
training and others in primary care teams as a readily
accessible source of practical advice.
ANDREW FARMER
relevance to the GP. Topics such as ethnic variation,
A- and B-type personality, Echo cardiography, HRT
and Ischaemic Heart Disease are grouped under broad
chapter headings such as 'Clot-Busting and Clot Prevention', 'ACE Inhibitors', 'Arrhythmias', 'Hypertension'
and 'Ischaemia'. The authors are a consultant cardiologist and an experienced GP. This is their second collaboration and the reader is given the strong impression
that they must be good friends.
The style is an easy and natural conversational
approach with a series of questions and answers. Each
topic is covered in no more than one page of text. The
100 questions are based on concise case vignettes such
as the potential cardiological risks for a 6-foot 6-inch
basket ball player with Marian's syndrome. Some questions are more whimsical, asking the cardiologist to
reflect on changes in cardiology over the last 10 years
and into the next 10 years. Other questions seem to
be based on real experience such as who should we
advise to shovel snow, the 56-year-old man or his
56-year-old wife? The cardiologist's answers to the 100
questions take a straightforward and rational approach
and are very practical. Check lists are unobtrusively
included in the text and reasons for referral are always
given. The answers give a quick and reassuring
coverage of the topics.
This book will satisfy the experienced and busy family
doctor looking for a non-threatening update in cardiology. The book covers some intriguing points such as
the German preference for nitrates and digoxin, as well
as medicines old and new. There are interesting comments on 'partial truths', such as the need to test for
potassium when using thiazide diuretics, and on practical issues, such as the choice of a stethoscope.
In a book of 90 pages covering 100 topics there are
inevitably some shortfalls. This is not a textbook of cardiology and some readers may find the approach superficial. Many of the answers invite a supplementary
question, but with no scope to develop the questions
and answers, this can be quite frustrating. On the vexed
question of driving and cardiovascular disease there is
only reference to angina—an example of how the book
fails as an easy reference for everyday practical problems in general practice. Finally, no references are
given, which is rather unfashionable in these days of
evidence-based medicine.
Nonetheless, this is an attractive and interesting
approach to problems in cardiology and is a good book
to have in the consulting room.
SIMON STREET
Cardiologjcal dilemmas. R Blackwood, B Daily. (87
pages, £10.95.) Beaconsfield Publishers Ltd, 1995.
ISBN 0-906584-40-X.
ABC of rheumatology. M L Snaith (ed.). (90 pages,
£14.95.) London, BMJ Publishing Group, 1996. ISBN
0-7279-0997-5.
Cardiological Dilemmas is an accessible and wideranging book covering 100 questions of interest and
The ABC series from the BMJ Publishing Group
is always lavishly illustrated, pithy in form and
Be careful when you read it: whoever you are, it will
make uncomfortable reading in parts.
SUSAN DOVEY
Coronary heart disease. Prevention, management
and rehabilitation. C Waine (ed.). (54 pages, £13.20
non-members, £12.00 members.) London, Royal
College of General Practitioners, 1996. ISBN
0-85084-221-2.