Correlative Cardiology [antikvár]

Preface The Merriam-Webster dictionary defines an essay as— a literary composition usually dealing with a subject from a limited or personal point of view.' As one can see, an essay can be what the author wants it to be. I believe there should be a place where a physician, unencumbered by strict guidelines, can express his or her views on medical matters. There are important messages to be communicated that do not fit into our scientific journals or books. Accordingly, Clinical Essays on the Heart have been created to permit an author to have more freedom of expression than is allowed by the conventional vehicles that are used for communication. Some of the editions of Clinical Essays on the Heart have a theme while others are journal-like. Volume 2 dealt with coronary disease while Volumes 1 and 3 dealt with a large number of interesting subjects. This volume has a theme but it is expressed in 50 different subjects. CORRELATIVE CARDIOLOGY This Essay is a very personal one. It relates my personal way of teaching and learning. My work with students, house officers, and cardiac fellows at Emory University permitted me to stumble into the system that is described here. I must, in my own defense, state that this volume was created at the strong request of several cardiac fellows who enjoyed the method of teaching as much as I did and, because of their interest, became contributors to the project. The book is called Correlative Cardiology. It is my belief that all of the data collected from a patient must be inspected carefully and that each fact must be carefully viewed in relationship to other facts. There is a modern tendency to view facts in isolation whereas facts obtained from a complex biological system, such as a human being, are not always isolated. The book is designed to show the value of correlating all of the facts. Chapter 1 deals with a discussion of Correlative Cardiology and the method 1 have chosen to teach it. Chapter 2 begins with a short introduction which describes how to use the book. This is followed by the presentation and discussion of 50 carefully chosen patients who exhibit diagnostic problems covering the entire field of cardiology. The patients become the teachers. If the reader will turn each page in sequence but resist the temptation of looking up the answer, which is given a few pages later, he or she will enjoy the challenge of thinking of diagnostic possibilities using 'Ttie new Merriam-Webster Pocket Dictionary by G. & C. Merriam Company, 1964. Ttie Pocket Cardinal edition was published by Pocket Books, a division of Simon and Schuster, New York, New York. the clues that are in hand at that moment. There should be no guesses. By the time the clues from the history, physical examination, electrocardiogram, chest x-ray, and additional data are available, the reader should make the diagnosis in each case. As stated in Chapter 1, a live conference presented in the format used here permits me to see a patient I have never seen before. Therefore, I grope along the diagnostic path with members of the audience. Since I am the editor and author of this volume, I could not keep the patient's problems secret to myself. Therefore, unlike the live conferences, I have known the diagnosis in each patient. I have, however, tried to communicate what I think a reader should reasonably consider after viewing the data. Some readers will disagree with the analysis that is presented. This is expected and is actually desired because in the doing we, the reader and I, will be forced to think. I wish to thank Joe Brehm and Donna Mclvor of McGraw-Hill publishers for their help. I thank my secretary, Carol Miller, for turning her remarkable ability toward this fascinating project. As always, I thank my wife. No Nellie—no book. Willis Hurst. M.D. Acknowledg ments We wish to thank the following physicians for permission to use the x-rays presented in this book. Dr. William J. Casarella, Professor and Chairman, Department of Radiology, Emory University School of Medicine, for x-rays made at Grady Memorial Hospital on the patients discussed in Chapters 1, 2, 5, 6, 8, 9, 11-19, 22, 24, 26, 28, 30, 35-38, 40, 43, 45, 46, 49, and 50; and for x-rays made at Emory University Hospital on the patients discussed in Chapters 3,4,21, 23, 25, 27, 31-34, 39, 41, 42, and 48. Dr. William A. Davis III, Director, Department of Radiology, Crawford W. Long Memorial Hospital, for x-rays made at Crawford Long Hospital on the patients discussed in Chapters 7, 20, 44, and 47. Dr. Brit B. Gay, Jr., Chief of Radiology, Henrietta Egleston Hospital for Children, Inc., for x-rays made at Henrietta Egleston Hospital on the patient discussed in Chapter 10. Dr. Henry E. Johnson, Jr., Chairman, Department of Radiology, Piedmont Hospital, for x-rays made at Piedmont Hospital on the patient discussed in Chapter 29. We wish to thank the following physicians for permission to use the electrocardiograms presented in this book. Dr. J. Willis Hurst, Candler Professor of Medicine (Cardiology), Chairman of the Department of Medicine, Emory University School of Medicine; Chief of xlll