Heart Disease I-II [antikvár]

Részlet az első kötetből:IMPORTANCE OF THE HISTORY: THE PHYSICIAN'S ROLE Specialized examinations of the cardiovascular system, presented in Chapters 3 to 11, provide a large portion of the data base required to establish a specific anatomical diagnosis of cardiac disease and to determine the extent of functional impairment of the heart. Although the development of these methods represents one of the triumphs of modern medicine, their appropriate use is to supplement but not to supplant a careful clinical examination, which remains the cornerstone of the assessment of the patient with known or suspected cardiovascular disease. There is a temptation in cardiology, as in many other areas of medicine, to carry out expensive, uncomfortable, and occasionally even hazardous procedures to establish a diagnosis when a detailed and thoughtful history and physical examination may be sufficient. Obviously, it is undesirable to subject patients to thes unnecessary risks and expenses inherent in many specialized tests when a diagnosis can be made based on an adequate clinical examination or when their management will not be altered significantly as a result of these tests.1 Intelligent selection of investigative procedures from the broad array now available requires more sophisticated decision-making than was necessary when the choices were limited to the electrocardiogram and chest roentgenogram. The history and physical examination provide the critical information necessary for these decisions. The Role of the History. The overreliance on laboratory tests has* increased as physicians attempt to utilize their time more efficiently by delegating responsibility for taking the history to a physician's assistant or nurse or even by issuing a questionnaire-an approach that I consider to be an undesirable trend insofar as the patient with known or suspected heart disease is concerned.Részlet a második kötetből:INTRODUCTION DEFINITION. Congenital cardiovascular disease is defined as an abnormality at birth in cardiocirculatory structure or functioa. Congenital cardiovascular malformations result generally from altered embryonic development of a normál structure or failure of such a structure to progress beyond an early stage of embryonic or fetal development. The aberrant patterns of flow created by an anatomical defect may, in turn, significantly influence the structural and functional devel-