by: Paul A. Iaizzo
643pp.+ index, $179
The second edition of the Handbook of Cardiac Anatomy, Physiology, and Devices is an outstanding text that integrates basic and clinical heart-oriented biomedical science with a unique translational research focus on medical devices and therapies.
The book is divided into four sections: introduction, anatomy, physiology and medical devices, and therapies, and is accompanied by a DVD that includes many of the beautifully illustrated diagrams and figures from the text. The DVD also draws from the Visible Heart® Laboratory with unique movies that enhance understanding of cardiac anatomy and physiology and integrate form and function. Chapters are authored by authorities and scholars from the Lillehei Heart Institute at the University of Minnesota and Medtronics Inc.
The target audience is clinicians and cardiac researchers with an emphasis ideal for biomedical engineers interested in the development of new therapies and medical devices. Beyond the intended audience, this text is a necessity for faculty members teaching cardiac physiology and anatomy in both discipline-based and integrated curricula and those involved in the postgraduate teaching of surgical specialties. It should be required reading for residents and fellows in cardiology and cardiothoracic surgery.
Each well-written chapter is introduced with an abstract and keywords, followed by text delineated with clear subheadings, and concluded with a summary, a list of very appropriate historical and current references, and suggested readings.
The introductory chapter provides some general background to cardiac physiology, circulation, and regulation of cardiovascular function. The first anatomy chapter discusses “attitudinally correct cardiac anatomy” and will assist the learner in understanding the positioning of the human heart in the thorax. The embryology chapter succinctly describes the development of the vertebrate heart from its four embryonic regions: primary heart field, secondary heart field, cardiac neural crest and proepicardial region. The timeline of cardiac development is very helpful, as are the clear diagrammatic presentations of the steps in cardiac development. While molecular aspects of cardiac development are not included, there are appropriate references for the learner who seeks that additional information.
The next chapter discusses the anatomical relationship of the heart to vessels, the thoracic wall, pulmonary cavities, and mediastinum. The following chapter discusses the internal and external anatomy of the human heart with clear explanations and appropriate diagrams to facilitate learning. The comparative cardiac anatomy chapter will be an important resource for cardiovascular research faculty, students, and staff, including sections on preservation and preparation of cardiac tissue for research investigations.
The anatomy is related to medical devices and procedures in the next chapter. The pericardium and its use in future treatment devices and paradigms is an important chapter on this often ignored cardiac component. The last anatomy chapter, which would benefit from immediately following and being more closely tied to the normal cardiac development chapter, provides an excellent overview of the most common embryological cardiac anomalies. The chapters on cardiac physiology and assessment of cardiac function provide a comprehensive overview of those areas. The first chapter in this section clearly describes the cellular physiology of cardiac myocytes, as well as basic principles of cardiac electrophysiology. The following two chapters provide an excellent discussion of the cardiac conduction system in relation to cardiac anatomy and function and the role of the autonomic nervous system in regulating cardiovascular function.
A chapter is dedicated to an overview on signaling mechanisms for both cardiac and vascular receptors, as well as an up-to-date discussion of inflammation in relation to coronary artery disease. The pathophysiology of myocardial ischemia/reperfusion injury is then described, along with current myocardial protective strategies. The effects of anesthetic agents on cardiovascular function are presented in the following chapter. An excellent description of various methods for measurement of blood pressure, the physiological basis of heart sounds, and murmurs associated with cardiac valve defects follows. The history and concepts of electrocardiography are logically presented, which will be of value to those new to this field, as well as to readers seeking to review this area. The cardiac physiology section also includes a superb presentation of the cardiac cycle, factors determining myocardial performance, and techniques for monitoring arterial and central venous pressures.
The metabolic pathways in energy production in the normal heart are reviewed in the next chapter, followed by the significance of alterations in those pathways in clinical settings. An excellent overview of the use of echocardiography to assess cardiac structure and function then follows. The next chapter clearly presents the principles and techniques for monitoring pressures and tissue perfusion in critically ill patients. The final chapter provides a very useful overview of the concepts involved in cardiac magnetic resonance imaging to assess structure and function of the heart.
The fourth section of the book is related to innovative devices and therapies used to treat cardiac dysfunction. It begins with an historical overview of cardiovascular devices and therapies developed at the University of Minnesota. Current pharmacologic approaches for treatment of hypertension, acute coronary syndrome, myocardial infarction, heart failure, and cardiac arrhythmias are then clearly presented. A critical review of current animal models used in cardiac investigative work is a chapter ideal for those involved in cardiovascular research.
The next chapter provides an elegant overview of the pathophysiology of various cardiac arrhythmias as well as current approaches for their treatment. The use of pacing and defibrillation systems to treat inappropriate cardiac rhythms is then discussed, followed by a chapter on cardiac resynchronization therapy. The description of cardiac electrical mapping techniques in treatment of cardiac arrhythmias will be of interest to a wide group of readers. A chapter is dedicated to the development of the techniques involved in cardiopulmonary bypass. Surgical approaches in the treatment of cardiac valve disease are then clearly described.
The next two chapters provide a glimpse into the future of cardiovascular treatments and present recent advances in minimally invasive cardiac surgery and transcatheter cardiac valve repair and replacement. An elegant discussion of the treatment of cardiac septal defects using catheter-delivered self-expanding stents then follows. Recently developed devices that lower intrathoracic pressure to increase venous return in the treatment of hypovolemic shock and cardiac arrest are well integrated with the cardiac physiology. The next chapter clearly describes the use of ventricular assist devices in the treatment of heart failure. An excellent review of the use of various stem cell populations in the treatment of ischemic heart disease will be of interest to both basic scientists and clinicians. The final chapter is an informative overview of innovative technologies for the treatment of cardiac dysfunction.
The DVD that accompanies the book will be of considerable value to readers. The Visible Heart® Viewer is organized into three sections: Heart Anatomy, Diseases and Treatments, and Device Choices. The illustrations associated with each are excellent. For example, there are views of the heart in 3D that allow the viewer to rotate the image and facilitate understanding of the inter-relationship between cardiac structure and function.
The Handbook of Cardiac Anatomy, Physiology, and Devices is an outstanding resource for both clinicians and cardiovascular researchers. It will be of value to those new to the field as well as to those interested in reviewing the wide variety of topics covered. The authors’ enthusiasm for cardiology education and learning is apparent from the preface through the last chapter of the book. This enthusiastic approach should enhance the learner’s desire to master the challenging content.
Robert M. Klein, Ph.D.,
Professor, Department of Anatomy and Cell Biology &
John G. Wood, Ph.D., Associate Professor,
Department of Molecular and Integrative Physiology,
University of Kansas School of Medicine