Atlas of Cardiovascular Monitoring.By Jonathan B. Mark. New York, Churchill Livingstone, 1998. Pages: 362. Price: $79.00.
Accurate integration and interpretation of cardiovascular monitoring data are paramount to proper care of patients. However, this standard is not always met, as is evidenced by numerous studies during the past decade or so that question the safety and effectiveness of invasive hemodynamic monitoring. Whether this deficiency is caused by the monitor itself, improper usage, or inadequate education is open for debate, but the Atlas of Cardiovascular Monitoring by Jonathan Mark goes a long way toward combating the problem of inadequate education.
The Atlas of Cardiovascular Monitoring consists of 20 relatively concise chapters, each followed by extensive examples of various tracings, waveforms, and diagrams that discuss invasive and noninvasive cardiovascular monitoring. The text is well-written, accurate, and thorough without being oppressive, which allows for quick review when needed. The strength of this book, however, is in the diagrams. The diagrams are clear and well-captioned enough to stand on their own, and complement the text. They extensively show normal physiologic, diseased, and artifactual states that are frequently (and infrequently) seen during the care of patients in both the operating room and the intensive care unit. The diagrams emphasize, as is stressed and repeated throughout the entire book, the more accurate picture seen when various monitoring methods are integrated together.
The first two chapters discuss general definitions of monitoring and waveform interpretation and its relation to the cardiac cycle. Chapters 3–6 discuss the basic waveforms found when floating a pulmonary artery catheter, identification and interpretation of the wedge pressure, artifacts encountered and how to recognize them, and the prediction of left ventricular end-diastolic pressure in both normal and diseased states. The next three chapters discuss invasive and noninvasive arterial blood pressure measurement and interpretation and thoroughly explain the technical aspects of monitoring systems, damping coefficients, and the like. The next two chapters discuss basic electrocardiology (lead placement, systems, and selection) and electrocardiographic detection of myocardial ischemia, including limitations and artifacts. The next three chapters (12–14) integrate information discussed previously to combine electrocardiographic and hemodynamic data for more accurate detection of myocardial ischemia, heart rate, and heart rhythm. The final six chapters focus on pressure–volume relations, interactions between the respiratory and circulatory systems, and various pathophysiologic states, including valvular heart disease, pericardial disease, changes during cardiopulmonary bypass, and proper interpretation of intraaortic balloon counterpulsation data.
The Atlas of Cardiovascular Monitoring is one of those books that should be on all bookshelves. It is applicable to all levels of training and is appropriate for anesthesiologists, intensivists, cardiologists, and surgeons who rely on cardiovascular monitoring for diagnosis and guidance of therapy. At $79.00, it is reasonably priced (especially considering the information contained within), and it is of reasonable size to fit in my briefcase along with my laptop and go from the office to the operating room to the intensive care unit and home, without wearing me down.