Bedside Cardiology Atul Luthra
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1Tips and Tricks of Bedside Cardiology2
3Tips and Tricks of Bedside Cardiology
Atul Luthra MBBS MD DNB Diplomate National Board of Medicine Consultant Physician and Cardiologist New Delhi, India
4
Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Tips and Tricks of Bedside Cardiology
© 2010, Jaypee Brothers Medical Publishers (P) Ltd.
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2010
9789380704999
Typeset at JPBMP typesetting unit
Printed at
5To My Father Mr PP Luthra who made me & to My Mother Ms Prem Luthra whose fond memories always guide me6
7Foreword
With the widespread availability of sophisticated investigative technology, the clinical approach towards the diagnosis of heart disease has undergone a paradigm shift. These days, it has become customary to diagnose a cardiac ailment solely on the basis of an electronic report generated by a CATH-lab., ECHO-room or EPS-facility. Nevertheless, a meticulously taken medical history and a thoroughly performed physical examination have been and will remain indispensable tools to mentally construct a plausible clinical diagnosis of heart disease.
The electrocardiogram (ECG), chest skiagram (X-Ray) and echocardiogram (ECHO) are simple yet informative diagnostic modalities that have withstood the test of time. They elegantly complement the information gathered from medical history and physical examination and they are cost-effective investigations in resource sensitive settings. Moreover, since the equipment for these tests are portable, the tests can be conveniently performed at the patient's bedside and the results interpreted in the light of clinical data.
I must compliment Dr Luthra for this brilliant and unique title Tips and Tricks of Bedside Cardiology. He has elegantly compiled a wide variety of real-world clinical situations encountered during the course of cardiology practice. The discussion and clinical pearls after each case description are really worth appreciating. Cardiology students preparing for their examinations, resident doctors and paramedical staff working in cardiac-care units as well as non-cardiologist physicians dealing with heart patients are most likely to benefit from this book.
I wish Atul and his excellent book all success.
Dr JPS Sawhney
Chief of Clinical Cardiology
Chairman, Department of Cardiology
Sir Ganga Ram Hospital
New Delhi, India
9Preface
There was a time when heart disease was diagnosed at the bedside of the patient. Clinicians were like detectives who would skillfully gather vital diagnostic clues from a thoughtfully taken medical history and a meticulously performed clinical examination. Present-day cardiology is replete with a wide variety of high-tech diagnostic tools that seem to have eclipsed the art of making a clinical diagnosis. In this scenario, it would be worthwhile to amalgamate the conventional with the contemporary as in several other aspects of life in general and the field of clinical medicine in particular.
It gives me immense pleasure to present Tips and Tricks of Bedside Cardiology, a harmonious blend of the time-honored clinical approach with the modern technical approach, towards the diagnosis of heart disease. The book is formatted as clinical cases, giving the reader an opportunity to mentally construct a plausible diagnosis from symptoms and signs. Illustrations of electrocardiograms, chest radiographs and echocardiograms that follow, aid in clinching the diagnosis. Each case description is followed by a discussion which incorporates the differential diagnosis in that particular patient. The clinical pearls given at the end provide the key ‘take-home’ messages.
It has been my endeavor to incorporate most cardiac diseases encountered in heart-clinics and ward-rounds but there may be some omissions. While avoiding case duplication to the extent possible, some clinically important facts may have been emphasized repeatedly. I sincerely hope that the wealth of clinical material presented in a concise, readable and assimilable form will rekindle the romance between the clinician and clinical cardiology. These tips and tricks should benefit students undergoing training in cardiology and preparing for examinations as much as they would interest clinicians involved in the care of heart patients.
Atul Luthra
11Acknowledgments
I am extremely grateful to: