Hurst’s the Heart, Tenth Edition

Editors: Valentin Fuster MD, PhD, R.Wayne Alexander MD, PhD, Robert A. O'Rourke MD

Reviewed by: Madhuri Reddy, MD
Associate Editor, Geriatrics & Aging

Thirty-five years after Dr. J. Willis Hurst published the first edition of Hurst's The Heart, the 10th edition has been released. The new edition covers the entire spectrum of cardiovascular disease, from basic science and molecular development, to clinical applications and the latest genetic therapies.

From the perspective of a clinician caring for the elderly, there is one particularly useful chapter, entitled "Cardiovascular aging in health and therapeutic considerations in older patients with cardiovascular diseases." It provides detailed descriptions of the anatomic and physiological changes in the normal aging heart, and explores their possible relationships with pathological states. Therapeutic options and evidence-based rationale are given for the most common disease states such as systolic hypertension, valvular disease and coronary syndromes.

Another practical chapter describes practice guidelines in cardiovascular care. It reviews, in straightforward charts and diagrams, guidelines for risk stratification and treatment for everything from blood pressure to cholesterol (in mg/dL rather than SI). Algorithms are given for treatment of chest pain, heart failure, valvular disease and preoperative assessment of cardiac risk.

A particularly timely chapter describes "Cost-effective strategies in cardiology." Costs are initially described from a societal perspective, with background provided on the different types of economic analyses used to study costs, and on cost-effectiveness in prevention, diagnosis and therapy in common areas such as hyperlipidemia, smoking cessation, anti-hypertensive screening and atrial fibrillation. This is a wonderful chapter, supplying practical information to the clinician (and non-health economist) and insight into public policy as it relates to cardiovascular medicine.

There are also a couple of interesting chapters on insurance and legal issues in patients with heart disease. Other chapters explore the effects of mood and anxiety disorders in cardiovascular disease and describe behavioural therapies.

Overall, this substantial text acts as an excellent reference for the non-cardiologist. It reviews common cardiovascular conditions in a clear, well-presented manner and provides a multitude of charts and graphs to display information. Chapters on history and cardiac auscultation will appeal to those clinicians early in their training, whereas chapters on MRI and PET (with superb imaging) and techniques of electrophysiology make wonderful reference for even the experienced clinician.