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50 Cases in

Clinical Cardiology

®

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50 Cases in Clinical Cardiology: A Problem Solving Approach

First Edition: 2014

ISBN 978-93-5152-110-5

Printed at

Dedicated to

My Parents

Ms Prem Lata Luthra and

Mr Prem Prakash Luthra Who guide and bless me from heaven

Foreword

With the widespread availability of sophisticated cutting-edge technology, the clinician’s approach towards the diagnosis of heart disease has undergone a paradigm shift. These days, it is not uncommon for the patient to be wheeled into the ECHO-room or even the cath-lab, without anyone taking a medical history or even caring to place a stethoscope over the patient’s precordium. This is not a good sign since history-taking along with clinical examination should continue to occupy their rightful place in the practice of bedside cardiology. Moreover, a wealth of information is available in simple diagnostic modalities such as the ECG and X-ray chest, which should be interpreted in the light of clinical data.

I must compliment Atul Luthra for this brilliant compilation of a wide variety of real-world clinical situations, encountered during the practice of cardiology. He has elegantly discussed each case and solved the clinical problem in a meticulous way. The section on discussion incorporates a bewildering array of high-quality ECG strips, X-ray films and ECHO images. Students preparing for their examinations, resident doctors working in cardiac units and clinicians involved in heart-care are bound to benefit from this book. I wish Atul and his excellent book, all the best.

JPS Sawhney

Chief of Clinical Cardiology

Chairman, Department of Cardiology

Sir Ganga Ram Hospital, New Delhi, India

www.preventivecardiology.in

Preface

Present-day cardiology is replete with a bewildering array of sophisticated investigative techniques, that have eclipsed the art of arriving at a diagnosis on the bedside of the patient. Yet, a relevant medical history and a meticulous physical examination are indispensable tools to mentally construct a plausible clinical diagnosis. Further, simple but informative investigations such as electrocardiography (ECG), chest radiography (X-ray) and echocardiography (ECHO), have withstood the test of time in clinical cardiology. Moreover, they are cost-effective in resource-sensitive settings and can be performed at the patient’s bedside.

It gives me immense pleasure to proudly present 50 Cases in Clinical Cardiology: A Problem Solving Approach, a compilation of real-world situations in clinical cardiology. Each case is introduced with a brief history and findings on physical examination. The clinical problem is then discussed analytically and ultimately solved with the aid of one or more simple bedside investigations. The case concludes with pertinent management issues along with some recent advances in diagnostics and therapeutics pertaining to that clinical entity. The text is suitably complemented by impressive illustrations of ECG strips, chest X-rays and ECHO images.

I have tried to incorporate most clinical situations encountered in heart clinics and cardiology ward-rounds, but there might be some omissions. Nevertheless, I sincerely hope that the wealth of clinical material on cardiac symptoms, physical signs and auscultatory findings, will rekindle the romance between the clinician and clinical cardiology. This book should be most useful for cardiology students preparing for examinations, resident doctors working in cardiac units as well as for physicians involved in the care of heart patients.

Atul Luthra