Essential Adult Cardiology: A Textbook for Aspiring Cardiologists

This is a practical textbook of adult cardiology aimed at medical students, junior doctors, and those more senior who need to know more about cardiac trial results and recent research advances. It represents a digest of 50 years of practical clinical experience, much of which will be valuable to nurses and paramedics engaged with heart problems. The book covers basic topics through to advanced ones.

Many medical professionals find diagnosing and managing cardiac conditions harder than most other specialties. Only those who study the mechanical and electrical functions of the heart will gain a facility for accurate diagnosis and management. The aim of this book has been to define and explain all the key information about cardiac problems and to provide the evidence needed for sound cardiac diagnosis and management.

Knowing and understanding all this book has to offer will not a cardiologist make; especially one capable of complex assessment, judgement, and invasive intervention. It will, however, provide a foundation.

Managing a disturbed cardiovascular system from every physical, emotional, and functional point of view requires some talent. Through the knowledge gained within and hands-on experience, a cardiologist with enough clinical wisdom to achieve patient benefit should emerge.

I have summarised the history of cardiology, modern advances in cardiac intervention, and key references to many important therapeutic trials. All are necessary for an appreciation of current cardiac management.

An area of difficulty for many students and doctors is cardiac examination, especially auscultation of the heart. Another area of difficulty is 'reading' ECGs. Few now appreciate that it was over seven decades ago that cardiologists first developed the skills needed to detect and assess congenital and valvular abnormalities using only their eyes, ears, and hands. Using feedback from cardiac catheterisation and surgery, these skills developed further. Except for those working on desert islands and in impoverished third world countries, the highly specialised skills of cardiologist doyens like Paul Wood and Aubrey Leatham might now seem antiquated. Echocardiography, MRI, CT, and PET scanning are now seen as more useful and reliable.

ECG interpretation is difficult because it requires not only experience with true abnormalities but also an acquaintance with the many variations of normal. I hope to impart a better understanding by including details of how ECGs are generated and how abnormalities arise.

The two commonest causes of cardiac morbidity are atherosclerosis and arteriosclerosis. To understand how atherosclerosis affects the coronary and other arteries and how arteriosclerosis relates to left ventricular hypertrophy and hypertension, I have included information about these processes at a clinical, histological, and molecular level.

Patients are most troubled by shortness of breath, angina, heart attacks, and rhythm problems. To understand them fully, one must consider valvular and adult congenital heart disease, together with the reasons for heart failure and its optimal management. Also included are less common conditions like myocarditis, cardiomyopathy, cardiac tumours, and heart disease in pregnancy.

Cardiologists like to quote relevant trials as acronyms, so some of the game-changing and controversial ones will be found throughout the text. The bibliography provided will enable dedicated students to take their study of cardiology further, to an expert level, should they wish. Those who want details of cardiac surgery will not find enough detail here. They should consult dedicated surgical textbooks on the subject.

Dr. David H. Dighton qualified at the London Hospital Medical College in 1966 with MB and BS (London) degrees. In 1970, after some time spent in an NHS general practice, he became a British Heart Foundation Fellow in Cardiology at St. George's Hospital, Hyde Park Corner, London, working with cardiologists Dr. Aubrey Leatham and Dr. Alan Harris. In 1973, he became a MRCP(UK), and later a Lecturer (London University) in Medicine and Cardiology at Charing Cross Hospital, London. In 1980, he became Chef de Clinique (Assistant Professor) at the Vrije University Hospital, Amsterdam. After returning to the UK in 1982, he worked both in his own private medical and cardiac practice in Loughton, Essex (The Loughton Clinic, established in 1973), and at the Wellington Hospital, London. In 2000, he started a private cardiac diagnostic centre, specialising in heart disease prevention and the early detection of heart and artery disease (The Cardiac Centre, Loughton). This closed after the PSA directed the GMC to withdrawn his licence to practice (see the details in 'The NHS. Our Sick Sacred Cow.' 2023). As an independent private cardiologist and general physician, he disagreed with them about UK medical practice bureaucracy, and those most qualified to devise, regulate and supervise it; opinions he based on having been a medical student, general physician and cardiologist for sixty years. In 2003 and 2006, he wrote two books on food and the heart, and between 2023 and 2014, six books on medical and cardiac subjects. He is currently engaged in forming Chigwell Cardiac Centre, Essex, UK., and continuing to publish books on both medical topics and his research relating to secondary cardiac prevention.One result of his interest in the frontier between art and science, is one small book of poems, haiku and senryu, on inter-personal relationships. His magnum opus, The Art and Science of Medical Practice, details what he learned from practising the art and science of medicine for sixty years. This is his ninth book, but he has other interests. He draws (all the illustrations in this book) and paints in oils on canvas. He has played the guitar and piano for many decades, for his own amusement. He has composed several simple melodies, one of which introduces his YouTube series on understanding heart problems (Dr. Dighton interviews), another of which he played live (on Facebook) for his now much missed patient and friend, June Robins. For further information go to: www.daviddighton.com