Preface

This volume is the outgrowth of my book The Heart: Its Function in Health and Disease , originally published in 1966. In the nearly twenty-five years since that book first appeared, there has been extraordinary progress in the diagnosis and treatment of heart disease, along with a growth of public interest in and awareness of heart disease, which remains the number-one cause of death and disability despite a significant decline in the past few decades. In response to this high interest, the news media cover medical advances in the field of heart disease extensively. Exaggerated and premature reports of newer aspects of treatment frequently lead to misunderstanding and unreasonable expectations.

Along with the introduction of new technologies in the diagnosis and treatment of heart disease, there has been a growth in the number of hospitals and clinics providing specialized care for cardiac patients that is generally considered excessive. Furthermore, the question of whether too many complex diagnostic tests and operations are being performed on patients with heart disease has been raised and widely discussed in the news media and has aroused the interest of Congress. Among the reasons for this alleged overuse is the demand by the often poorly informed public for the "newest."

These considerations influenced me to shift the emphasis in this new book. Rather than update the previous volume, which discussed the normal and abnormal heart in simple terms, I decided to present the problems facing today's cardiologist, explaining the technologies and the decision-making process but avoiding direct

advice to a cardiac patient—in other words, emphasizing the "why" rather than the "how" of prevention and treatment of heart disease. I hope that a better-informed reader in need of medical care will be able to cooperate more successfully with the physician.

To keep the book within the framework of these objectives, I eliminated certain subjects or discussed them only briefly. Among those are epidemiological data related to heart disease, such as statistics regarding the incidence, the age and sex, and the racial and geographical distribution of various types of heart disease. Similarly, I have omitted detailed presentations of treatment, including specific recommendations regarding drug and dietary management of heart disease, in favor of concise statements of principles.

Cardiologists now have a wide range of options, from conservative to aggressive, in managing patients. Many steps are subject to controversy and debate. In writing this book, I have attempted to take the middle-of-the-road attitude and identify controversial questions. The first two chapters review the structure and function of the normal heart and the circulation of blood. The following two chapters present general approaches to diagnosis and treatment of heart disease and describe the available technology. The balance of the book reviews the principal cardiac diseases, explaining their causes, recognition, and management.