Cardiovascular Hemodynamics: An Introductory Guide, 2nd ed.

Abstract

August 2020 • Volume 131 • Number 2 www.anesthesia-analgesia.org e55 DOI: 10.1213/ANE.0000000000004857 T treatment of patients that are hemodynamically compromised, either due to acute decompensated heart failure, cardiogenic shock, or a postoperative low cardiac output state, can be difficult and frustrating, given that these conditions are frequently associated with poor clinical outcomes. However, when taking a glance at the European guidelines1 or some recent publications on the diagnosis of acute heart failure states one gets the impression that, despite the complexity and severity of the underlying disease, diagnosis and appropriate management of these patients can be easily accomplished using an ultrasound machine,2 a few cardiovascular drugs, and a protocol.1 When reading the second edition of the book, Cardiovascular Hemodynamics: An Introductory Guide, 2nd ed, edited by Askari and Messerli and published within the book series Contemporary Cardiology, it becomes obvious that these statements are most likely an oversimplification and that an appropriate and successful management of patients with acute and severe cardiovascular failure cannot be accomplished without a profound knowledge and understanding of the underlying complex cardiovascular pathophysiology. Over 371 text pages with 22 chapters, written by expert cardiologists, with more than 150 figures, detailed legends, and 50 tables, the book gives an overview on myocardial pathophysiology, clinical noninvasive and invasive diagnostic measures for assessing cardiac function and hemodynamic status, pharmacological treatment, and mechanical circulatory support. Additionally, the clinical features of frequently observed clinical situations with hemodynamic compromise are covered. Most chapters follow a “bench-to-bedside” approach that starts with the presentation of physiological and pathophysiological details and then transfers this information into clinical scenarios. Each chapter ends with board-like review questions that allow the reader to test her individual learning experience, then with references and some suggestions for further reading. There are some highlights that deserve to be mentioned, like the chapter on afterload and on cardiac tamponade. Many other cardiovascular textbooks reduce the complex physiological and pathophysiological factors the heart is facing when expelling blood simply to Ohm’s equation. In contrast to these basic assumptions, the author of the “afterload” chapter concisely extends the resistance model to input impedance including the effects of reflected pressure waves on arterial pulse contour and arterioventricular coupling, concepts that are emerging also outside cardiology.3 Comparably, the chapter on cardiac tamponade elegantly elucidates how challenging this diagnosis may be and clearly shows the necessity to consider multiple modalities: clinical examination, pressure curve analyses, and echocardiography to substantiate the diagnosis. By the way, as a common concept across multiple chapters, the authors always point out that monitoring pressures, including pulmonary artery pressures, and adequately interpreting their curves is a pivotal step in the diagnosis and management of cardiovascular disease states, and that pressure monitoring and echocardiography should be regarded as complimentary in patients with severe hemodynamic compromise. However, there are also a few chapters with some limitations. From my perspective, this holds especially true for ones dealing with inotropes, vasopressors, and beta-blocker therapy that simply describe the pharmacological properties of these drugs but miss the opportunity to discuss their current role in the context of guidelines,1 clinical practice,4 and recent findings.5,6 Comparably, I missed a dedicated discussion of the clinically challenging management of right heart dysfunction and failure. Nonetheless, the recent edition of the Cardiovascular Hemodynamics: An Introductory Guide, 2nd ed, fulfills the goals set up by the editors: as they state in the preface to this second edition of their book, it will indeed be of high “value and interest to every student and practitioner of cardiovascular medicine who wishes to fully learn the hemodynamic foundation of cardiovascular medicine.”