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Shelton, CT: People's Medical Publishing House, 2009. 274 pp., paperback, $59.95.
Before a single technique is discussed, the first chapter of this book takes readers on a tour of medicine's past, vividly reminding us that a physical examination is the culmination of a 3000-year struggle to find internal diagnoses in even the most subtle of external abnormalities. With this book, Dr. Joseph Perloff (famed for both his expertise in the bedside exam and his pioneering work in adult congenital cardiology) provides a conversational and unique tour through the history, execution, and purpose of every aspect of the core cardiovascular examination.
The book is organized by the structure being examined: general appearance, arteries and pulses, veins, cardiac motion, auscultation, chest, and abdomen. I will not belabor the instruction in physical examination techniques presented except to say that it is outstandingly comprehensive—enough so to serve as a sole reference for the cardiovascular exam and filled with caveats to help avoid errors commonly made in practice. It is also extremely well illustrated, albeit in grayscale, but with carefully chosen photographs reproduced in a size large enough to make it easy to see the features under discussion. The importance of these oversized figures cannot be overemphasized; they make the illustrations functional and genuinely useful additions to the text.
What truly separates this book from its more generalized peers are the presentation style and tools used to put physical findings to a printed page. Throughout the text, the descriptions of classic exam findings are presented in the original words of their eponymous creators. Pulses are presented alongside invasive manometry. Jugular exam findings are shown with invasive hemodynamics. Apical impulses are shown alongside apex cardiograms. Each of these adds substantially to the text, not just describing but showing as clearly as possible in the format how, for example, a sustained, dyskinetic heave might actually feel under the fingers. Finally, the auscultation section, which is extensive, is exhaustively illustrated not with cartoons of murmurs, but with true phonocardiographic tracings, each of which was restored for this book's publication. While each of these features can be found in one text or another, it is unique to this title to bring them all together so comprehensively.
Testing without presumptive diagnosis can be a costly and counterproductive endeavor, but there are indeed a great many who for various reasons no longer rehearse or teach their bedside clinical skills. For them, this book should be regarded as a remarkable and comprehensive tour through the history of physical diagnosis and the technologies that confirmed its utility. For those students lacking in bedside instruction, this book goes perhaps as far as any can in attempting to fill this gap. Whether the reader is a clinical novice or expert, Physical Examination of the Heart and Circulation is a definitive guide to the art of cardiovascular diagnosis from one of its modern masters.