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This ambitious textbook achieves its goal of being a comprehensive and evidence-based resource for emergency cardiac care. It closely follows clinical guidelines and scientific statements from the standard cardiac authorities, with many references to and informative figures and tables from these works. There is an online searchable version, with accompanying videos. No 600-word review can do this comprehensive book justice.

There is some important chapter-to-chapter repetition, reinforcing important information and making for easy reading. For instance, the chapter on out-of-hospital strategies discusses dependence of triage of STEMI patients on the therapy chosen (fibrinolytics or intervention), and their comparative risks and benefits. Choice of STEMI treatment is also discussed, but slightly differently, in the chapter on acute coronary syndromes. This is the way a comprehensive text should read. Biomarkers are similarly discussed in 2 separate chapters, providing 2 insightful perspectives on the same topic.

However, the messages on the use of morphine and angiotensin-converting enzyme inhibitors for treatment of pulmonary congestion were somewhat conflicting in separate chapters on Heart Failure and on Cardiogenic Shock, and the differences could not be evaluated by the reader because of inadequate discussion of evidence, rationale, and specific indications regarding these 2 therapies. For these topics, and some others, there is more reliance on the authority of the American Heart Association guidelines than on references to original articles.

The text correctly refers to the ECG as “the single best test to identify patients with STEMI,” and also correctly identifies it as the single best risk stratification tool in chest pain patients. But there is little guidance in ECG interpretation. It would have been appropriate to describe what it takes to become expert at interpreting the ECG and what resources to seek in order to achieve this goal.

A fine chapter on emergency ultrasound includes advanced uses such as tissue Doppler M-mode imaging to look at mitral valve inflow velocity and septal velocity in heart failure. The videos on the Web site associated with the chapter are likewise informative, although labeling is problematic, resulting in inconvenient tabbing back and forth to read the legend.

An excellent chapter on out-of-hospital therapy of acute coronary syndrome and STEMI had minimal discussion of out-of-hospital activation of the cath lab, in spite of ample literature on the topic. There is an excellent and extensive discussion of adjunctive pharmacologic therapy for reperfusion therapy, with discussion of the major relevant clinical trials, though I would have liked to see more discussion of the referenced foundational studies of fibrinolytics. A single sentence implies that ST elevation is frequently obscured by right bundle branch block, and unfortunately furthers the misleading notion that any bundle branch block is an indication for fibrinolysis. There is also little mention of the many issues surrounding left bundle branch block in the diagnosis of STEMI.

As for dysrhythmias, the discussion of differentiation of stable regular wide complex tachycardias is too brief. Had the author recommended shocking them all, I could not disagree. Instead there was a long discussion of pharmacotherapy for stable ventricular tachycardia, but such therapy cannot be undertaken without a correct diagnosis. Another chapter implied that adenosine is not safe in ventricular tachycardia, but the reference cited actually found it to be safe. There was mention of Wellens' and Brugada's criteria for differentiation of ventricular tachycardia from supraventricular tachycardia with aberrancy, but no mention of Vereckei's newer methods.

There was no chapter on hemodynamic monitoring. The chapter on cardiogenic shock had much information straight from the American Heart Association guidelines, but pressors are not discussed in enough detail. Why would one choose one pressor over another, and what is the evidence for relative efficacy? How do their various pharmacologies affect their use and efficacy? The pharmacotherapy chapter on this topic was similarly lacking, with no rationale for picking dobutamine over dopamine or vice versa. There was mention of milrinone and dosing but no guidance to, or rationale for, its use, and how it compares with others. There was no mention of levosimendan except in passing in the chapter on electrical injuries.

There is much more to the book, including sections and chapters on cardiac arrest and CPR, which are comprehensive and comprise a significant part of the book.

In spite of some omissions, and some issues that one may disagree with, all chapters are very well written and researched. This text is a fine reference and starting point for nearly every issue in emergency cardiac care. I am very glad to have it on my shelf.