Book Review

ELEKTROKARDIOGRAPHIE FUR DIE ARZTLICHE PRAXIS, Prof. Dr. Erich Boden, ed. 7, Darmstadt, 1952, Dr. Dietrich Steinkopff, 287 pages, 246 figures, Price D. M. 26.

The first edition appeared in 1932 and was followed by five more in the short interval of six years thus making this the electrocardiographic textbook with the largest number of editions. The seventh edition has been, for the greater part, rewritten and most of the illustrative material is new.

The book is written for the practitioner, and the material is presented in the form of twenty- one lectures. The author has been active in electrocardiographic research and teaching for forty years, and his great teaching experience is reflected in the simplicity of presentation and the large number of escellent diagrams and illustrations.

The book is divided into two parts: the theoretical and experimental basis (Lectures 1 to 9), and the practical application (Lectures 10 to 21). It is primarily based on German information; there is hardly any reference to the postwar American electrocardiographic literature. For the American reader, the condensed presentation of current German theory and interpretation is of interest.

The electrocardiogram is interpreted on the basis of spatial vectorcardiography but limited mainly to mean vectors. The interpretation on the basis of local patterns (“Unipolar Electro- cardiography”) is rejected, and in this the author is in agreement with an increasing number of American electrocardiographers. Thus, the book has a certain parallel in Grant and Estes’ “Spatial Electrocardiography” but includes also other aspects of electrocardiography. In the analysis of spatial vectors the author refers mainly to Gillmann’s work.

It is consistent with this approach that all electrocardiograms used for illustrations are taken with a three-channel apparatus, and this is also an advantage for the analysis of extrasystoles and other types of arrhythmias. On the other hand. it is surprising that no illustrations of elec- tronically recorded spatial loops are given.

The author’s experiments on the isolated dog’s heart, beating in a bath with Tyrode’s solu- tion, are reported in some detail. This is an excellent preparation for the demonstration of posi- tional effects versus lesions. The importance of the angle between the mean QRS and T vectors, which remains the same in positional changes but may be altered in lesions, is stressed. A nega- tive Ta is considered as normal in left QRS axis shift (the angle between QRS and T being normal), but abnormal in right QRS axis shift (the angle between QRS and T being enlarged).

The important problem of normal standards is not adequately treated, and most of the normal standards given are much too conservative, which will result in false diagnoses of ab- normality in healthy people. It is suggested that “. . . by frequent inspection of ECG’s you will obtain very soon an estimate for the correct amplitude relationships of the various deflections.” This reliance on a subjective estimate, instead of valid standards, invites misinterpretation. It is of interest that a large Qz is, as a rule, considered as a normal peculiarity of the vector, althnugh it is admitted that occasionally it may represent a posterior wall infarct residuum. In this country the opposite tendency prevails.

The section entitled “Practical Application” is presented in the form of individual cases, with a short history and summary of other clinical findings. \Vith this the author exceeds the scope of an electrocardiographic textbook; he discusses clinical aspects of the various lesions including prognosis and the therapy of arrhythmias. There is more to be svid against such extension than for it. The data are too fragmentary to give a proper evaluation of the individual patient, and overemphasize the importance of electrocardiography. In arrhythmias there is no detinite corre- lation between disease and electrocardiogram, and for this reason individual case presentations

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are irrelevant and potentially misleadiug. In infarct, or right or left ventricular hypertrophy, a correlation to autopsy findings would have been more pertinent than the clinical picture which is fairly typical for the cases selected.

In certain points one can disagree with the interpretation, for instance, arborization block (with normal P-R interval) is presented as evidence for bilateral bundle branch block. No differ- entiation between bundle branch block and ventricular conduction defects is made. Septum involvement in myocardial infarct is diagnosed only if the infarcted area is so large that it involves the precordial leads as well as Leads I and III. The discussion of pulmonary infarct is also in- adequate.

It should be kept in mind, however, that the book is written for the practitioner, and, as such, represents a very readable introduction to the fundamentals of electrocardiography. ‘The absence of any bibliography is regrettable, especially for the American reader.

E. s.