Mastering the cognitive knowledge within a field such as cardiology is a formidable task. It is even more difficult to draw on that knowledge, procure and filter through the clinical and laboratory data, develop a differential diagnosis, and, finally, to make a rational treatment plan. To gain these skills, the student learns best at the bedside, guided and instructed by experienced teachers, and inspired toward selfdirected, diligent reading. Clearly, there is no replacement for education at the bedside. Unfortunately, clinical situations rarely encompass the breadth of the specialty. Perhaps the best alternative is a carefully crafted patient case designed to stimulate the clinical approach and the decision-making process. In an attempt to achieve that goal, we have constructed a collection of clinical vignettes to teach diagnostic or therapeutic approaches relevant to cardiology. In this age of technology and high-definition imaging, we would like to reinforce the importance of the history and physical examination. We urge that students diligently read through this area in Section I of the book, and practice their skills. We likewise urge our peer colleagues to spend time demonstrating to students and trainees how to properly perform the physical exam maneuvers.
We hope that our cases will stimulate excitement for the clinical care of patients. Most importantly, the explanations for the cases emphasize the mechanisms and underlying principles, rather than merely rote questions and answers. This book is organized for versatility: it allows the student “in a rush” to go quickly through the scenarios and check the corresponding answers, and it allows the student who wants thought-provoking explanations to obtain them. The answers are arranged from simple to complex: the bare answers, an analysis of the case, an approach to the pertinent topic, a comprehension test at the end, clinical pearls for emphasis, and a list of literature sources for further reading. The clinical vignettes are purposely placed in random order to simulate the way that real patients present to the practitioner. A listing of cases is included in Section III to aid the student who desires to test his/her knowledge of a certain area, or to review a topic, including basic definitions. Finally, we intentionally did not use a multiple-choice question format in the case scenarios, because clues (or distractions) are not available in the real world.