Edited by J. Willis Hurst and Douglas C. Morris. Armonk, New York: Future Publishing Company, Inc., 2001; 528 pp., 136 figures, 25 tables. ISBN: 0-87993-482-4.

Chest pain is one of the symptoms that frequently motivate a visit to the physician. Its importance lies not only in its high prevalence, but also in its potentially serious clinical connotations, particularly in pain of coronary origin. However, patients complaining of this type of pain often are released with a vague diagnosis, such as non-coronary precordial pain, or atypical precordial pain, which are absolutely non-specific. To compound matters, often no attempt is made to ascertain the true origin of the symptom.

This book attempts to make a systematic clinical analysis of different types from chest pain in 52 chapters. The title appears in quotation marks because of the number of sites covered by the designation. Rather than addressing only precordial pain, it examines most or all possible sources of pain «from the waist up.» The arrow is another element of the title that has a specific meaning.

It is worth taking the time to appreciate the clinical sense that guides this book. First and foremost, it addresses the specific and differential characteristics of each type of pain: location, extension, duration, precipitating causes, nature of resolution, and others. It also describes the most appropriate diagnostic tools for reaching a positive and differential diagnosis in each case, and only at the conclusion of each chapter does it offer a pathophysiological commentary and a brief review of fundamental aspects of therapy.

It is a book worthy of recommendation to the clinical cardiologist. It also is undoubtedly useful for family practitioners, internists, and academics, who will find useful information in this book for preparing courses or programs based on resolving problems. Residents not only will find a large amount of practical information in this work, but also obtain a clinical sense of the diagnostic process that should rule all medical actions, before quickly reaching for instrumental diagnostic methods, as we so often do.

The figures show only schemes of the anterior or posterior face of the thorax and the sites of each type of pain described. Willis Hurst is a well-known and accredited professor emeritus at the University of Emory in Atlanta, author of one of the classic cardiology texts usually found in our libraries. He has directed this work in collaboration with another professor of the same university, Douglas C. Morris, and the contributions of another 28 authors. I believe that it is a highly recommendable reference, and not overly expensive.