12-Lead ECG: The Art of Interpretation

by Garcia, Thomas B.; Holtz, Neil

• ISBN13: 9780763712846
• ISBN10: 0763712841
• Edition: 1st
• Format: Paperback
• Copyright: 2001-01-01
• Publisher: Jones & Bartlett

Summary

Welcome To The comprehensive resource on 12-lead ECG! This all-encompassing 4-color text is designed to make you a fully advanced interpreter of ECGs. Whether you are an EMT, nurse, medical student, or physician wanting to learn or brush up on your knowledge of electrocardiography, this book will meet your needs. 12-Lead ECG: The Art of Interpretation  takes the complex subject of electrocardiography and presents it in a simple, innovative, 3-level approach. Level 1 provides basic information for those with minimal experience interpreting ECGs. Level 2 provides intermediate information for those with a basic understanding of the principles of electrocardiography. Level 3 provides advanced information for those with some mastery of the subject. The entire text is written in a friendly, easy-to-read tone. Full-Size ECGs This text contains real-life full-size ECG strips! ECGs are integrated throughout the text and analyzed in conjunction with the concepts they illustrate.  

Table of Contents

PART 1: THE BASICS	1	(70)
Anatomy	3	(12)
Gross Anatomy	3	(1)
Anterior View	3	(1)
The Heart in Cross Section	4	(1)
The Heart as a Pump	4	(2)
Pump Function Simplified	5	(1)
The Electrical Conduction System	6	(7)
Pacemaker Function	7	(1)
Pacemaker Settings	7	(1)
The Sinoatrial (SA) Node	8	(1)
The Internodal Pathways	8	(1)
The Atrioventricular (AV) Node	9	(1)
The Bundle of His	9	(1)
The Left Bundle Branch (LBB)	10	(1)
The Right Bundle Branch (RBB)	10	(1)
The Left Anterior Fascicle (LAF)	11	(1)
The Left Posterior Fascicle (LPF)	11	(1)
The Purkinje System	12	(1)
Chapter in Review	13	(2)
Electrophysiology	15	(6)
Mechanics of Contraction	15	(1)
Ion Movement and Polarity	16	(2)
Membrane Channels and Action Potential Phases	18	(2)
Chapter in Review	20	(1)
Individual Vectors	21	(8)
Adding and Subtracting Vectors	21	(1)
The Electrical Axis of the Heart	22	(1)
Electrodes and Waves	22	(1)
Leads Are Like Pictures of the Heart	23	(1)
Lead Placement (Where to Put the``Cameras'')	23	(1)
How the Machine Manipulates the Leads	24	(1)
The Two Lead Systems	24	(1)
The Hexaxial System	24	(1)
The Precordial System	25	(1)
The Heart in Three Dimensions	25	(3)
Localizing an Area: Inferior Wall	26	(1)
Localizing Other Areas	27	(1)
Chapter in Review	28	(1)
The Actual ECG: Paper and Ink	29	(4)
Boxes and Sizes	29	(1)
Calibration	30	(1)
Where Is Each Lead Represented?	30	(1)
Temporal Relationship of the ECG	31	(1)
Why Is Temporal Spacing Important?	31	(1)
Chapter in Review	32	(1)
ECG Tools	33	(6)
Calipers: The ECG Interpreter's Best Friend	33	(3)
How to Use Your Calipers	34	(1)
Comparing Wave Heights	34	(1)
Adding Wave Heights	35	(1)
Comparing Widths	36	(1)
Axis-Wheel Ruler	36	(1)
ECG Rulers	36	(1)
Straight Edge	37	(2)
The Basic Beat	39	(10)
Introduction to Basic Components	39	(1)
Wave Nomenclature	39	(1)
Individual Components of the ECG Complex	40	(7)
The P Wave	40	(1)
The Tp Wave	41	(1)
The PR Segment	41	(1)
The PR Interval	42	(1)
The QRS Complex	42	(2)
The ST Segment	44	(1)
The T Wave	44	(2)
The QT Interval	46	(1)
The U Wave	46	(1)
Additional Intervals	47	(1)
Looking Ahead	47	(1)
Chapter in Review	48	(1)
The Rate	49	(4)
Establishing the Rate	49	(3)
Normal and Fast Rates	49	(1)
Bradycardic Rates	50	(2)
Chapter in Review	52	(1)
Rhythms	53	(18)
Major Concepts	53	(2)
General	53	(1)
P Waves	54	(1)
QRS Complexes	54	(1)
Individual Rhythms	55	(15)
Supraventricular Rhythms	55	(8)
Ventricular Rhythms	63	(5)
Heart Blocks	68	(2)
Chapter in Review	70	(1)
PART 2: ECG INTERPRETATION	71	(453)
The P Wave	73	(40)
Overview	73	(3)
ECG Case Study: P Wave Basics	74	(2)
P Wave Morphology	76	(6)
ECG Case Studies: P Wave Morphology	77	(5)
Abnormal P Waves	82	(24)
P-mitrale	82	(1)
ECG Case Studies: P-mitrale	83	(5)
P-pulmonale	88	(1)
ECG Case Studies: P-pulmonale	89	(5)
Intraatrial Conduction Delay (IACD)	94	(1)
ECG Case Studies: Biphasic P Waves	95	(11)
Biatrial Enlargement	106	(6)
ECG Case Studies: Biatrial Enlargement	107	(5)
Chapter in Review	112	(1)
The PR Interval	113	(44)
Conduction Overview	113	(2)
PR Depression	115	(3)
ECG Case Study: PR Interval Depression	116	(2)
Measuring the Interval	118	(2)
Short PR Interval	120	(5)
ECG Case Study: Short PR Interval	121	(1)
Wolff-Parkinson-White Syndrome (WPW)	122	(1)
ECG Case Studies: WPW	123	(2)
WPW Syndrome---Advanced Information	125	(18)
Prolonged PR Interval	143	(13)
ECG Case Studies: Prolonged PR Interval	143	(13)
Chapter in Review	156	(1)
The QRS Complex	157	(66)
How Are the Waves Made?	157	(2)
What to Look for in the QRS Complex	159	(1)
QRS Height (Amplitude)	159	(7)
Abnormal Amplitude	160	(1)
ECG Case Studies: Pericardial Effusion	161	(3)
ECG Case Study: Large QRS Complexes	164	(2)
Left Ventricular Hypertrophy (LVH)	166	(14)
Electrocardiogram Criteria for LVH	166	(1)
Identifying LVH, Step by Step	167	(1)
ECG Case Studies: Left Ventricular Hypertrophy	168	(12)
Right Ventricular Hypertrophy (RVH)	180	(5)
RVH and the ECG	181	(1)
ECG Case Studies: RVH	182	(3)
QRS Duration	185	(6)
ECG Case Studies: QRS Duration	186	(5)
The Wide-QRS Differential, Simplified	191	(1)
QRS Morphology	191	(4)
ECG Case Studies: QRS Morphology	192	(3)
Q Wave Significance	195	(10)
Benign Q Waves	195	(1)
Respiratory Variation of Q Waves	195	(1)
ECG Case Studies: Q Wave Significance	196	(5)
Significant (Pathological) Q Waves	201	(4)
Transition Zone	205	(9)
ECG Case Studies: Transition Zone	208	(6)
QRS Notching	214	(1)
Osborn (J) Waves	214	(8)
ECG Case Studies: QRS Notching and Osborn Waves	215	(7)
Chapter in Review	222	(1)
The Electrical Axis	223	(18)
How to Calculate the Electrical Axis	224	(3)
Isolating the Axis	227	(7)
Find the Quadrant	227	(1)
Isolate the Isoelectric Lead	227	(1)
Isolate the Closest Lead	228	(2)
Isolate the Vector	230	(3)
Double-Check Your Findings	233	(1)
Causes of Axis Deviation	234	(1)
Right Axis Deviation (RAD)	234	(1)
Left Axis Deviation (LAD)	234	(1)
The Z Axis	234	(6)
The Z Axis Precordial Lead System	236	(1)
More Examples: Adding the Z Axis	237	(2)
Z Axis: Other Approaches	239	(1)
Chapter in Review	240	(1)
Bundle Branch Blocks and Hemiblocks	241	(68)
Right Bundle Branch Block	241	(19)
ECG Findings in Right Bundle Branch Blocks	243	(1)
The QR' Wave	244	(1)
ECG Case Studies: Right Bundle Branch Block	244	(16)
Left Bundle Branch Block	260	(17)
Criteria for Diagnosing LBBB	261	(1)
ECG Case Studies: Left Bundle Branch Block	262	(15)
Intraventricular Conduction Delay (IVCD)	277	(1)
Summary Comments on Bundle Branch Blocks	277	(4)
ECG Case Studies: Intraventricular Conduction Delay	278	(3)
Hemiblocks	281	(16)
Left Anterior Hemiblock	282	(2)
ECG Case Studies: Left Anterior Hemiblock	284	(5)
Left Posterior Hemiblock	289	(1)
ECG Case Studies: Left Posterior Hemiblock	290	(7)
Bifascicular Blocks	297	(11)
ECG Case Studies: Bifascicular Block	298	(10)
Chapter in Review	308	(1)
ST Segment and T Waves	309	(94)
Basics	309	(31)
Where Is the J Point?	310	(1)
ST Elevation or Depression	311	(1)
ST Segment Shapes	311	(1)
The T Wave	312	(2)
ECG Case Studies: ST Segments and T Waves	314	(26)
Ischemia and Injury	340	(6)
ECG Case Studies: Ischemia and Injury	341	(5)
Strain Pattern	346	(44)
Right Ventricular Strain Pattern	346	(1)
ECG Case Studies: Right Ventricular Strain Pattern	347	(4)
Left Ventricular Strain Pattern	351	(2)
ECG Case Studies: Left Ventricular Strain Pattern	353	(9)
ECG Comparisons: Benign Changes Versus Infarct	362	(28)
Pericarditis Revisited	390	(7)
ECG Case Studies: Pericarditis	391	(6)
STs and T Waves in Blocks	397	(5)
ECG Case Studies: STs and Ts in Blocks	398	(4)
Chapter in Review	402	(1)
Acute Myocardial Infarction	403	(76)
Introduction	403	(2)
Zones of Ischemia, Injury, and Infarction	405	(1)
Infarct and Q Waves	406	(2)
Q Wave Infarct	406	(1)
Non-Q Wave Infarct	407	(1)
ECG Progression in Infarct	408	(1)
Reciprocal Changes	409	(1)
Infarct Regions on the ECG	410	(67)
Infarct Regions in Combination	411	(3)
ECG Case Studies: Anteroseptal AMI	414	(5)
ECG Case Studies: Anteroseptal AMI with Lateral Extension	419	(12)
ECG Case Studies: Lateral Wall AMI	431	(3)
ECG Case Studies: Inferior Wall AMI	434	(4)
ECG Case Studies: Inferolateral AMI	438	(8)
ECG Case Studies: Apical AMI	446	(9)
ECG Case Studies: Right Ventricular Infarction	455	(7)
ECG Case Studies: Posterior Wall AMI	462	(3)
ECG Case Studies: Inferoposterior AMI	465	(5)
ECG Case Studies: Inferior-RV-Posterior AMI	470	(7)
Chapter in Review	477	(2)
Electrolyte and Drug Effects	479	(34)
Hyperkalemia and Its Effects	479	(21)
The Spectrum of Hyperkalemia	480	(1)
T Wave Abnormalities in Hyperkalemia	480	(2)
ECG Case Studies: T Wave Changes in Hyperkalemia	482	(7)
IVCD and Hyperkalemia	489	(1)
P Waves and Hyperkalemia	489	(1)
ECG Case Studies: IVCD and P Waves in Hyperkalemia	490	(10)
Other Electrolyte Abnormalities	500	(7)
Hypokalemia	500	(1)
Hypercalcemia	500	(1)
Hypocalcemia	500	(1)
ECG Case Studies: Other Electrolyte Abnormalities	501	(6)
Drug Effects	507	(5)
Digoxin	507	(1)
ECG Case Studies: Drug Effects	508	(4)
Chapter in Review	512	(1)
Putting It All Together	513	(11)
New Ground	513	(1)
The 10 Questions of the Gram	513	(10)
What Is My General Impression?	514	(1)
Is There Anything That Sticks Out?	515	(1)
What Is the Rate?	515	(1)
What Are the Intervals?	516	(1)
What Is the Rhythm?	517	(3)
What Is the Axis?	520	(1)
Is There Any Hypertrophy?	521	(1)
Is There Any Ischemia or Infarction?	521	(1)
What Is the Differential Diagnosis of the Abnormality?	522	(1)
How Can I Put It All Together with the Patient?	523	(1)
The Big Picture	523	(1)
Acronyms	524	(1)
Additional Readings	525	(1)
Glossary	526	(5)
Index	531