ECG from Basics to Essentials (eBook)

Step by Step

Roland X. Stroobandt, S. Serge Barold, Alfons F. Sinnaeve (Autoren)

eBook Download: PDF

2015
John Wiley & Sons (Verlag)
9781119066439 (ISBN)

Infos

This brand new guide assists students, interns and residents in developing a functional understanding of the set-up, workings and interpretation of ECGs

• Step-by-step graphics and short, bite-sized explanations
• Covers all major cardiac abnormalities including hypertrophy, arrhythmias, conduction blocks, and pre-excitation syndromes
• Begins with a section on physiology of the heart and the basic set up of ECG recording
• Features top tips on what to look for, complete with illustrated examples
• Supported by a companion website featuring additional practice tracings

Roland X. Stroobandt MD, PhD, FHRS
Professor of Medicine
Ghent University Hospital
Ghent, Belgium

S. Serge Barold, MD, FRACP, FACP, FACC, FESC, FHRS
The Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

Alfons F. Sinnaeve ing., MSc
Professor Emeritus of Electronic Engineering
Technical University KUL-Vives, Department of Electronics
Oostende, Belgium

Inhalt

Cover 1
Title Page 5
Copyright 6
Contents 7
Preface 8
About the companion website 9
Chapter 1 ANATOMY AND BASIC PHYSIOLOGY 11
WHAT IS AN ECG? 12
BLOOD CIRCULATION – THE HEART IN ACTION 14
THE CONDUCTION SYSTEM OF THE HEART 16
ABOUT CARDIAC CELLS 18
DEPOLARIZATION OF A MYOCARDIAL FIBER 24
DISTRIBUTION OF CURRENT IN MYOCARDIUM AND RAPID SPREAD OF ELECTRICAL ACTIVITY 24
RECORDING A VOLTAGE BY EXTERNAL ELECTRODES 26
THE RESULTANT HEART VECTORDURING VENTRICULAR DEPOLARIZATION 28
Further Reading 30
Chapter 2 ECG RECORDING AND ECG LEADS 31
THE ECG MACHINE OR ELECTROCARDIOGRAPH 32
THE ECG GRID 34
TIME INTERVAL VS RATE 36
REGISTRATION OF AN ECG 40
STANDARD LEADS ACCORDING TO EINTHOVEN 42
WILSON CENTRAL TERMINAL 44
AUGMENTED LIMB LEADS ACCORDING TO GOLDBERGER 46
THE PRECORDIAL LEADS AFTER WILSON 48
HOW TO LOCATE THE 4TH RIGHT AND LEFT INTERCOSTAL SPACES 50
THE 12 LEADS PUT TOGETHER 52
UNDERSTANDING THE HEXAXIAL DIAGRAM AND ITS IMPORTANCE 56
COMMON ERRORS IN RECORDING THE ECG FROM PRECORDIAL LEADS 58
LEAD REVERSALS IN FRONTAL PLANE 60
Further Reading 62
Chapter 3 THE NORMAL ECG AND THE FRONTAL PLANE QRS AXIS 63
THE ORIGIN OF THE ECG 64
NEUTRAL PLANE AND HEMISPHERE CONCEPT 66
THE ORIGIN OF THE ECG 68
NORMAL QRS COMPLEX IN THE FRONTAL PLANE 70
SUMMARY OF THE FRONTAL PLANE FOR A NORMAL HEART 71
SUMMARY OF THE PRECORDIAL PLANE FOR A NORMAL HEART 72
ROTATION OF THE HEART 74
MEAN FRONTAL PLANE ELECTRICAL QRS AXIS 76
DETERMINATION OF THE MEAN QRS AXIS IN THE FRONTAL PLANE 77
Further Reading 82
Chapter 4 THE COMPONENTS OF THE ECG WAVES AND INTERVALS 83
WHAT CAN BE SEEN ON THE NORMAL ECG 84
ABOUT INTERVALS AND SEGMENTS 86
THE QT INTERVAL 88
THE U WAVE 88
T-WAVE POLARITY AND MORPHOLOGY 90
THE QRS COMPLEX: Designation of special cases 92
Further Reading 94
Chapter 5 P WAVES AND ATRIAL ABNORMALITIES 95
TOPOGRAPHICAL ANATOMY OF THE HEART 96
THE NORMAL P WVE 1: THE FRONTAL PLANE 98
THE NORMAL P WAVE 2 THE HORIZONTAL PLANE 100
LEFT ATRIAL ABNORMALITY 102
RIGHT ATRIAL ABNORMALITY 104
BIATRIAL ABNORMALITY 106
INTERATRIAL CONDUCTION DELAY 106
Further Reading 108
Chapter 6 CHAMBER ENLARGEMENT AND HYPERTROPHY 109
LEFT VENTRICULAR HYPERTROPHY 110
RIGHT VENTRICULAR HYPERTROPHY 112
Further Reading 114
Chapter 7 INTRAVENTRICULAR CONDUCTION DEFECTS 115
RIGHT BUNDLE BRANCH BLOCK 116
LEFT BUNDLE BRANCH BLOCK 118
LBBB versus RBBB 121
LEFT ANTERIOR HEMIBLOCK 122
LEFT POSTERIOR HEMIBLOCK 124
LAH versus LPH 126
INCOMPLETE RIGHT BUNDLE BRANCH BLOCK 128
LEFT HEMIBLOCK AND RIGHT BUNDLE BRANCH BLOCK 129
RATE-DEPENDENT LEFT BUNDLE BRANCH BLOCK 130
PHASE 3 AND PHASE 4 BLOCKS 131
Further Reading 132
Chapter 8 CORONARY ARTERY DISEASE AND ACUTE CORONARY SYNDROMES 133
ELECTROPHYSIOLOGIC CONCEPTS OF ISCHEMIA 134
T WAVE CHANGES DURING ISCHEMIA 138
CORONARY ARTERY DISEASE AND ACUTE CORONARY SYNDROMES 142
CORONARY ARTERY DISEASE 142
PATHOPHYSIOLOGY of ACUTE CORONARY SYNDROMES 144
COMMON CAUSES OF MYOCARDIAL INFARCTION 145
OLD TERMINOLOGY OF MI 145
MANIFESTATIONS OF ACUTE ST ELEVATION MI 146
RECIPROCAL CHANGES IN ST ELEVATION MI 148
ST ELEVATION MI VS EARLY REPOLARIZATION 149
Q WAVES IN ST ELEVATION MI 150
Conditions that mimic MI either by simulating pathologic Q waves or QS complexes or mimicking the typical ST-T changes of acute MI 152
T waves in ST elevation MI 153
Right-sided leads and right ventricular infarction 153
NON-STEMI AND UNSTABLE ANGINA 154
ST SEGMENT DEPRESSION 154
OTHER FEATURES OF MYOCARDIAL INFARCTION 157
Poor R wave Progression 157
Persistent ST elevation 158
Reperfusion 158
Takotsubo cardiomyopathy 159
LOCALIZATION OF STEMI 160
Myocardial infarction and right bundle branch block 168
Myocardial infarction during left bundle branch block 168
Diagnosis of MI during right ventricular pacing 170
Diagnosis of coronary artery disease: Exercise testing 171
Arrhythmias in acute myocardial infarction 172
Further Reading 196
Chapter 9 ACUTE PERICARDITIS 197
Clinical stages 198
DIFFERENTIAL DIAGNOSIS 199
Early repolarization 200
Further Reading 202
Chapter 10 THE ECG IN EXTRACARDIAC DISEASE 203
PULMONARY DISEASES and COR PULMONALE 204
Right atrial enlargement 204
Chronic obstructive pulmonary disease 204
Pulmonary embolism 205
HYPOTHERMIA 206
DISEASES OF THE CENTRAL NERVOUS SYSTEM 208
ACUTE PANCREATITIS 209
HYPOTHYROIDISM 209
HYPERTHYROIDISM 209
ELECTROCARDIOGRAPHY IN ATHLETES 210
Increased QRS voltage 210
Incomplete right bundle branch block 210
Early repolarization 210
Manifestation of increased vagal tone 211
Axis 211
T wave inversion 211
ST depression 211
Further Reading 212
Chapter 11 SINUS NODE DYSFUNCTION 213
SINUS RHYTHMS 214
SINOATRIAL BLOCKS 216
Sinoatrial Wenckebach 219
Sinoatrial 2:1 block 219
WANDERING ATRIAL PACEMAKER 220
AV JUNCTIONAL RHYTHM 222
Further Reading 226
Chapter 12 PREMATURE VENTRICULAR COMPLEXES (PVC) 227
Unifocal PVC with fully compensatory pause 228
Multifocal PVCs 228
PVC causing a retrograde P wave and noncompensatory pause 229
Interpolated PVC and PR prolongation 229
The Coupling Interval 230
End-diastolic PVC 230
PVCs and the “R on T” Phenomenon 231
Paired PVCs 231
PVC Configuration and Morphology 232
Parasystole 233
ACCELERATED IDIOVENTRICULAR RHYTHM 235
Further Reading 236
Chapter 13 ATRIOVENTRICULAR BLOCK 237
NORMAL CONDUCTION 238
1st degree AV BLOCK 238
2nd degree AV BLOCK type I (Wenckebach or Mobitz 1) 238
Left Unifascicular Block or Hemiblock 244
OVERVIEW OF 2ND-DEGREE AV BLOCK 246
ECG Pitfalls in the Diagnosis of 2nd-Degree AV Block 251
Further Reading 252
Chapter 14 ATRIAL RHYTHM DISORDERS 253
ATRIAL FLUTTER 254
Reentry 254
ECG of the typical AFL 255
Diagnosis 256
Ventricular rate 258
Atypical Atrial Flutter 259
ATRIAL FIBRILLATION 262
Classification scheme for patients with atrial fibrillation 262
Lone atrial fibrillation 263
Electrocardiogram 263
Regular ventricular rate 264
Long-Short Rule – Ashman phenomenon 265
Pathophysiology 265
Principles of therapy 265
CAROTID SINUS MASSAGE 266
SICK SINUS SYNDROME 268
SUPRAVENTRICULAR TACHYARRHYTHMIAS 270
TACHYCARDIAS RELATED TO THE SINOATRIAL NODE 270
ATRIAL TACHYCARDIAS 271
ATRIAL TACHYCARDIA WITH AV BLOCK 275
ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA 278
ATRIOVENTRICULAR REENTRANT TACHYCARDIA 282
Manifestations of orthodromic AV reentrant tachycardia 284
Permanent junctional reciprocating tachycardia (PJRT) 286
Focal junctional tachycardia 287
Nonparoxysmal junctional tachycardia 287
Overview of supraventricular tachycardia 287
Further Reading 288
Chapter 15 VENTRICULAR TACHYCARDIAS 289
VENTRICULAR TACHYCARDIA 290
Electrocardiography of monomorphic ventricular tachycardia 291
Brugada algorithm for the diagnosis of wide complex tachycardias 294
THE BRUGADA SYNDROME 302
Catecholaminergic Polymorphic Ventricular Tachycardia 304
Idiopathic Ventricular Tachycardia 304
Arrhythmogenic right ventricular dysplasia 306
Bundle Branch Reentry 307
Long QT syndrome 308
Torsades de pointes 310
Short QT syndrome 312
Polymorphic ventricular tachycardia and cardiac ischemia 313
Short-coupled variant of Torsades de Pointes 313
Further Reading 314
Chapter 16 VENTRICULAR FIBRILLATION AND VENTRICULAR FLUTTER 315
VENTRICULAR FIBRILLATION 316
VENTRICULAR FLUTTER 316
Termination of ventricular fibrillation by a shock from an implanted defibrillator 319
Further Reading 320
Chapter 17 PREEXCITATION AND WOLFF-PARKINSON-WHITE SYNDROME (WPW) 321
MECHANISM 322
ECG MANIFESTATIONS 322
ASSOCIATED FINDINGS 325
DEGREE OF PREEXCITATION 325
LOCATION OF ACCESSORY PATHWAYS 325
ARRHYTHMIAS 329
PREEXCITATION VARIANTS 334
ATRIOFASCICULAR BYPASS 334
ATRIOHISIAN BYPASS 334
FASCICULOVENTRICULAR BYPASS 335
Further Reading 336
Chapter 18 ELECTROLYTE ABNORMALITIES 337
HYPERKALEMIA 338
HYPOKALEMIA 340
HYPOMAGNESEMIA 341
HYPERMAGNESEMIA 341
HYPOCALCEMIA 341
HYPERCALCEMIA 341
Further Reading 342
Chapter 19 ELECTROPHYSIOLOGIC CONCEPTS 343
ABERRANT CONDUCTION 344
Ashman phenomenon 344
Phase 3 Aberrancy 346
Bradycardia-dependent aberration 347
Retrograde invasion of bundle branch 347
CONCEALED CONDUCTION 348
Ventricular premature beats 348
Atrial fibrillation and flutter 349
Concealed extrasystoles 349
VENTRICULAR FUSION 350
OVERDRIVE SUPPRESSION 351
R on T PHENOMENON 351
ATRIOVENTRICULAR DISSOCIATION 352
CARDIAC MEMORY 354
PARASYSTOLE 356
ELECTRICAL ALTERNANS 358
Further Reading 360
Chapter 20 ANTIARRHYTHMIC DRUGS 361
The action potential 362
Vaughan-Williams Classification of Antiarrhythmic Drugs 362
Proarrhythmia 365
Prolongation of the QT interval and torsades de pointes 365
OVERVIEW OF ANTIARRHYTHMIC DRUGS 366
DIGITALIS TOXICITY 367
Further Reading 368
Chapter 21 PACEMAKERS AND THEIR ECGs 369
Introduction 370
Rate or interval? 370
Pacing nomenclature 370
VOO pacing 371
VVI pacing 371
Interval terminology of a VVI pacemaker 372
Sensing 373
AAI pacing 374
DDD pacing 375
What are refractory periods? 377
Upper rate response of DDD pacemakers 381
Pacemaker-mediated tachycardia 383
Repetitive nonreentrant ventriculoatrial synchrony 385
Tachycardias during DDD(R) pacing 387
Automatic mode switching 387
Rate-adaptive pacemakers 389
Patterns of depolarization during ventricular pacing 389
Cardiac resynchronization with biventricular pacing 392
Evaluation of atrial capture and sensing in dual chamber pacemakers 393
Electrical complications during ventricular pacing 395
Myopotential interference 395
Hyperkalemia 397
Algorithms to minimize right ventricular pacing 397
Further Reading 400
Chapter 22 ERRORS IN ELECTROCARDIOGRAPHY MONITORING, COMPUTERIZED ECG, OTHER SITES OF ECG RECORDING 401
ERRORS IN ELECTROCARDIOGRAPHY 402
Inaccurate Lead Placement 402
Superimposition of Standard ECG Leads with Telemetry Leads 403
Technically Unacceptable ECG Recordings 403
Baseline wander 404
Wrong speed 404
ELECTROCARDIOGRAPHIC MONITORING 406
ELECTRODE POSITIONING ON THE TORSO 406
BIPOLAR LEADS 406
COMMON 5-ELECTRODE SYSTEM: LIMB LEADS plus 1 PRECORDIAL LEAD COMBINATION 407
REDUCED LEAD ECG 407
COMPUTERIZED ELECTROCARDIOGRAPHY 408
Strengths of computerized ECG analysis 408
Clinical value and limitations 409
OTHER SITES OF ECG RECORDING 410
Lewis lead 410
Esophageal recordings 410
His bundle recordings 412
Further Reading 415
Chapter 23 HOW TO READ AN ECG 417
Further Reading 434
Index 435
EULA 442

Produkt-Details

• Erscheint lt. Verlag: 13.11.2015
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Kardiologie / Angiologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Radiologie / Bildgebende Verfahren
• Schlagworte: Alfons F. Sinnaeve • Arrhythmias • Cardiac Disorders • Cardiac Pacemakers and Resynchronisation: Step by Step • Cardiology • Cardiovascular Disease • Conduction blocks • ECGs from Basics to Essentials Step by Step • EKG • Electrical activity • ELECTROCARDIOGRAPH • electrophysiology • Elektrophysiologie • Hypertrophy • Implantable Cardioverter Defibrillators Step by Step • Kardiovaskuläre Erkrankungen • Kardiovaskuläre Erkrankungen • medical education • Medical Science • Medizin • Medizinstudium • Normal electrical pattern • Physiology • Pre-excitation syndromes • Roland X. Stroobandt • S. Serge Barold • Tracing interpretation
• ISBN-13: 9781119066439 / 9781119066439