Interpreting ECGs: A Practical Approach

 

Description:

Interpreting ECGs: A Practical Approach Third Edition uses an easy-to-understand how-to approach to develop solid ECG analysis and recognition skills. Learn how to measure waveforms segments and interval durations to determining heart rates and types of irregularity.

 

Table of Contents:

 

Features to Help You Study and Learn

Section 1: Preparatory

Chapter 1 Anatomy and Electrophysiology of the Heart

The Electrocardiogram

How It Works

The Circulatory System

Anatomy of the Heart

Shape and Position of the Heart

The Pericardial Sac

The Heart Wall

The Internal Heart

Cells of the Heart

Myocytes

Pacemaker and Electrical Conducting Cells

The Heart’s Conductive Pathway

SA Node

AV Node

Bundle of His and Right and Left Bundle Branches

Purkinje Fibers

The Heart’s Blood Supply

Right Coronary Artery

Left Main Coronary Artery

Coronary Veins

Physiology of the Heart and Circulation

The Cardiac Cycle

Cardiac Output

Blood Pressure

Blood Flow through the Atria

Initiation of Impulse in the SA Node

Atrial Depolarization and Contraction

Conduction through the AV Node

Conduction through the His-Purkinje System

Ventricular Depolarization and Contraction

Atrial and Ventricular Repolarization

Alternate Pacemaker Sites

Influences on the Heart and Circulatory System

The Autonomic Nervous System

Sympathetic Nervous System

Parasympathetic Nervous System

Increased Myocardial Oxygen Needs

Nerve Impulse Generation and Muscle Contraction

Polarized State

Depolarization

Repolarization

Refractory Periods

Impulse Generation of the SA Node

Depolarization and Repolarization of the Myocytes

Chapter 2 The Electrocardiogram

The Electrocardiogram and ECG Machines

ECG Lead Wires and Electrodes

Lead Wires

Electrodes

Heart’s Normal Electrical Activity

ECG Leads

Bipolar/Unipolar Leads

Planes of the Heart and Lead Placement

Frontal Plane

Horizontal Plane

Putting the Views Together

15- and 18-Lead ECGs

Displays and Printouts

Reading Printouts

Section 2: The Nine-Step Process

Chapter 3 Analyzing the Electrocardiogram

Characteristics of the Normal ECG

Analyzing the Electrocardiogram Using the Nine-Step Process

Step 1: Heart Rate

Step 2: Regularity

Step 3: P Waves

Step 4: QRS Complexes

Step 5: PR Intervals

Step 6: ST Segments

Step 7: T Waves

Step 8: QT Intervals

Step 9: U Waves

Flexibility in the Nine-Step Process

Dysrhythmia and Cardiac Condition Characteristics

Analyzing the ECG

Analyzing the Rhythm Strip

Analyzing the 12-Lead Tracing

Calibrating the ECG

Artifact

Chapter 4 Heart Rate

Importance of Determining the Heart Rate

Quick Check of the Heart Rate

Heart Rates Seen with Various Dysrhythmias

Methods of Determining Heart Rate

6-Second Interval × 10 Method

300, 150, 100, 75, 60, 50 Method

1500 Method

Rate Calculators

Counting Both the Atrial and Ventricular Rates

Normal, Slow, and Fast Rates

Slow Rates—Bradycardia

Fast Rates—Tachycardia

Stable or Unstable, Narrow or Wide

Chapter 5 Regularity

Importance of Determining Regularity

Quick Check of Regularity

Methods of Determining Regularity

Paper and Pen Method

Caliper Method

Counting the Small Squares Method

Using a Rate Calculator

Types of Irregularity

Occasionally or Very Irregular

Slightly Irregular

Irregularity Caused by Sudden Changes in the Heart Rate

Irregularly (Totally) Irregular

Patterned Irregularity

Irregularity Caused by Varying Conduction Ratios

Chapter 6 P Waves

Importance of Determining the P Waves

Examining the P Waves

Normal P Waves

Identifying and Characterizing Abnormal P Waves

Peaked, Notched, or Enlarged Sinus P Waves

Atrial P Waves

Varying Atrial P Waves

Flutter and Fibrillatory Waves

Inverted and Absent P Waves

More P Waves than QRS Complexes

Chapter 7 QRS Complexes

Importance of Examining the QRS Complexes

Examining the QRS Complexes

Measuring QRS Complexes

Variations in the QRS Configuration

QRS Complexes in Different Leads

Where We See Normal QRS Complexes

Abnormal QRS Complexes

Tall and Low-Amplitude QRS Complexes

Wide QRS Complexes of Supraventricular Origin

Wide, Bizarre-Looking QRS Complexes of Ventricular Origin

Absent QRS Complexes

Chapter 8 PR Intervals

Importance of Determining the PR Intervals

Characteristics of Normal PR Intervals

Measuring the PR Intervals

PR Intervals That Are Different

Shorter PR Intervals

Longer PR Intervals

Varying PR Intervals

Absent or Not Measurable PR Intervals

Constant PR Intervals Seen with More P Waves

Chapter 9 ST Segments, T Waves, QT Intervals, and U Waves

Analyzing the Specific Waveforms, Segments, and Intervals

Normal and Abnormal ST Segments

Normal Characteristics

Measuring the ST Segments

Abnormal ST Segments

Normal and Abnormal T Waves

Normal Characteristics

Measuring the T Waves

Abnormal T Waves

Normal and Abnormal QT Intervals

Normal Characteristics

Measuring the QT Interval

Abnormal QT Intervals

Normal and Abnormal U Waves

Normal Characteristics

Abnormal U Waves

Section 2 Practice Makes Perfect

Chapter 10 Heart Disease

Defining Heart Disease

Risk Factors of Heart Disease

Age, Gender, and Family History

Smoking and Alcohol Intake

Poor Diet, Obesity, and Physical Inactivity

High Blood Pressure

High Blood Cholesterol Levels

Diabetes

Stress and “Type A” Personalities

Poor Hygiene

Complications of Heart Disease

Dysrhythmias

Angina

Myocardial Infarction

Dilation and Hypertrophy

Heart Failure

Cardiogenic Shock

Stroke

Aneurysm

Peripheral Artery Disease

Pulmonary Embolism

Sudden Cardiac Arrest

Types of Heart Disease

Coronary Artery Disease

Myocardial Ischemia

Myocardial Injury

Myocardial Infarction

Cardiomyopathy

Arrhythmogenic Right Ventricular Dysplasia

Heart Infection

Rheumatic Fever

Valvular Heart Disease

Congenital Heart Defects

Section 3: Origin and Clinical Aspects of Dysrhythmias

Chapter 11 Overview of Dysrhythmias

The Heart’s Normal Electrical Activity

Dysrhythmias

The Effects of Dysrhythmias

Types of Dysrhythmias

Bradycardia

Tachycardia

Early (Premature) Beats

Dropped Beats or QRS Complexes

Irregularity

Causes and Mechanisms of Dysrhythmias

Increased Parasympathetic Tone

Myocardial Hypoxia, Injury, and Infarction

Increased Automaticity

Reentry

Triggered Beats

Proarrhythmia

Site of Origin

Sinus Dysrhythmias

Atrial Dysrhythmias

Junctional Dysrhythmias

Ventricular Dysrhythmias

AV Heart Block

Identifying Dysrhythmias

Patient Assessment

Primary Assessment (ABCDEs)

Secondary Assessment

Ongoing Assessment

Treatment of Dysrhythmias

Physical Maneuvers

Electrical Therapy

Medications

Chapter 12 Sinus Dysrhythmias

Rhythms Originating from the Sinus Node

ECG Appearance of Sinus Rhythms

Normal Sinus Rhythm

Sinus Bradycardia

Description

Causes

Effects

ECG Appearance

Treatment

Sinus Tachycardia

Description

Causes

Effects

ECG Appearance

Treatment

Sinus Dysrhythmia

Description

Causes

ECG Appearance

Treatment

Sinus Arrest

Description

Causes

Effects

ECG Appearance

Treatment

Sinoatrial Exit Block

Description

Causes

Effects

ECG Appearance

Treatment

Sick Sinus Syndrome

Description

Causes

Effects

ECG Appearance

Treatment

Sinus Rhythm as the Underlying Rhythm

Practice Makes Perfect

Chapter 13 Atrial Dysrhythmias

Rhythms Originating in the Atria

Key Features of Atrial Dysrhythmias

P Wave Appearance

QRS Complex Appearance

Effects of Atrial Dysrhythmias

Premature Atrial Complexes

Description

Causes

Effects

ECG Appearance

Differentiating Blocked PACs from Sinus Arrest

Treatment

Wandering Atrial Pacemaker

Description

Causes

Effects

ECG Appearance

Treatment

Atrial Tachycardia

Description

Causes

Effects

ECG Appearance

Treatment

Multifocal Atrial Tachycardia

Description

Causes

Effects

ECG Appearance

Treatment

Supraventricular Tachycardia

Atrial Flutter

Description

Causes

Effects

ECG Appearance

Treatment

Atrial Fibrillation

Description

Causes

Effects

ECG Appearance

Treatment

Practice Makes Perfect

Chapter 14 Junctional Dysrhythmias

Dysrhythmias Originating in the Atrioventricular Junction

Key Features of Junctional Dysrhythmias

P Wave Appearance

PR Interval

QRS Complex Appearance

Effects

Premature Junctional Complex

Description

Causes

Effects

ECG Appearance

Treatment

Junctional Escape Rhythm

Description

Causes

Effects

ECG Appearance

Treatment

Accelerated Junctional Rhythm

Description

Causes

Effects

ECG Appearance

Treatment

Junctional Tachycardia

Description

Causes

Effects

ECG Appearance

Atrioventricular Nodal Reentrant Tachycardia

Description

ECG Appearance

Effects

Preexcitation

Wolff-Parkinson-White Syndrome

Lown-Ganong-Levine Syndrome

Atrioventricular Reentrant Tachycardia

Description

Appearance

Effects

Treatment of Supraventricular Tachycardia

Practice Makes Perfect

Chapter 15 Ventricular Dysrhythmias

Dysrhythmias Originating in the Ventricles

Key Features of Ventricular Dysrhythmias

P Wave Appearance

QRS Complex Appearance

Effects

Premature Ventricular Complexes

Description

Causes

Effects

ECG Appearance

Treatment

Ventricular Escape Beats

Description

Causes

Effects

ECG Appearance

Treatment

Idioventricular Rhythm

Description

Causes

Effects

ECG Appearance

Treatment

Accelerated Idioventricular Rhythm

Description

Causes

Effects

ECG Appearance

Treatment

Ventricular Tachycardia

Description

Causes

Effects

ECG Appearance

Treatment

Polymorphic Ventricular Tachycardia

Description

Causes

Effects

ECG Appearance

Treatment

Ventricular Fibrillation

Description

Causes

Effects

ECG Appearance

Treatment

Asystole

Description

Causes

Effects

ECG Appearance

Treatment

Pulseless Electrical Activity

Description

Causes

Effects

ECG Appearance

Treatment

Practice Makes Perfect

Chapter 16 AV Heart Blocks

Block of the Atrioventricular Node

1st-Degree Atrioventricular Heart Block

Description

Causes

Effects

ECG Appearance

Treatment

2nd-Degree Atrioventricular Heart Block, Type I

Description

Causes

Effects

ECG Appearance

Treatment

2nd-Degree Atrioventricular Heart Block, Type II

Description

Causes

Effects

ECG Appearance

Treatment

3rd-Degree Atrioventricular Heart Block

Description

Causes

Effects

ECG Appearance

Treatment

Atrioventricular Dissociation

Description

Causes

Effects

ECG Appearance

Treatment

Practice Makes Perfect

Chapter 17 Pacemakers and Implanted Cardioverter-Defibrillators

Pacemakers and Implantable Defibrillators

Temporary Pacemakers

Epicardial Pacing

Transvenous Pacing

Permanent Pacemakers

Uses

Permanent Pacemaker Components

Generator

Lead Wire(s)

Function of Permanent Pacemakers

Pacing Modes

Output

Sensitivity

Refractory Period

Rate Adaptation

Coding System

Cardiac Resynchronization Therapy

Appearance of the Paced ECG

Unipolar vs. Bipolar Systems

Pacemaker Failure and Complications

Failure to Capture

Failure to Pace

Failure to Sense

Oversensing

Pacemaker-Mediated Tachycardia

Complications of Pacemakers

Implantable Cardioverter-Defibrillators

Pulse Generator

Electrode Wires

Recognition of Ventricular Dysrhythmias

Therapies Provided by the ICD

Provider Safety

Practice Makes Perfect

Section 4: 12-Lead ECGs

Chapter 18 Overview of 12-Lead ECGs and Electrical Axis

The 12-Lead ECG

Views

Limb Leads

Leads I, II, and III

Leads aVR, aVL, and aVF

Precordial Leads

Leads V1, V2, V3

Leads V4, V5, V6

ECG Views of the Heart

Contiguous Leads

Analyzing the 12-Lead ECG

Electrical Axis and the ECG

Vectors

Mean Instantaneous Vector

Waveform Direction

Ventricular Depolarization and Mean QRS Axis

Determining the Electrical Axis

Hexaxial Reference System

Altered QRS Axis

Causes of Altered Electrical Axis

Practice Makes Perfect

Chapter 19 Myocardial Ischemia, Injury, and Infarction

Coronary Circulation

Right Coronary Artery (RCA)

Left Coronary Artery (LCA)

The ECG Waveforms

Q Waves

Normal ST Segments

Normal T Waves

ECG Indicators of Ischemia, Injury, and Infarction

T Wave Changes

ST Segment Changes

STEMI and NSTEMI

Q Wave Changes

Left Bundle Branch Block

Reciprocal Changes

ECG Evolution during Myocardial Infarction

MI—Age Indeterminate

Criteria for Diagnosing Myocardial Infarction

Clinical History

Serum Cardiac Markers

ECG Findings

Identifying the Myocardial Infarction Location

Septal Wall Infarction

Anterior Wall Infarction

Lateral Wall Infarction

Anterolateral Wall Infarction

Extensive Anterior Wall Infarction

Inferior Infarction

Posterior Wall Infarction

Right Ventricular Infarction

Treatment of Myocardial Infarction

Right Ventricular Infarction Treatment

Practice Makes Perfect

Chapter 20 Bundle Branch Block

Ventricular Conduction Disturbances

The Bundle Branches

Bundle Branch Block

ECG Leads Used to Identify Ventricular Conduction Disturbances

Right Bundle Branch Block

Left Bundle Branch Block

Incomplete Bundle Branch Block

Nonspecific Intraventricular Conduction Defect

Fascicular Block

Left Anterior Fascicular Block

Left Posterior Fascicular Block

Bifascicular and Trifascicular Blocks

Identifying MI and/or Hypertrophy in the Presence of Bundle Branch Block

Treatments of Bundle Branch Block

Inherited Conditions That Mimic Right Bundle Branch Block

Brugada Syndrome

Arrhythmogenic Right Ventricular Dysplasia (AVRD) (ARVC)

Practice Makes Perfect

Chapter 21 Atrial Enlargement and Ventricular Hypertrophy

ECG Changes Used to Identify Enlargement and Hypertrophy

Atrial Enlargement

Right Atrial Enlargement

Left Atrial Enlargement

Ventricular Hypertrophy

Right Ventricular Hypertrophy

Left Ventricular Hypertrophy

ST Segment and T Wave Changes

Hypertrophic Cardiomyopathy

Practice Makes Perfect

Chapter 22 Other Cardiac Conditions and the ECG

Pericarditis

ECG Changes

Pericardial Effusion

ECG Changes

Pulmonary Embolism

ECG Changes

Electrolyte Imbalance

Hyperkalemia

Hypokalemia

Calcium Disorders

Drug Effects and Toxicity

Digoxin

Other Medications

Practice Makes Perfect

Section 5: Review and Assessment

Chapter 23 Putting It All Together

Using the Nine-Step Process and Deductive Analysis

Step 1: Heart Rate

Slow Rate

Normal Rate

Fast Rate

Step 2: Regularity

Regular Rhythms

Irregular Rhythms

Step 3: P Waves

Normal P Waves

Abnormal P Waves

Step 4: QRS Complexes

Normal QRS Complexes

Abnormal QRS Complexes

Step 5: PR Intervals

Normal PR Intervals

Abnormal PR Intervals

Step 6: ST Segments

Normal ST Segments

Abnormal ST Segments

Step 7: T Waves

Normal T Waves

Abnormal T Waves

Step 8: QT Intervals

Normal QT Intervals

Abnormal QT Intervals

Step 9: U Waves

So Why Do It?

Practice Ruling Out Dysrhythmias and Conditions

Practice Makes Perfect

Appendix A

Glossary

Index

 

An aparitie	2018
Autor	Bruce Shade
Dimensiuni	275 x 217 x 28 mm
Editura	McGraw-Hill
Format	Paperback
ISBN	9781260092936
Limba	Engleza
Nr pag	733