Making Sense of the ECG: A Hands-On Guide, Fourth Edition

Description:

Interpreting an ECG correctly and working out what to do next can seem like a daunting task to the non-specialist, yet it is a skill that will be invaluable to any doctor, nurse or paramedic when evaluating the condition of a patient. Making Sense of the ECG has been written specifically with this in mind, and will help the student and more experienced healthcare practitioner to identify and answer crucial questions. This popular, easy-to-read and easy-to-remember guide to the ECG as a tool for diagnosis and management has been fully updated in its fifth edition to reflect the latest guidelines.

Table of Contents:

1. Anatomy and physiology

Cardiac activation

The cardiac conduction system

The cardiac cycle

Further reading

2. PQRST: Where the waves come from

What does the ECG actually record?

How does the ECG ‘look’ at the heart?

Where do each of the waves come from?

Further reading

3. Performing an ECG recording

Initial preparations

Placement of the limb electrodes

Placement of the chest (precordial) electrodes

Einthoven’s triangle

Recording the 12-lead ECG

Further reading

4. Reporting an ECG recording

Patient data

Technical data

ECG fundamentals

ECG details

Report summary

Further reading

5. Heart rate

Is the heart rate below 60/min?

Is the heart rate above 100/min?

Further reading

6. An approach to heart rhythms

Identifying the cardiac rhythm

How is the patient?

Is ventricular activity present?

What is the ventricular rate?

Is the ventricular rhythm regular or irregular?

Is the QRS complex width normal or broad?

Is atrial activity present?

How are atrial activity and ventricular activity related?

Determining the cardiac rhythm

Further reading

7. Supraventricular rhythms

Sinus rhythm

Sinus arrhythmia

Sinus bradycardia

Sinus tachycardia

Sick sinus syndrome

Atrial ectopic beats

Atrial fibrillation

Atrial flutter

Atrial tachycardia

AV re-entry tachycardia

AV nodal re-entry tachycardia

Further reading

8. Ventricular rhythms

Ventricular ectopic beats

Accelerated idioventricular rhythm

Monomorphic ventricular tachycardia

How do I distinguish between VT and SVT?

Polymorphic ventricular tachycardia

Fascicular ventricular tachycardia

Ventricular fibrillation

Further reading

9. Conduction problems

Conduction block at the SA node

Conduction block at the AV node or bundle of His

Conduction block at the bundle branches

Conduction block at the fascicles

Escape rhythms

Accelerated conduction and accessory pathways

Further reading

10. The axis

Understanding and measuring the QRS axis

Is there left axis deviation?

Is there right axis deviation?

Is there extreme right axis deviation?

Further reading

11. The P wave

Are any P waves absent?

Are any P waves inverted?

Are any P waves too tall?

Are any P waves too wide?

Further reading

12. The PR interval

Is the PR interval less than 0.12 s long?

Is the PR interval more than 0.2 s long?

Does the PR interval vary or can it not be measured?

Is the PR segment elevated or depressed?

Further reading

13. The Q wave

Are there any ‘pathological’ Q waves?

Further reading

14. The QRS complex

Are any R or S waves too big?

Are the QRS complexes too small?

Are any QRS complexes too wide?

Are any QRS complexes an abnormal shape?

Are epsilon waves present?

Further reading

15. The ST segment

Are the ST segments elevated?

Are the ST segments depressed?

Are J waves present?

Further reading

16. The T wave

Are the T waves too tall?

Are the T waves too small?

Are any of the T waves inverted?

Further reading

17. The QT interval

Correcting the QT interval

Is the QTc interval long?

Is the QTc interval short?

Further reading

18. The U wave

Do the U waves appear too prominent?

Are any of the U waves inverted?

Further reading

19. Artefacts on the ECG

Electrode misplacement

External electrical interference

Incorrect calibration

Incorrect paper speed

Patient movement

Further reading

20. ECG interpretation in athletes

Normal ECG findings

Abnormal ECG findings

‘Borderline’ ECG findings

Further reading

21. Pacemakers and implantable cardioverter-defibrillators

What do pacemakers do?

Indications for temporary pacing

Temporary pacemaker insertion and care

Indications for permanent pacing

Selection of a permanent pacemaker

Pacing and the ECG

Pacemakers and surgery

Implantable cardioverter-defibrillators

Cardiac resynchronization therapy (biventricular pacing)

Further reading

22. Ambulatory ECG recording

24-h ambulatory ECG recording

Event recorder

ECG ‘on demand’

Bedside monitoring/telemetry (inpatient)

Insertable cardiac monitor (ICM)

External loop recorder (ELR)

Smartphone/smartwatch applications

Further reading

23. Exercise ECG testing

What are the indications for an exercise ECG?

What are the risks of an exercise ECG?

How do I perform an exercise ECG?

When do I stop an exercise ECG?

How do I interpret an exercise ECG?

Further reading

Appendix 1: Glossary

Appendix 2: ECG resources

Appendix 3: Help with the next edition

Index