A Visual Guide to ECG Interpretation

Covering the range of pathologies that emergency medicine physicians, hospitalists, and internal medicine physicians see daily, A Visual Guide to ECG Interpretation, Third Edition, helps you easily recognize key ECG patterns, test your diagnostic skills, and quickly identify potentially lethal cardiac conditions. Drs. Susan R. Wilcox and David F. M. Brown use a combination of vivid illustrations, detailed annotations, clinical cases, and ECGs to help you recognize and interpret significant features. On the following page, abnormal patterns are enlarged, highlighted in color, and briefly described. The ECGs are presented with and without annotations to better test your diagnostic skills.

• Features hundreds of illustrations with detailed annotations, notes on underlying conditions, and discussions of abnormalities that help demystify ECG interpretation
• Depicts critical pathologies for quick recognition, including hyperkalemia, coronary occlusion, and massive pulmonary embolism
• Provides expanded content on the ECG signs of ischemia and RV strain/failure, BRASH syndrome, the patient with an LVAD or heart transplant, and more
• Contains an online-only appendix with additional ECGs in random order and clinical cases
• Includes introductory content that reflects anatomic processes and approaches to reading ECGs, emphasizing rate, rhythm, axis, intervals, and ischemia
• Ideal for clinicians who have a broad understanding of ECGs and need further training on quick recognition of important patterns

Table of Contents:

1 Concept Review

Action Potential—Pacemaker Cell

Action Potential—Myocardial Cell

Refractory Periods

Conduction Anatomy

Retrograde Conduction Patterns

Waves, Intervals, and Segments

The P Wave

The QRS Wave

The T Wave

Rate

Recording the 12-Lead ECG

Rhythm Nomenclature

Axis and the Frontal Leads

The Precordial Leads

R-Wave Progression

General Approach to ECG Interpretation

References

2 Sinus Dysfunction

Sinus Arrhythmia

Wandering Atrial Pacemaker

Sinus Arrest

Sinoatrial Exit Block

Inappropriate Bradycardia

Tachycardia-Bradycardia Syndrome

Sick Sinus Syndrome

References

3 Bundle Branch and Fascicular Blocks

Right Bundle-Branch Block

Right Bundle-Branch Block

Left Bundle-Branch Block

Left Bundle-Branch Block

Left Bundle-Branch Block Pattern (LAFB)

Left Anterior Fascicular Block

Left Posterior Fascicular Block

Bifascicular Block

Trifascicular Block

References

4 AV Conduction Blocks

First-Degree AV Block

Second-Degree AV Block: Mobitz I

Second-Degree AV Block: Mobitz II

Third-Degree AV Block

AV Dissociation

Atrial Fibrillation with Complete Heart Block

References

5 Premature Beats

Premature Atrial Complex

Premature Junctional Complex

Premature Ventricular Complex

References

6 Abnormal QRS Morphology

Brugada Pattern and Syndrome

Arrhythmogenic Right Ventricular Dysplasia

Wolff-Parkinson-White Pattern

Hypothermia

Na+ Channel Blockade

References

7 Abnormal T Waves

Ischemic T-Wave Changes

Wellens’ Syndrome

LV Strain Pattern (Fig. 7.5)

Digitalis Effect

Persistent Juvenile T-Wave Pattern

Hyperkalemia

Cerebral T Waves (Fig. 7.10)

ECG Abnormalities Associated with Pulmonary Embolism

ECG Abnormalities Associated with RV Strain

References

8 QT Abnormalities and Electrolyte Disturbances

The QT Interval

Congenital Long QT Syndrome

Hypocalcemia (Fig. 8.4A)

Hypercalcemia (Fig. 8.4B)

Hyperkalemia (Fig. 8.5)

Hypokalemia

References

9 Voltage Abnormalities

The Low-Voltage ECG

Electrical Alternans

Left Ventricular Hypertrophy (Fig. 9.1)

Right Ventricular Hypertrophy

COPD

Hypertrophic Cardiomyopathy

References

10 Fast and Narrow

Mechanisms Underlying Supraventricular Tachyarrhythmias

Narrow Complex Tachycardias Classified

Atrial Fibrillation

Atrial Flutter

Typical AV Nodal Reentrant Tachycardia

Atypical AV Nodal Reentrant Tachycardia

Orthodromic Atrioventricular Reciprocating Tachycardia

Focal Atrial Tachycardia

Junctional Tachycardia

Multifocal Atrial Tachycardia

Digitalis Toxicity: Electrophysiology

Digitalis Toxicity

References

11 Fast and Wide

Wide Complex Tachycardia: An Overview

Monomorphic Ventricular Tachycardia: Causes

Monomorphic VT: ECG Features

VT Versus SVT with Aberrancy: Algorithms

Polymorphic VT

Ventricular Flutter

Ventricular Fibrillation

Supraventricular Causes of Wide Complex Tachycardia

Antidromic Atrioventricular Reciprocating Tachycardia

Atrial Fibrillation Down an Accessory Pathway

Aberrancy

References

12 Ischemic Patterns

Coronary Anatomy

Subendocardial Ischemia

ST-Elevation MI

ST Elevation

Localizing the Infarct

Anterior MI

Inferior MI

Posterior Myocardial Infarction

Right Ventricular MI

Complications of a Right Ventricular MI

Lateral MI

Pericarditis

Diffuse ST Depressions

Left Ventricular Aneurysm Morphology

Benign Early Repolarization

Takotsubo Cardiomyopathy

Left Bundle Branch Block and Acute MI

Mimics of ST-Elevation MI

References

13 Cardiac Devices

The Pacemaker (Fig. 13.1)

Pacemaker Nomenclature

Single-Chamber Pacing

Dual-Chamber Pacing

Biventricular Pacing—Cardiac Resynchronization Therapy

Pacemaker-Mediated Tachycardia

Pacemaker Failures

The Magnet

Left Ventricular Assist Devices

References

Online Appendix

Index