Making Sense of the ECG: A Hands-On Guide

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. Cover......Page 1 Title Page......Page 2 Copyright Page......Page 3 Contents......Page 4 Preface to the fifth edition......Page 8 Acknowledgements......Page 10 Author......Page 12 1. Anatomy and physiology......Page 14 Cardiac activation......Page 15 The cardiac conduction system......Page 16 The cardiac cycle......Page 17 Further reading......Page 18 What does the ECG actually record?......Page 20 How does the ECG ‘look’ at the heart?......Page 21 Where do each of the waves come from?......Page 24 Further reading......Page 31 Initial preparations......Page 32 Placement of the limb electrodes......Page 33 Placement of the chest (precordial) electrodes......Page 34 Einthoven’s triangle......Page 35 Recording the 12-lead ECG......Page 38 Further reading......Page 40 Technical data......Page 42 Report summary......Page 43 Further reading......Page 44 5. Heart rate......Page 46 Is the heart rate below 60/min?......Page 48 Is the heart rate above 100/min?......Page 49 Further reading......Page 52 6. An approach to heart rhythms......Page 54 Identifying the cardiac rhythm......Page 55 How is the patient?......Page 56 Is the ventricular rhythm regular or irregular?......Page 57 Is the QRS complex width normal or broad?......Page 58 Determining the cardiac rhythm......Page 60 Further reading......Page 61 Sinus rhythm......Page 62 Sinus bradycardia......Page 63 Sinus tachycardia......Page 64 Sick sinus syndrome......Page 65 Atrial ectopic beats......Page 66 Atrial fibrillation......Page 67 Atrial flutter......Page 72 Atrial tachycardia......Page 74 AV re-entry tachycardia......Page 75 AV nodal re-entry tachycardia......Page 80 Further reading......Page 83 Ventricular ectopic beats......Page 84 Accelerated idioventricular rhythm......Page 87 Monomorphic ventricular tachycardia......Page 88 How do I distinguish between VT and SVT?......Page 91 Polymorphic ventricular tachycardia......Page 93 Ventricular fibrillation......Page 94 Further reading......Page 96 Conduction block at the AV node or bundle of His......Page 98 Conduction block at the bundle branches......Page 101 Escape rhythms......Page 106 Accelerated conduction and accessory pathways......Page 107 Further reading......Page 108 Understanding and measuring the QRS axis......Page 110 Is there left axis deviation?......Page 119 Is there right axis deviation?......Page 121 Further reading......Page 123 Are any P waves absent?......Page 124 Are any P waves inverted?......Page 127 Are any P waves too tall?......Page 128 Are any P waves too wide?......Page 129 Further reading......Page 130 12. The PR interval......Page 132 Is the PR interval less than 0.12 s long?......Page 133 Is the PR interval more than 0.2 s long?......Page 135 Does the PR interval vary or can it not be measured?......Page 136 Is the PR segment elevated or depressed?......Page 140 Further reading......Page 142 Are there any ‘pathological’ Q waves?......Page 144 Further reading......Page 149 Are any R or S waves too big?......Page 150 Are the QRS complexes too small?......Page 155 Are any QRS complexes too wide?......Page 158 Are any QRS complexes an abnormal shape?......Page 161 Are epsilon waves present?......Page 163 Further reading......Page 165 Are the ST segments elevated?......Page 166 Are the ST segments depressed?......Page 179 Are J waves present?......Page 183 Further reading......Page 185 16. The T wave......Page 186 Are the T waves too tall?......Page 187 Are the T waves too small?......Page 189 Are any of the T waves inverted?......Page 190 Further reading......Page 195 17. The QT interval......Page 196 Correcting the QT interval......Page 197 Is the QTc interval long?......Page 198 Is the QTc interval short?......Page 201 Further reading......Page 204 18. The U wave......Page 206 Do the U waves appear too prominent?......Page 207 Are any of the U waves inverted?......Page 208 Further reading......Page 209 External electrical interference......Page 210 Incorrect calibration......Page 211 Patient movement......Page 212 Further reading......Page 214 Normal ECG findings......Page 216 ‘Borderline’ ECG findings......Page 219 Further reading......Page 220 What do pacemakers do?......Page 222 Indications for permanent pacing......Page 223 Selection of a permanent pacemaker......Page 224 Pacing and the ECG......Page 225 Implantable cardioverter-defibrillators......Page 227 Further reading......Page 228 22. Ambulatory ECG recording......Page 230 Event recorder......Page 231 Bedside monitoring/telemetry (inpatient)......Page 232 Smartphone/smartwatch applications......Page 233 Further reading......Page 234 What are the indications for an exercise ECG?......Page 236 What are the risks of an exercise ECG?......Page 237 How do I perform an exercise ECG?......Page 238 How do I interpret an exercise ECG?......Page 239 Further reading......Page 241 Appendix 1: Glossary......Page 242 Appendix 2: ECG resources......Page 246 Appendix 3: Help with the next edition......Page 248 Index......Page 250