The ECG Made Practical

Description

Front Cover Inside Front Cover The ECG Made Practical Copyright Page Table Of Contents Preface What to expect of this book What to expect of the ECG Acknowledgements 12-lead ECGs 1 The ECG in healthy people Types of ECG The ‘normal’ ECG The normal cardiac rhythm The heart rate Sinus tachycardia Sinus bradycardia Extrasystoles The P wave The PR interval The QRS complex The cardiac axis The size of R and S waves in the chest leads The width of the QRS complex Q waves The ST segment The T wave The QT interval The ECG in athletes The ECG in pregnancy The ECG in children What is a ‘normal ECG’ What to do Further investigations Treatment of asymptomatic ECG abnormalities 2 The ECG in patients with palpitations and syncope The clinical history and physical examination Palpitations Dizziness and syncope Physical examination The ECG Syncope due to cardiac disease other than arrhythmias Patients with possible tachycardias Mitral stenosis Pre-excitation syndromes The Wolff–Parkinson–White Syndrome The long QT syndrome The Brugada syndrome Patients with possible bradycardias Escape rhythms Syncope Potentially significant conduction abnormalities. 3 The ECG in patients with palpitations and syncope Types of ecg monitors Features of ambulatory ECG traces 4 The ECG when the patient has a tachycardia Mechanism of tachycardias Enhanced automaticity and triggered activity Abnormalities of cardiac rhythm due to re-entry Differentiation between re-entry and enhanced automaticity Extrasystoles causing symptoms Narrow complex tachycardias causing symptoms Atrioventricular re-entry tachycardia AV nodal re-entry tachycardia (AVNRT) Atrial tachycardia Atrial flutter Atrial fibrillation Broad complex tachycardias causing symptoms P waves The QRS complex Fusion beats and capture beats Differentiation of broad complex tachycardias Special forms of VT in patients with symptoms Right ventricular outflow tract ventricular tachycardia Torsade de pointes Broad complex tachycardia associated with the WPW syndrome Management of arrhythmias Electrophysiology and catheter ablation The endocardial ECG Catheter ablation Arrhythmias amenable to ablation Atrial flutter Atrial fibrillation AV node ablation Pathway ablation Ventricular tachycardia Indications for electrophysiology Cardiac arrest ICD devices Pacemaker function Defibrillator function Anti-tachycardia pacing Indications for ICD devices ECG appearance Abnormal ICD function 5 The ECG when the patient has a bradycardia Mechanism of bradycardias Sinoatrial disease – the ‘sick sinus syndrome’ Atrial fibrillation and flutter AV block The endocardial ECG in AV block Management of bradycardias Temporary pacing in patients with acute myocardial infarction Permanent pacing Pacing Sensing Monitoring Pacemaker nomenclature Right ventricular pacemakers (VVI) ECG appearance Extra functions Leadless pacemakers His pacemakers Right atrial pacemakers (AAI) ECG appearance Extra functions Dual-chamber pacemakers (DDD) ECG appearance Specialist functions Abnormal pacemaker function Failed pacing capture Under-sensing Over-sensing or far-field sensing Pacemaker-mediated tachycardia Magnet rate Indications for pacemaker insertion 6 The ECG in patients with chest pain History and examination Acute chest pain The ECG in the presence of acute chest pain The ECG in patients with myocardial ischaemia ECG changes in STEMI Inferior infarction Anterior and lateral infarction Posterior infarction Right ventricular infarction Multiple infarctions Bundle branch block and myocardial infarction Left bundle branch block. Right bundle branch block. ECG changes in NSTEMI Ischaemia without myocardial infarction Prinzmetal’s ‘variant’ angina The ECG in pulmonary embolism The ECG in other causes of chest pain Pericarditis Aortic stenosis ECG pitfalls in the diagnosis of chest pain ST elevation R wave changes ST segment and T wave changes Chronic chest pain The investigation of chronic chest pain Practical aspects of exercise testing Reasons for discontinuing an exercise test Interpretation of ECG changes during exercise testing Risks of exercise testing Management of chest pain 7 The ECG in patients with breathlessness History and examination Rhythm problems The ECG in disorders affecting the left side of the heart The ECG in left atrial hypertrophy The ECG in left ventricular hypertrophy ECGs that can mimic left ventricular hypertrophy The ECG in disorders affecting the right side of the heart The ECG in right atrial hypertrophy The ECG in right ventricular hypertrophy What to do Cardiac resynchronization therapy Indications for CRT ECG appearance Specialist functions 8 The effects of other conditions on the ECG Artefacts in ECG recordings The effects of abnormal muscle movement Hypothermia The ECG in congenital heart disease The ECG in systemic diseases Thyroid disease Malignancy The Effects of serum electrolyte abnormalities on the ECG Potassium Magnesium Calcium The effects of medication on the ECG Digoxin Drugs that prolong the QT interval Lithian Other causes of an abnormal ECG Trauma Metabolic diseases Cerebrovascular accidents Muscle disease 9 Conclusions Description Interpretation Diagnosis Treatment Conclusion Now test yourself Index A B C D E F G H I J L M N O P Q R S T U V W Inside Back Cover