Interpreting ECGs : a practical approach

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Cover Title Page Copyright Page About the Author Dedication Contents Preface 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 A B C D E F G H I J L M N O P Q R S T U V W