12 lead ECG : the art of interpretation / Thomas B. Garcia, Neil E. Holtz.

Format:

Book

Author/Creator:

Garcia, Thomas B., 1952-

Contributor:

Holtz, Neil E.

Language:

English

Subjects (All):

Electrocardiography.

Medical Subjects:

Electrocardiography.

Genre:

Programmed instructional materials.

Physical Description:

xvi, 536 pages : color illustrations ; 28 cm

Other Title:

Twelve lead ECG

Place of Publication:

Sudbury, MA : Jones and Bartlett, [2001]

Contents:

Chapter 1 Anatomy 3

Gross Anatomy 3

Anterior View 3

The Heart in Cross Section 4

The Heart as a Pump 4

Pump Function Simplified 5

The Electrical Conduction System 6

Pacemaker Function 7

Pacemaker Settings 7

The Sinoatrial (SA) Node 8

The Internodal Pathways 8

The Atrioventricular (AV) Node 9

The Bundle of His 9

The Left Bundle Branch (LBB) 10

The Right Bundle Branch (RBB) 10

The Left Anterior Fascicle (LAF) 11

The Left Posterior Fascicle (LPF) 11

The Purkinje System 12

Chapter 2 Electrophysiology 15

Mechanics of Contraction 15

Ion Movement and Polarity 16

Membrane Channels and Action Potential Phases 18

Chapter 3 Individual Vectors 21

Adding and Subtracting Vectors 21

The Electrical Axis of the Heart 22

Electrodes and Waves 22

Leads Are Like Pictures of the Heart 23

Lead Placement (Where to Put the "Cameras") 23

How the Machine Manipulates the Leads 24

The Two Lead Systems 24

The Hexaxial System 24

The Precordial System 25

The Heart in Three Dimensions 25

Localizing an Area: Inferior Wall 26

Localizing Other Areas 27

Chapter 4 The Actual EGG: Paper and Ink 29

Boxes and Sizes 29

Calibration 30

Where Is Each Lead Represented? 30

Temporal Relationship of the ECG 31

Why Is Temporal Spacing Important? 31

Chapter 5 ECG Tools 33

Calipers: The ECG Interpreter's Best Friend 33

How to Use Your Calipers 34

Comparing Wave Heights 34

Adding Wave Heights 35

Comparing Widths 36

Axis-Wheel Ruler 36

ECG Rulers 36

Straight Edge 37

Chapter 6 The Basic Beat 39

Introduction to Basic Components 39

Wave Nomenclature 39

Individual Components of the ECG Complex 40

The P Wave 40

The Tp Wave 41

The PR Segment 41

The PR Interval 42

The QRS Complex 42

The ST Segment 44

The T Wave 44

The QT Interval 46

The U Wave 46

Additional Intervals 47

Looking Ahead 47

Chapter 7 The Rate 49

Establishing the Rate 49

Normal and Fast Rates 49

Bradycardic Rates 50

Chapter 8 Rhythms 53

Major Concepts 53

P Waves 54

QRS Complexes 54

Individual Rhythms 55

Supraventricular Rhythms 55

Ventricular Rhythms 63

Heart Blocks 68

Part 2 ECG Interpretation 71

Chapter 9 The P Wave 73

ECG Case Study: P Wave Basics 74

P Wave Morphology 76

ECG Case Studies: P Wave Morphology 77

Abnormal P Waves 82

P-mitrale 82

ECG Case Studies: P-mitrale 83

P-pulmonale 88

ECG Case Studies: P-pulmonale 89

Intraatrial Conduction Delay (IACD) 94

ECG Case Studies: Biphasic P Waves 95

Biatrial Enlargement 106

ECG Case Studies: Biatrial Enlargement 107

Chapter 10 The PR Interval 113

Conduction Overview 113

PR Depression 115

ECG Case Study: PR Interval Depression 116

Measuring the Interval 118

Short PR Interval 120

ECG Case Study: Short PR Interval 121

Wolff-Parkinson-White Syndrome (WPW) 122

ECG Case Studies: WPW 123

WPW Syndrome

Advanced Information 125

Prolonged PR Interval 143

ECG Case Studies: Prolonged PR Interval 143

Chapter 11 The QRS Complex 157

How Are the Waves Made? 157

What to Look for in the QRS Complex 159

QRS Height (Amplitude) 159

Abnormal Amplitude 160

ECG Case Studies: Pericardial Effusion 161

ECG Case Study: Large QRS Complexes 164

Left Ventricular Hypertrophy (LVH) 166

Electrocardiogram Criteria for LVH 166

Identifying LVH, Step by Step 167

ECG Case Studies: Left Ventricular Hypertrophy 168

Right Ventricular Hypertrophy (RVH) 180

RVH and the ECG 181

ECG Case Studies: RVH 182

QRS Duration 185

ECG Case Studies: QRS Duration 186

The Wide-QRS Differential, Simplified 191

QRS Morphology 191

ECG Case Studies: QRS Morphology 192

Q Wave Significance 195

Benign Q Waves 195

Respiratory Variation of Q Waves 195

ECG Case Studies: Q Wave Significance 196

Significant (Pathological) Q Waves 201

Transition Zone 205

ECG Case Studies: Transition Zone 208

QRS Notching 214

Osborn (J) Waves 214

ECG Case Studies: QRS Notching and Osborn Waves 215

Chapter 12 The Electrical Axis 223

How to Calculate the Electrical Axis 224

Isolating the Axis 227

1. Find the Quadrant 227

2. Isolate the Isoelectric Lead 227

3. Isolate the Closest Lead 228

4. Isolate the Vector 230

5. Double-Check Your Findings 233

Causes of Axis Deviation 234

Right Axis Deviation (RAD) 234

Left Axis Deviation (LAD) 234

The Z Axis 234

The Z Axis Precordial Lead System 236

More Examples: Adding the Z Axis 237

Z Axis: Other Approaches 239

Chapter 13 Bundle Branch Blocks and Hemiblocks 241

Right Bundle Branch Block 241

ECG Findings in Right Bundle Branch Blocks 243

The QR' Wave 244

ECG Case Studies: Right Bundle Branch Block 244

Left Bundle Branch Block 260

Criteria for Diagnosing LBBB 261

ECG Case Studies: Left Bundle Branch Block 262

Intraventricular Conduction Delay (IVCD) 277

Summary Comments on Bundle Branch Blocks 277

ECG Case Studies: Intraventricular Conduction Delay 278

Hemiblocks 281

Left Anterior Hemiblock 282

ECG Case Studies: Left Anterior Hemiblock 284

Left Posterior Hemiblock 289

ECG Case Studies: Left Posterior Hemiblock 290

Bifasciular Blocks 297

ECG Case Studies: Bifascicular Block 298

Chapter 14 ST Segment and T Waves 309

Where Is the J Point? 310

ST Elevation or Depression 311

ST Segment Shapes 311

The T Wave 312

ECG Case Studies: ST Segments and T Waves 314

Ischemia and Injury 340

ECG Case Studies: Ischemia and Injury 341

Strain Pattern 346

Right Ventricular Strain Pattern 346

ECG Case Studies: Right Ventricular Strain Pattern 347

Left Ventricular Strain Pattern 351

ECG Case Studies: Left Ventricular Strain Pattern 353

ECG Comparisons: Benign Changes Versus Infarct 362

Pericarditis Revisited 390

ECG Case Studies: Pericarditis 391

STs and T Waves in Blocks 397

ECG Case Studies: STs and Ts in Blocks 398

Chapter 15 Acute Myocardial Infarction 403

Zones of Ischemia, Injury, and Infarction 405

Infarct and Q Waves 406

Q Wave Infarct 406

Non-Q Wave Infarct 407

ECG Progression in Infarct 408

Reciprocal Changes 409

Infarct Regions on the ECG 410

Infarct Regions in Combination 411

ECG Case Studies: Anteroseptal AMI 414

ECG Case Studies: Anteroseptal AMI with Lateral Extension 419

ECG Case Study: Lateral Wall AMI 431

ECG Case Studies: Inferior Wall AMI 434

ECG Case Studies: Inferolateral AMI 438

ECG Case Studies: Apical AMI 446

ECG Case Studies: Right Ventricular Infarction 455

ECG Case Studies: Posterior Wall AMI 462

ECG Case Studies: Inferoposterior AMI 465

ECG Case Studies: Inferior-RV-Posterior AMI 470

Chapter 16 Electrolyte and Drug Effects 479

Hyperkalemia and Its Effects 479

The Spectrum of Hyperkalemia 480

T Wave Abnormalities in Hyperkalemia 480

ECG Case Studies: T Wave Changes in Hyperkalemia 482

IVCD and Hyperkalemia 489

P Waves and Hyperkalemia 489

ECG Case Studies: IVCD and P Waves in Hyperkalemia 490

Other Electrolyte Abnormalities 500

Hypokalemia 500

Hypercalcemia 500

Hypocalcemia 500

ECG Case Studies: Other Electrolyte Abnormalities 501

Drug Effects 507

Digoxin 507

ECG Case Studies: Drug Effects 508

Chapter 17 Putting It All Together 513

New Ground 513

The 10 Questions of the Gram 513

What Is My General Impression? 514

Is There Anything That Sticks Out? 515

What Is the Rate? 515

What Are the Intervals? 516

What Is the Rhythm? 517

What Is the Axis? 520

Is There Any Hypertrophy 521

Is There Any Ischemia or Infarction? 521

What Is the Differential Diagnosis of the Abnormality? 522

How Can I Put It All Together with the Patient? 523

The Big Picture 523.

Notes:

Includes index.

ISBN:

0763712841

OCLC:

44613015