Getting Started 1 Chapter 1 The Basics 9 Electricity and the Heart 10 The Cells of the Heart 13 Time and Voltage 19 P Waves, QRS Complexes, T Waves, and Some Straight Lines 21 Naming the Straight Lines 30 Summary: The Waves and Straight Lines of the EKG 32 Making Waves 34 The 12 Views of the Heart 39 A Word About Vectors 49 The Normal 12-Lead EKG 51 Summary: Orientation of the Waves of the Normal EKG 62 Some Really Important Stuff That You May Be Wondering: Part 1: Why Not Just Let the Computer Do It? 64 Some Really Important Stuff That You May Be Wondering: Part 2: How Do I Get the Goop Off My Patient’s Chest Once the EKG Is Finished? 66 Coming Attractions 67 Chapter 2 Hypertrophy and Enlargement of the Heart 69 A Few Introductory Remarks 70 Definitions 71 Axis 74 Summary: Axis 83 Axis Deviation, Hypertrophy, and Enlargement 86 ContentsAtrial Enlargement 89 Summary: Atrial Enlargement 92 Ventricular Hypertrophy 93 Secondary Repolarization Abnormalities of Ventricular Hypertrophy 99 Summary: Ventricular Hypertrophy 102 CASE 1 103 CASE 2 104 Chapter 3 Arrhythmias 107 The Clinical Manifestations of Arrhythmias 109 Why Arrhythmias Happen 110 Rhythm Strips 111 How to Determine the Heart Rate From the EKG 115 The Five Basic Types of Arrhythmias 119 Arrhythmias of Sinus Origin 120 Summary: Arrhythmias of Sinus Origin 127 Ectopic Rhythms 129 Reentrant Rhythms 130 The Four Questions 132 Supraventricular Arrhythmias 135 Summary: Supraventricular Arrhythmias 157 Ventricular Arrhythmias 158 Summary: Ventricular Arrhythmias 166 Supraventricular vs Ventricular Arrhythmias 167 Summary: Ventricular Tachycardia vs Supraventricular Tachycardia With Aberrancy 174 Electrophysiology Studies (EPS) 175 Implantable Defibrillators 177 External Defibrillators 178 CASE 3 180 CASE 4 183 CASE 5 185 Chapter 4 Conduction Blocks 189 What Is a Conduction Block? 190 AV Blocks 192Summary: AV Blocks 202 Bundle-Branch Block 204 Summary: Bundle-Branch Block 210 Hemiblocks 211 Combining Right Bundle-Branch Block and Hemiblocks 216 Blocks That Underachieve 219 The Ultimate in Playing With Blocks: Combining AV Blocks, Right Bundle-Branch Block, and Hemiblocks 220 Pacemakers 222 CASE 6 227 CASE 7 229 CASE 8 230 Chapter 5 Preexcitation Syndromes 233 What Is Preexcitation? 234 Wolff-Parkinson-White 235 A Short PR Interval Without a Delta Wave 237 Why Do We Care About Preexcitation? 238 Summary: Preexcitation 244 CASE 9 245 Chapter 6 Myocardial Ischemia and Infarction 247 Stable Angina and Acute Coronary Syndromes 248 How to Diagnose a Myocardial Infarction 251 ST-Segment Elevation Myocardial Infarctions 254 Summary: The EKG Changes of an Evolving STEMI 266 Localizing the Infarct 267 Non–ST-Segment Elevation Myocardial Infarctions 280 Takotsubo Cardiomyopathy 281 Angina Without Infarction 283 Sorting Out the Different Ischemic Syndromes 285 Limitations of the EKG in Diagnosing an Infarction 287 Stress Testing 288 CASE 10 294 CASE 11 299Chapter 7 Finishing Touches 301 Electrolyte Disturbances 303 Hypothermia 308 Drugs 310 More on the QT Interval 315 Other Cardiac Disorders 317 Pulmonary Disorders 323 Central Nervous System Disease 325 Sleep Disorders 326 Sudden Cardiac Death 328 The Athlete’s Heart 331 Preparticipation Screening for Athletes 332 The Preoperative Evaluation 334 Summary: Miscellaneous Conditions 335 CASE 12 338 CASE 13 341 Chapter 8 Putting It All Together 343 The 9-Step Method for Reading EKGs 346 Chapter 9 How Do You Get to Carnegie Hall? 369 Index 393
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