The Only EKG Book You’ll Ever Need

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