Clinical Electrocardiography: A Simplified Approach

front matter
	Goldberger’s Clinical Electrocardiography: A Simplified Approach
preface
	Preface
chapter 1
	1 - Key Concepts
		Essential Cardiac Electrophysiology
			Electrical Activation of the Heart
		Cardiac Automaticity and Conductivity: “Clocks and Cables”
		Preview: Looking Ahead
		Concluding Notes: Why is the ECG So Clinically Useful
chapter 2
	2 - ECG Basics: Waves, Intervals, and Segments
		Depolarization and Repolarization
		Basic ECG Waveforms: P, QRS, ST-T, and U Waves
		ECG Graph Paper
		Basic ECG Measurements and Some Normal Values
			Standardization (Calibration) Marker
			P Wave
			PR Interval
			QRS Complex
			QRS Width (Interval)
			ST Segment
			T Wave
			QT Interval
			U Wave
		Calculation of Heart Rate
			Box Counting Methods
			QRS Counting Methods
		Heart Rate and RR Interval: How are they Related
		ECG Terms are Confusing
		The ECG as a Combination of Atrial and Ventricular Waveforms
		The ECG in Perspective
chapter 3
	3 - ECG Leads
		Limb (Extremity) Leads
			Standard Limb Leads: I, II, and III
			Augmented Limb Leads: aVR, aVL, and aVF
			Relationship of Extremity Leads
		Chest (Precordial) Leads
			The 12-Lead ECG: Frontal and Horizontal Plane Leads
		Cardiac Monitors and Monitor Leads
			Bedside Cardiac Monitors
			Ambulatory ECG Technology: Holter Monitors and Event Recorders
chapter 4
	4 - Understanding the Normal ECG
		Three Basic “Laws” of Electrocardiography
		Normal Sinus P Wave
		Normal QRS Complex: General Principles
			The Normal QRS: Chest Leads
		Normal ST Segment
		Normal T Wave
chapter 5
	5 - Electrical Axis and Axis Deviation
		Mean QRS Axis: Definition
		Mean QRS Axis: Calculation
		Axis Deviation
			Axis Deviation: Instant Recognition
			Clinical Significance
		Mean Electrical Axis of the P Wave and T Wave
chapter 6
	6 - Atrial and Ventricular Enlargement
		Right Atrial Abnormality
		Left Atrial Abnormality
		Right Ventricular Hypertrophy
		Left Ventricular Hypertrophy
		The Ecg in Cardiac Enlargement: A Clinical Perspective
chapter 7
	7 - Ventricular Conduction Disturbances: Bundle Branch Blocks and Related Abnormalities
		ECG in Ventricular Conduction Disturbances: General Principles
		Right Bundle Branch Block
			Complete and Incomplete RBBB
			Clinical Significance
		Left Bundle Branch Block
			Complete and Incomplete LBBB
			Clinical Significance
		Differential Diagnosis of Bundle Branch Blocks
		Fascicular Blocks (Hemiblocks)
			Bifascicular and Trifascicular Blocks
		Diagnosis of Hypertrophy in the Presence of Bundle Branch Blocks
		Diagnosis of Myocardial Infarction in the Presence of Bundle Branch Blocks
chapter 8
	8 - Myocardial Infarction and Ischemia, I: ST Segment Elevation and Q Wave Syndromes
		Myocardial Ischemia
		Transmural and Subendocardial Ischemia
		Myocardial Blood Supply
		St Segment Elevation, Transmural Ischemia, and Acute Myocardial Infarction
			QRS Changes: Q Waves of Infarction
		ECG Localization of Infarctions
			Anterior Wall Q Wave Infarctions
				“Anteroseptal” Q Wave Infarctions
				“Strictly” Anterior Q Wave Infarctions
				Anterolateral or Anteroapical Q Wave Infarctions
				Differentiating Anterior Wall Infarctions: General Comments and Caveats
			Inferior Wall Infarctions
			Posterior Infarctions
			Right Ventricular Infarctions
		Classic Sequence of St-T Changes and Q Waves with Stemi
			Normal and Abnormal Q Waves: A Brief Overview
		Ventricular Aneurysm
		Multiple Infarctions
		“Silent” Myocardial Infarction
		Diagnosis of Myocardial Infarction In the Presence of Bundle Branch Block
			Right Bundle Branch Block with Myocardial Infarction
			Left Bundle Branch Block with Myocardial Infarction
chapter 9
	9 - Myocardial Infarction and Ischemia, II: Non–ST Segment Elevation and Non–Q Wave Syndromes
		Subendocardial Ischemia
			ECG Changes with Angina Pectoris
			Exercise (Stress) Testing and Coronary Artery Disease
			“Silent” Myocardial Ischemia
		Subendocardial Infarction
		Variety of ECG Changes Seen with Myocardial Ischemia
			ECG Changes Associated with Noninfarction Ischemia
			Takotsubo Cardiomyopathy (Stress Cardiomyopathy)
		St Segment Elevations: Differential Diagnosis
		St Segment Depressions: Differential Diagnosis
		Deep T Wave Inversions: Differential Diagnosis
		Complications of Myocardial Infarction
		ECG After Coronary Revascularization
		The ECG in Myocardial Infarction: A Clinical Perspective
chapter 10
	10 - Drug Effects, Electrolyte Abnormalities, and Metabolic Factors
		Drug Effects
			Drugs Used to Treat Arrhythmias
			Psychotropic and Related Drugs
		Electrolyte Disturbances
			Hyperkalemia
			Hypokalemia
			Hypercalcemia and Hypocalcemia
			Magnesium Disturbances
		Other Metabolic Factors
			Hypothermia
			Endocrine Abnormalities
			Acidosis and Alkalosis
		ST-T Changes: Specific and Nonspecific
chapter 11
	11 - Pericardial, Myocardial, and Pulmonary Syndromes
		Acute Pericarditis, Pericardial Effusion, and Chronic Constrictive Pericarditis
			Acute Pericarditis
			Pericardial Effusion
			Chronic Constrictive Pericarditis
		Myocarditis
		CHRONIC Heart Failure
		Pulmonary Embolism
		Chronic Lung Disease (Emphysema)
chapter 12
	12 - Wolff-Parkinson-White Preexcitation Patterns
		Wolff-Parkinson-White Pattern: Preexcitation and Bypass Tracts
			Clinical Significance
			Treatment
		Overview: Differential Diagnosis of Wide QRS Complex Patterns
chapter 13
	13 - Sinus and Escape Rhythms
		Sinus Rhythms
			“Normal” Sinus Rhythm
		Regulation of the Heart Rate
		Sinus Tachycardia
		Sinus Bradycardia
		Sinus Arrhythmia
		Sinus Pauses, Sinus Arrest, and Sinoatrial Block
			Secondary Pacemakers and Escape Rhythms
14
	14 - Supraventricular Arrhythmias, Part I: Premature Beats and Paroxysmal Supraventricular Tachycardias
		General Principles: Triggers and Mechanisms of Tachyarrhythmias
		Atrial and Other Supraventricular Premature Beats
			Clinical Significance
		Paroxysmal Supraventricular Tachycardias
			Atrial Tachycardia
				Conduction
				Termination
				Multifocal Atrial Tachycardia
				Clinical Considerations
			AV Nodal Reentrant (Reentry) Tachycardia
				Termination
				Clinical Considerations
			Atrioventricular Reentrant (Bypass Tract–Mediated) Tachycardia
				Initiation and Conduction
				Termination
				Clinical Considerations
		Differential Diagnosis and Treatment of PSVT
			Management of an Acute PSVT Episode
			Long-Term Management of PSVT
15
	15 - Supraventricular Arrhythmias, Part II: Atrial Flutter and Atrial Fibrillation
		Atrial Flutter
			Location of Conduction Pathways
			Conduction to the Ventricles
		Atrial Fibrillation
			Conduction Properties
		Atrial Fibrillation vs. Atrial Flutter: Differential Diagnosis
		Atrial Fibrillation and Flutter: Overview of Major Clinical Considerations
		Treatment of Atrial Fibrillation/Flutter: Acute and Long-Term Considerations
			Rate Control
			Rhythm Control
16
	16 - Ventricular Arrhythmias
		Ventricular Premature Beats
			Features
				Frequency
				Morphology and Origin
				Coupling Interval
				Compensatory Pauses
				Uniform and Multiform VPBs
				R on T Phenomenon
			Clinical Significance
		Ventricular Tachycardias
			Monomorphic Ventricular Tachycardia
				Clinical Significance of Monomorphic Ventricular Tachycardia
			Polymorphic Ventricular Tachycardias
				Classification
				Torsades de Pointes
				Acquired Long QT Syndrome
				Hereditary Long QT Syndromes:
		Accelerated Idioventricular Rhythm
		Ventricular Fibrillation
		Differential Diagnosis of Wide Complex Tachycardias
17
	17 - Atrioventricular Conduction Abnormalities: Delays, Blocks, and Dissociation Syndromes
		What is the Degree of AV Block
			Prolonged PR Interval (First-Degree AV Block)
			Second-Degree AV Block Syndromes
			Third-Degree (Complete) AV Block
				Treatment Considerations
		AV Dissociation Syndromes
18
	18 - Digitalis Toxicity
		Mechanism of Action and Indications
		Digitalis Toxicity Vs. Digitalis Effect
		Symptoms and Signs of Digitalis Toxicity
		Factors Predisposing to Digitalis Toxicity
			Electrolyte Disturbances
			Coexisting Illness
			Drug-Drug Interactions
		Prevention of Digitalis Toxicity
		Treatment of Digitalis Toxicity
		Serum Digoxin Concentrations (Levels)
19
	19 - Sudden Cardiac Arrest and Sudden Cardiac Death
		Clinical Aspects of Cardiac Arrest
		Basic ECG Patterns in Cardiac Arrest
			Ventricular Tachyarrhythmia (Ventricular Fibrillation or Pulseless VT)
			Ventricular Asystole and Brady-Asystolic Rhythms
			Pulseless Electrical Activity (Electromechanical Dissociation)
		Clinical Causes of Cardiac Arrest
		Sudden Cardiac Death/Arrest
20
	20 - Bradycardias and Tachycardias: Review and Differential Diagnosis
		Bradycardias (Bradyarrhythmias)
			Sinus Bradycardia and Related Rhythms
			Wandering Atrial Pacemaker
			AV Junctional (Nodal) and Ectopic Atrial Rhythms
			AV Heart Block (Second or Third Degree) or AV Dissociation
			Atrial Fibrillation or Flutter with a Slow Ventricular Rate
			Idioventricular Escape Rhythm
		Tachycardias (Tachyarrhythmias)
			Differential Diagnosis of Narrow Complex Tachyarrhythmias
				Sinus Tachycardia
				Paroxysmal Supraventricular Tachycardias
				Atrial Flutter
			Differential Diagnosis of Wide Complex Tachycardias
			Differentiation of SVT with Aberrancy from Ventricular Tachycardia
				SVT with Aberrancy
				SVT with the Wolff-Parkinson-White Preexcitation Syndrome
				VT vs. SVT with Aberration: ­Important Diagnostic Clues in Wide Complex ­Tachycardia
					Clinical Clues
				ECG Clues
			Clinical Significance: Some Important Reminders
		Slow and Fast: Sick Sinus Syndrome and the Brady-Tachy Syndrome
21
	21 - Pacemakers and Implantable Cardioverter Defibrillators: Essentials for Clinicians
		Pacemakers: Definitions and Types
			Single- and Dual-Chamber Pacemakers
			ECG Morphology of Paced Beats
			Electronic Pacemaker Programming: Shorthand Code
			Single-Chamber Pacemaker Programming
			Dual-Chamber Pacemaker Programming
			Managing Adverse Effects of Right Ventricular Pacing
			Biventricular Pacemakers: Cardiac Resynchronization Therapy
			ECG Diagnosis Related to Paced Rhythms
				Atrial Fibrillation
				ST-T Wave Changes Due to Acute Myocardial Ischemia
				Cardiac “Memory” T Wave Inversions
		Implantable Cardioverter-Defibrillators
		Recognizing Pacemaker and ICD Malfunction
		Magnet Response of Pacemakers and ICDs
		Pacemaker and ICD Implantation: Specific Indications
22
	22 - How to Interpret an ECG
		ECG Interpretation: Big Picture and General Approach
			Fourteen Specific ECG Features to Analyze
				Standardization and Technical Features
				Rhythm
				Heart Rate(s)
				PR Interval
				P Wave Size (Amplitude and Width)
				QRS Width (Interval or Duration)
				QT/QTc Interval
				QRS Voltage
				Mean QRS Electrical Axis
				R Wave Progression in Chest Leads
				Abnormal Q Waves
				ST Segments
				T Waves
				U Waves
			Formulating an Interpretation
		Caution: Computerized ECG Interpretations
		ECG Artifacts
			60-Hertz (Cycle) Interference
			Muscle Tremor
			Wandering Baseline
			Poor Electrode Contact or Patient Movement
			Improper Standardization
			Limb Lead Reversal
23
	23 - Limitations and Uses of the ECG
		Important Limitations of the ECG
		Utility of the ECG in Special Settings
		Common General Medical Applications of the ECG
			Syncope
			Coma
			Shock
			Weakness
		Reducing Medical Errors: Common Pitfalls in ECG Interpretation
24
	24 - ECG Differential Diagnoses: Instant Reviews
index
	Index
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