Learning electrocardiography: a complete course

Front Matter......Page 1
Contents......Page 5
Preface......Page 9
A BRIEF NOTE FOR BEGINNING STUDENTS......Page 10
2. Electrical Activity of the Heart......Page 14
FUNCTIONS OF AN ELECTROCARDIOGRAPH......Page 15
HOW THE ECG MACHINE MEASURES CURRENT DIRECTION......Page 16
ECG OF VENTRICULAR DEPOLARIZATION......Page 18
ECG OF VENTRICULAR REPOLARIZATION......Page 20
5. Electrocardiographic Language of Direction......Page 24
LEADS 1, 2, AND 3......Page 26
TRIAXIAL SYSTEM AND EINTHOVEN'S TRIANGLE......Page 28
QRS DURATION......Page 32
QRS DIRECTION RECOGNITION......Page 33
TELLING DIRECTION BY THE METHOD OF PERPENDICULARS......Page 36
8. Unipolar Limb Leads......Page 40
REFERENCES......Page 44
HOW TO DRAW A FRONTAL PLANE HEXAXIAL SYSTEM......Page 45
HOW TO PLOT VECTORS IN THE HEXAXIAL SYSTEM......Page 49
SEMICIRCLE METHOD OF PLOTTING FRONTAL VECTORS......Page 53
REFERENCE......Page 54
NORMAL QRS RANGE......Page 55
NORMAL T RANGE......Page 59
NORMAL P RANGE......Page 60
INDETERMINATE AXES......Page 61
REFERENCES......Page 63
PLACING THE CHEST ELECTRODES......Page 64
HOW TO PLOT VECTORS IN THE HORIZONTAL PLANE: HORIZONTAL PLANE HEXAXIAL SYSTEM......Page 67
HOW TO DRAW A SPATIAL VECTOR......Page 70
Steps in Drawing a Spatial QRS Vector......Page 74
Normal QRS Ranges and Patterns......Page 76
Electrical Positions of the Heart......Page 81
Normal T Ranges and Patterns Horizontal Plane......Page 82
PEDIATRIC, FRONTAL, AND HORIZONTAL P, QRS, AND T DIRECTIONS......Page 85
REFERENCES......Page 86
12. Normal P, P-R, QRS, and T Height, Width, and Duration......Page 87
REFERENCES......Page 88
13. Dipole Concept......Page 89
STANDARDIZATION......Page 90
PAPER SPEED AND TIME MARKINGS......Page 91
APPLYING ELECTRODES......Page 92
SPECIAL LEADS......Page 93
PATIENT AND BED ASPECT......Page 94
Routine Methods......Page 95
Grounding......Page 96
Lead Reversal and Lead Placement Artifacts......Page 97
Wandering or Jumping Baselines......Page 100
Somatic Tremor Artifacts......Page 101
REFERENCES......Page 102
15. Initial Activation and the Septal Vector......Page 103
REFERENCES......Page 107
Direction of the Terminal QRS Vector in RBBB......Page 108
Terminal Slowing in RBBB......Page 112
Complete and Incomplete RBBB......Page 114
Summary of Rules for Recognizing RBBB......Page 115
RBBB Pattern......Page 116
Axis in RBBB......Page 119
Initial Vector in LBBB......Page 120
Mid-QRS Forces in LBBB......Page 124
Terminal QRS Forces and Intrinsicoid Deflections in LBBB......Page 125
Complete and Incomplete LBBB......Page 129
SECONDARY S-T, T CHANGES......Page 132
SIGNIFICANCE OF RIGHT AND LEFT BUNDLE BRANCH BLOCK......Page 134
REFERENCES......Page 136
GENERAL VECTOR RULES......Page 139
Direction of Initial Forces in Myocardial Infarction......Page 142
Pathogenesis and Recognition of Necrosis Vectors......Page 143
Recognition of a Necrosis Vector in the Frontal Plane......Page 145
Recognizing Sites of Infarction by Frontal Plane Necrosis Changes......Page 147
Horizontal Plane Necrosis Changes......Page 153
Normal Septal Versus Infarct Vectors in the Horizontal Plane......Page 165
Uncovering Hidden Necrosis Vectors......Page 169
Infarction in the Presence of LBBB......Page 171
LBBB Initial Vectors Versus Infarct Vectors......Page 174
Right Ventricular Overload Initial Vectors Mimicking Necrosis......Page 177
Normal Q Wave in Lead 3 Versus Inferior Infarction......Page 181
REFERENCES......Page 183
CLASSIC WOLFF-PARKINSON-WHITE SYNDROME......Page 187
CLASSIFYING WPW TYPES......Page 190
ELICITING THE ACCESSORY AV BUNDLE TYPE OF PREEXCITATION......Page 193
DELTA WAVE MASKING AND MIMICKING EFFECTS......Page 194
James Fibers and Short P-R, Normal QRS Preexcitation......Page 196
REFERENCES......Page 200
HEMIBLOCKS OR DIVISIONAL BLOCKS......Page 202
Definitions of Left Axis Deviation......Page 206
Significance of Left Axis Deviation......Page 208
Anterior Divisional Blocks and Left Precordial S Waves......Page 214
Left Axis Deviation with No Divisional Blocks......Page 216
LVH and Anterior Divisional Blocks......Page 217
Congenital Heart Disease with Possible ADBs......Page 218
Posterior Divisional Blocks......Page 221
Initial Vector in Divisional Blocks......Page 222
Bifascicular Blocks......Page 225
Masquerading Bundle Branch Block......Page 228
Trifascicular and Quadrifascicular Blocks or Delays......Page 229
Etiologies and Prognoses of Bifascicular and Trifascicular Blocks......Page 231
PERIINFARCTION BLOCKS......Page 234
Imitators of Classic Periinfarction Block, or Divisional Blocks with Terminal Slowing plus a Necrosis Vector......Page 237
REFERENCES......Page 238
NORMAL REPOLARIZATION PROCESS......Page 241
GENESIS AND DIRECTION OF THE INJURY CURRENT......Page 242
Frontal Plane Sites of Infarction......Page 244
Horizontal Plane Sites......Page 247
Significance of the Injury Current......Page 250
THE BRUGADA SYNDROME......Page 252
PERICARDITIS VERSUS INFARCTION......Page 253
EARLY REPOLARIZATION VERSUS PERICARDITIS......Page 256
LEFT VENTRICULAR HYPERTROPHY STRAIN PATTERN VERSUS AN INJURY CURRENT......Page 261
DIGITALIS S-T VECTOR VERSUS THE LVH STRAIN PATTERN......Page 262
SUBENDOCARDIAL CURRENT OF INJURY......Page 265
J WAVE AND HYPOTHERMIA......Page 270
Methods and Purposes......Page 271
Safety Measures......Page 273
Criteria for Positivity for an Ischemic S-T Response......Page 274
How to Avoid False Positives......Page 279
How to Avoid False-Negative Tests for Ischemia......Page 281
VASOSPASTIC ANGINA PECTORIS S-T ABNORMALITIES......Page 283
REFERENCES......Page 286
DIRECTION OF THE NORMAL T VECTOR......Page 291
SHAPE AND DURATION OF THE ISCHEMIC T......Page 294
T DIRECTION IN MYOCARDIAL INFARCTION......Page 297
T NEGATIVITY IN PERICARDITIS......Page 306
POSTEXTRASYSTOLIC, POST-TACHYCARDIA, AND POSTPULMONARY EDEMA T ABNORMALITIES......Page 307
REFERENCES......Page 309
TALL T WAVE DIFFERENTIAL DIAGNOSIS......Page 311
Q-T INTERVAL......Page 318
Q-T and Hypercalcemia......Page 320
Q-T and T in Hypocalcemia......Page 322
U WAVE......Page 323
Negative U Waves......Page 325
Hypokalemia and U Waves......Page 327
T WAVES OF CARDIOMYOPATHIES MYOCARDIAL INFILTRATION, FIBROSIS, INFLAMMATION......Page 329
Notched T Waves......Page 330
REFERENCES......Page 337
JUVENILE T PATTERN......Page 341
NEUROTIC HEART T SYNDROME......Page 343
HYPERVENTILATION SYNDROME T ABNORMALITIES......Page 344
ISOLATED T NEGATIVITY SYNDROME......Page 345
BENIGN T NEGATIVITY OF ATHLETES......Page 346
CEREBRAL AUTONOMIC T ABNORMALITIES......Page 347
PROLAPSED MITRAL VALVE SYNDROME......Page 352
SUSPENDED HEART SYNDROME......Page 354
T WAVES AFTER ARTIFICIAL PACING......Page 355
REFERENCES......Page 357
PROBLEM OF INCREASED VOLTAGE......Page 359
FRONTAL PLANE LVH CRITERIA......Page 360
HORIZONTAL PLANE LVH CRITERIA......Page 363
SECONDARY LVH CRITERIA......Page 367
SECONDARY HORIZONTAL PLANE LVH CRITERIA......Page 371
LVH STRAIN PATTERN......Page 372
OTHER SECONDARY T CRITERIA FOR LVH......Page 375
CAUSES OF REDUCED VOLTAGE......Page 377
ACQUIRED VENTRICULAR DILATATION......Page 381
BUNDLE BRANCH BLOCK AND LVH......Page 384
SIGNIFICANCE OF LVH ON THE ECG IN SYSTOLIC OVERLOADS......Page 385
VOLUME OVERLOADING OF THE LEFT VENTRICLE......Page 387
REFERENCES......Page 390
FRONTAL PLANE CRITERIA......Page 394
Frontal Plane......Page 397
Horizontal Plane......Page 401
Pectus Excavatum Versus Emphysema......Page 402
P Signs......Page 403
Anterior QRS in RVH......Page 404
Posterior QRS in RVH......Page 408
R/S Ratio Regression Sign of RVH......Page 411
INITIAL NEGATIVITY IN V1 WITH RVH......Page 412
S-T, T IN THE RIGHT PRECORDIUM WITH RVH......Page 414
ECG with Systolic or Pressure Overloading......Page 416
RVH of Pulmonary Stenosis......Page 418
RBBB Pattern and Right Ventricular Overloading......Page 419
RVH WITH ACUTE PULMONARY EMBOLISM......Page 420
Right Ventricular Diastolic Overload Pattern......Page 423
Combined Ventricular Overloads......Page 424
REFERENCES......Page 426
P Axis in Right Atrial Overload......Page 430
P Axis in COPD......Page 431
P Pulmonale......Page 433
Pseudo P Pulmonale......Page 436
Horizontal Plane Signs of Right Atrial Overload......Page 437
Ta WAVE AND P-R SEGMENT......Page 440
Physiology and Etiologies......Page 442
Wide, Notched P Waves in Left Atrial Overload Intraatrial Block......Page 443
Horizontal Plane Signs of Left Atrial Overload......Page 445
Left Atrial Overload in Coronary Disease......Page 449
ATRIAL OVERLOADS IN ATRIAL ARRHYTHMIAS......Page 451
REFERENCES......Page 452
READING HEART RATES......Page 455
Sinus Tachycardia and Bradycardia......Page 456
Sinus Arrhythmia......Page 457
Natural Pacemakers and the Transmembrane Action Potential......Page 458
Phase 4 and Heart Rate......Page 460
Phase 4 and Dominant Pacemakers......Page 461
SA Block and Sinus Arrest......Page 462
Sinus Node Dysfunction and the Sick Sinus Syndrome......Page 464
AV Nodal Conduction Properties......Page 467
First-Degree AV Block......Page 469
Laddergram......Page 473
Type 1......Page 474
Type 2......Page 478
Pacemaker Site and Characteristics......Page 481
Atria in Complete AV Block......Page 484
Complete AV Block with Acute Myocardial Infarction......Page 485
Supernormal Conduction......Page 486
ESCAPE BEATS......Page 488
Escape Pacemakers with Myocardial Infarction......Page 490
Physiology of Automatic Cells......Page 491
P Wave Directions and Atrial Ectopic Sites......Page 492
Premature Atrial Contractions......Page 495
P' in Junctional and Low Atrial Pacemakers......Page 496
P'-R and P'-P Intervals......Page 498
Hidden Ectopic P Wave Diagnosis......Page 500
Aberrant Conduction with Premature Atrial Contractions......Page 501
RIGHT AND LEFT ATRIAL DISSOCIATION......Page 504
REFERENCES......Page 505
Site of Origin of PVCs......Page 511
Timing of PVCs in the Cycle......Page 512
Post-PVC Perfect Compensatory Pause......Page 514
Interpolated PVCs......Page 515
Group Beating......Page 518
Concealed Extrasystoles......Page 520
Reentry Theory......Page 521
Multiform Versus Multifocal PVCs......Page 524
Parasystole Defined......Page 525
Parasystole and Coupling......Page 526
Parasystolic Entrance and Exit Blocks......Page 527
Parasystole and Fusion Beats......Page 528
Parasystole Recognition......Page 529
RECIPROCAL BEATS......Page 530
Atrial and Ventricular Rates......Page 532
Characteristics of f Waves......Page 533
Causes of AF......Page 534
AF and Digitalis......Page 535
AF with Aberrant Conduction......Page 537
Atrial Flutter F Wave Characteristics......Page 541
F Wave-QRS Relations......Page 542
Causes of Atrial Flutter......Page 547
Atrial Tachycardia......Page 548
Reciprocal Beat Theory for ATs......Page 550
AT in the WPW and Lown-Ganong-Levine Syndromes......Page 552
AT with Block......Page 553
Junctional Tachycardias......Page 554
Multifocal or Chaotic AT......Page 556
Isorhythmic Dissociation......Page 558
ELECTRICAL ALTERNANS......Page 559
VENTRICULAR TACHYCARDIA......Page 560
Mechanisms and Causes of VT......Page 562
Chronic VT......Page 564
Arrhythmogenic Right Ventricular Dysplasia ARVD......Page 565
The Brugada Syndrome......Page 566
Differentiation of VT from Supraventricular Tachycardias......Page 567
AV Dissociation......Page 574
Capture and Fusion Beats......Page 578
Bidirectional Tachycardia......Page 579
VENTRICULAR FLUTTER AND FIBRILLATION......Page 580
REFERENCES......Page 582
FIXED-RATE PACEMAKERS......Page 589
DEMAND PACEMAKERS......Page 591
THREE-LETTER PACEMAKER CODE......Page 594
PACEMAKER FAILURE......Page 596
RECOGNITION OF IMPLANTATION SITE......Page 597
PACEMAKER ARRHYTHMIAS......Page 599
REFERENCES......Page 600
TECHNIQUE......Page 601
INTERVALS FROM THE HIS BUNDLE ELECTROGRAM......Page 602
Bundle Branch Block and Aberrant Conduction......Page 603
REFERENCES......Page 604
31. Systematic Approach to Reading an Electrocardiogram......Page 605
A NOTE ON DESCRIBING PREMATURE BEATS OR COMPLEXES......Page 607
Index......Page 608