Making Sense of the ECG: A Hands-On Guide

Cover......Page 1
Title Page......Page 2
Copyright Page......Page 3
Contents......Page 4
Preface to the fifth edition......Page 8
Acknowledgements......Page 10
Author......Page 12
1. Anatomy and physiology......Page 14
Cardiac activation......Page 15
The cardiac conduction system......Page 16
The cardiac cycle......Page 17
Further reading......Page 18
What does the ECG actually record?......Page 20
How does the ECG ‘look’ at the heart?......Page 21
Where do each of the waves come from?......Page 24
Further reading......Page 31
Initial preparations......Page 32
Placement of the limb electrodes......Page 33
Placement of the chest (precordial) electrodes......Page 34
Einthoven’s triangle......Page 35
Recording the 12-lead ECG......Page 38
Further reading......Page 40
Technical data......Page 42
Report summary......Page 43
Further reading......Page 44
5. Heart rate......Page 46
Is the heart rate below 60/min?......Page 48
Is the heart rate above 100/min?......Page 49
Further reading......Page 52
6. An approach to heart rhythms......Page 54
Identifying the cardiac rhythm......Page 55
How is the patient?......Page 56
Is the ventricular rhythm regular or irregular?......Page 57
Is the QRS complex width normal or broad?......Page 58
Determining the cardiac rhythm......Page 60
Further reading......Page 61
Sinus rhythm......Page 62
Sinus bradycardia......Page 63
Sinus tachycardia......Page 64
Sick sinus syndrome......Page 65
Atrial ectopic beats......Page 66
Atrial fibrillation......Page 67
Atrial flutter......Page 72
Atrial tachycardia......Page 74
AV re-entry tachycardia......Page 75
AV nodal re-entry tachycardia......Page 80
Further reading......Page 83
Ventricular ectopic beats......Page 84
Accelerated idioventricular rhythm......Page 87
Monomorphic ventricular tachycardia......Page 88
How do I distinguish between VT and SVT?......Page 91
Polymorphic ventricular tachycardia......Page 93
Ventricular fibrillation......Page 94
Further reading......Page 96
Conduction block at the AV node or bundle of His......Page 98
Conduction block at the bundle branches......Page 101
Escape rhythms......Page 106
Accelerated conduction and accessory pathways......Page 107
Further reading......Page 108
Understanding and measuring the QRS axis......Page 110
Is there left axis deviation?......Page 119
Is there right axis deviation?......Page 121
Further reading......Page 123
Are any P waves absent?......Page 124
Are any P waves inverted?......Page 127
Are any P waves too tall?......Page 128
Are any P waves too wide?......Page 129
Further reading......Page 130
12. The PR interval......Page 132
Is the PR interval less than 0.12 s long?......Page 133
Is the PR interval more than 0.2 s long?......Page 135
Does the PR interval vary or can it not be measured?......Page 136
Is the PR segment elevated or depressed?......Page 140
Further reading......Page 142
Are there any ‘pathological’ Q waves?......Page 144
Further reading......Page 149
Are any R or S waves too big?......Page 150
Are the QRS complexes too small?......Page 155
Are any QRS complexes too wide?......Page 158
Are any QRS complexes an abnormal shape?......Page 161
Are epsilon waves present?......Page 163
Further reading......Page 165
Are the ST segments elevated?......Page 166
Are the ST segments depressed?......Page 179
Are J waves present?......Page 183
Further reading......Page 185
16. The T wave......Page 186
Are the T waves too tall?......Page 187
Are the T waves too small?......Page 189
Are any of the T waves inverted?......Page 190
Further reading......Page 195
17. The QT interval......Page 196
Correcting the QT interval......Page 197
Is the QTc interval long?......Page 198
Is the QTc interval short?......Page 201
Further reading......Page 204
18. The U wave......Page 206
Do the U waves appear too prominent?......Page 207
Are any of the U waves inverted?......Page 208
Further reading......Page 209
External electrical interference......Page 210
Incorrect calibration......Page 211
Patient movement......Page 212
Further reading......Page 214
Normal ECG findings......Page 216
‘Borderline’ ECG findings......Page 219
Further reading......Page 220
What do pacemakers do?......Page 222
Indications for permanent pacing......Page 223
Selection of a permanent pacemaker......Page 224
Pacing and the ECG......Page 225
Implantable cardioverter-defibrillators......Page 227
Further reading......Page 228
22. Ambulatory ECG recording......Page 230
Event recorder......Page 231
Bedside monitoring/telemetry (inpatient)......Page 232
Smartphone/smartwatch applications......Page 233
Further reading......Page 234
What are the indications for an exercise ECG?......Page 236
What are the risks of an exercise ECG?......Page 237
How do I perform an exercise ECG?......Page 238
How do I interpret an exercise ECG?......Page 239
Further reading......Page 241
Appendix 1: Glossary......Page 242
Appendix 2: ECG resources......Page 246
Appendix 3: Help with the next edition......Page 248
Index......Page 250