The ECG Made Practical

Front Cover
Inside Front Cover
The ECG Made Practical
Copyright Page
Table Of Contents
Preface
	What to expect of this book
	What to expect of the ECG
	Acknowledgements
12-lead ECGs
1 The ECG in healthy people
	Types of ECG
	The ‘normal’ ECG
		The normal cardiac rhythm
		The heart rate
			Sinus tachycardia
			Sinus bradycardia
		Extrasystoles
		The P wave
		The PR interval
		The QRS complex
			The cardiac axis
			The size of R and S waves in the chest leads
			The width of the QRS complex
			Q waves
		The ST segment
		The T wave
		The QT interval
		The ECG in athletes
		The ECG in pregnancy
		The ECG in children
		What is a ‘normal ECG’
	What to do
		Further investigations
		Treatment of asymptomatic ECG abnormalities
2 The ECG in patients with palpitations and syncope
	The clinical history and physical examination
		Palpitations
		Dizziness and syncope
		Physical examination
	The ECG
		Syncope due to cardiac disease other than arrhythmias
		Patients with possible tachycardias
			Mitral stenosis
			Pre-excitation syndromes
				The Wolff–Parkinson–White Syndrome
			The long QT syndrome
			The Brugada syndrome
		Patients with possible bradycardias
			Escape rhythms
			Syncope
				Potentially significant conduction abnormalities.
3 The ECG in patients with palpitations and syncope
	Types of ecg monitors
	Features of ambulatory ECG traces
4 The ECG when the patient has a tachycardia
	Mechanism of tachycardias
		Enhanced automaticity and triggered activity
		Abnormalities of cardiac rhythm due to re-entry
		Differentiation between re-entry and enhanced automaticity
		Extrasystoles causing symptoms
		Narrow complex tachycardias causing symptoms
			Atrioventricular re-entry tachycardia
			AV nodal re-entry tachycardia (AVNRT)
			Atrial tachycardia
			Atrial flutter
			Atrial fibrillation
		Broad complex tachycardias causing symptoms
			P waves
			The QRS complex
			Fusion beats and capture beats
			Differentiation of broad complex tachycardias
		Special forms of VT in patients with symptoms
			Right ventricular outflow tract ventricular tachycardia
		Torsade de pointes
		Broad complex tachycardia associated with the WPW syndrome
	Management of arrhythmias
	Electrophysiology and catheter ablation
		The endocardial ECG
		Catheter ablation
		Arrhythmias amenable to ablation
			Atrial flutter
			Atrial fibrillation
			AV node ablation
			Pathway ablation
			Ventricular tachycardia
		Indications for electrophysiology
	Cardiac arrest
		ICD devices
			Pacemaker function
			Defibrillator function
			Anti-tachycardia pacing
			Indications for ICD devices
			ECG appearance
			Abnormal ICD function
5 The ECG when the patient has a bradycardia
	Mechanism of bradycardias
		Sinoatrial disease – the ‘sick sinus syndrome’
		Atrial fibrillation and flutter
		AV block
			The endocardial ECG in AV block
	Management of bradycardias
		Temporary pacing in patients with acute myocardial infarction
		Permanent pacing
			Pacing
			Sensing
			Monitoring
			Pacemaker nomenclature
		Right ventricular pacemakers (VVI)
			ECG appearance
			Extra functions
			Leadless pacemakers
			His pacemakers
		Right atrial pacemakers (AAI)
			ECG appearance
			Extra functions
		Dual-chamber pacemakers (DDD)
			ECG appearance
			Specialist functions
		Abnormal pacemaker function
			Failed pacing capture
			Under-sensing
			Over-sensing or far-field sensing
			Pacemaker-mediated tachycardia
			Magnet rate
		Indications for pacemaker insertion
6 The ECG in patients with chest pain
	History and examination
		Acute chest pain
		The ECG in the presence of acute chest pain
	The ECG in patients with myocardial ischaemia
		ECG changes in STEMI
			Inferior infarction
			Anterior and lateral infarction
			Posterior infarction
			Right ventricular infarction
			Multiple infarctions
			Bundle branch block and myocardial infarction
				Left bundle branch block.
				Right bundle branch block.
		ECG changes in NSTEMI
			Ischaemia without myocardial infarction
			Prinzmetal’s ‘variant’ angina
	The ECG in pulmonary embolism
	The ECG in other causes of chest pain
		Pericarditis
			Aortic stenosis
	ECG pitfalls in the diagnosis of chest pain
		ST elevation
		R wave changes
		ST segment and T wave changes
		Chronic chest pain
		The investigation of chronic chest pain
			Practical aspects of exercise testing
			Reasons for discontinuing an exercise test
			Interpretation of ECG changes during exercise testing
			Risks of exercise testing
			Management of chest pain
7 The ECG in patients with breathlessness
	History and examination
	Rhythm problems
	The ECG in disorders affecting the left side of the heart
		The ECG in left atrial hypertrophy
		The ECG in left ventricular hypertrophy
		ECGs that can mimic left ventricular hypertrophy
	The ECG in disorders affecting the right side of the heart
		The ECG in right atrial hypertrophy
		The ECG in right ventricular hypertrophy
	What to do
		Cardiac resynchronization therapy
			Indications for CRT
			ECG appearance
			Specialist functions
8 The effects of other conditions on the ECG
	Artefacts in ECG recordings
		The effects of abnormal muscle movement
		Hypothermia
	The ECG in congenital heart disease
	The ECG in systemic diseases
		Thyroid disease
		Malignancy
	The Effects of serum electrolyte abnormalities on the ECG
		Potassium
		Magnesium
		Calcium
	The effects of medication on the ECG
		Digoxin
		Drugs that prolong the QT interval
		Lithian
	Other causes of an abnormal ECG
		Trauma
		Metabolic diseases
		Cerebrovascular accidents
		Muscle disease
9 Conclusions
	Description
	Interpretation
	Diagnosis
	Treatment
	Conclusion
		Now test yourself
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
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