Table of Contents

Title 3
Copyright 4
Dedication 6
Preface 7
Content 8
Getting Started 11
Chapter 1 The Basics 16
Electricity and the Heart 16
The Cells of the Heart 18
Time and Voltage 23
P Waves, QRS Complexes, T Waves, and Some Straight Lines 24
Naming the Straight Lines 33
Summary: The Waves and Straight Lines of the EKG 35
Making Waves 36
The 12 Views of the Heart 40
A Word About Vectors 49
The Normal 12-Lead EKG 50
Summary: Orientation of the Waves of the Normal EKG 59
Coming Attractions 61
Chapter 2 Hypertrophy and Enlargement of the Heart 63
Definitions 63
Axis 65
Summary: Axis 72
Axis Deviation, Hypertrophy, and Enlargement 75
Atrial Enlargement 77
Summary: Atrial Enlargement 80
Ventricular Hypertrophy 81
Secondary Repolarization Abnormalities of Ventricular Hypertrophy 87
Summary: Ventricular Hypertrophy 89
Case 1 90
Case 2 91
Chapter 3 Arrhythmias 93
The Clinical Manifestations of Arrhythmias 94
Why Arrhythmias Happen 95
Rhythm Strips 95
How to Determine the Heart Rate From the EKG 97
The Five Basic Types of Arrhythmias 99
 Arrhythmias of Sinus Origin 100
Summary: Arrhythmias of Sinus Origin 105
Ectopic Rhythms 107
Reentrant Rhythms 107
The Four Questions 109
Supraventricular Arrhythmias 110
Summary: Supraventricular Arrhythmias 121
Ventricular Arrhythmias 122
Summary: Ventricular Arrhythmias 127
Supraventricular Versus Ventricular Arrhythmias 127
Summary: Ventricular Tachycardia Versus PSVT With Aberrancy 132
Programmed Electrical Stimulation 133
Implantable Defibrillators 134
External Defibrillators 134
Case 3 136
Case 4 139
Case 5 141
Chapter 4 Conduction Blocks 143
What Is a Conduction Block? 143
AV Blocks 144
Summary: AV Blocks 152
Bundle Branch Block 153
Summary: Bundle Branch Block 158
Hemiblocks 158
Combining Right Bundle Branch Block and Hemiblocks 163
Blocks That Underachieve 165
The Ultimate in Playing With Blocks: Combining AV Blocks, Right Bundle
165
Branch Block, and Hemiblocks
Pacemakers 166
Case 6 169
Case 7 172
Case 8 172
Chapter 5 Preexcitation Syndromes 175
What Is Preexcitation? 175
Wolff–Parkinson–White Syndrome 176
Lown–Ganong–Levine Syndrome 177
Associated Arrhythmias 178
Summary: Preexcitation 182
Case 9 183
Chapter 6 Myocardial Ischemia and Infarction 185
 What Is a Myocardial Infarction? 185
How to Diagnose a Myocardial Infarction 186
Summary: The EKG Changes of an Evolving Myocardial Infarction 196
Localizing the Infarct 197
Non–Q-Wave Myocardial Infarctions 206
Apical Ballooning Syndrome 208
Angina 208
Summary: The ST Segment in Ischemic Cardiac Disease 210
Limitations of the EKG in Diagnosing an Infarction 211
Stress Testing 211
Case 10 214
Case 11 218
Chapter 7 Finishing Touches 222
Electrolyte Disturbances 222
Hypothermia 225
Drugs 226
More on the QT Interval 229
Other Cardiac Disorders 231
Pulmonary Disorders 234
Central Nervous System Disease 236
Sudden Cardiac Death 236
The Athlete's Heart 238
Preparticipation Screening for Athletes 239
Sleep Disorders 239
The Preoperative Evaluation 240
Summary: Miscellaneous Conditions 241
Case 12 241
Case 13 243
Chapter 8 Putting It All Together 247
The 11-Step Method for Reading EKGs 248
Review Charts 249
Chapter 9 How Do You Get to Carnegie Hall? 261
Index 271