The Only EKG Book You'll Ever Need

Getting Started 1

Chapter 1
The Basics 9
Electricity and the Heart 10
Time and Voltage 17
P Waves, QRS Complexes, T Waves, and Some Straight Lines 19
Naming the Straight Lines 29
Summary:: The Waves and Straight Lines of the EKG 31 Making Waves 32
The 12 Views of the Heart 37
A Word About Vectors 46
The Normal 12-Lead EKG 47
Summary:: Orientation of the Waves of the Normal EKG 58
Coming Attractions 60

Chapter 2
Hypertrophy and Enlargement of the Heart 61
Definitions 62
Axis 65
Summary:: Axis 72
Axis Deviation, Hypertrophy, and Enlargement 75
Atrial Enlargement 78
Summary:: Atrial Enlargement 81
Ventricular Hypertrophy 82
Secondary Repolarization Abnormalities of Ventricular Hypertrophy 88
Summary:: Ventricular Hypertrophy 90
Case 1 91
Case 2 92

Chapter 3
Arrhythmias 95
The Clinical Manifestations of Arrhythmias 97
Why Arrhythmias Happen 98
Rhythm Strips 99
How To Determine the Heart Rate From the EKG 102
The Four Basic Types of Arrhythmias 106
Arrhythmias of Sinus Origin 107
Ectopic Rhythms 114
The Four Questions 117
Ectopic Supraventricular Arrhythmias 119
Summary:: Supraventricular Arrhythmias 130
Ectopic Ventricular Arrhythmias 131
Summary:: Ventricular Arrhythmias 138
Summary:: Rules of Malignancy for PVCs 138
Supraventricular Versus Ventricular Arrhythmias 139
Summary:: Ventricular Tachycardia (VT) Versus Paroxysmal Supraventricular Tachycardia (PSVT) With Aberrancy 145
Programmed Electrical Stimulation 146
Implantable Defibrillators 147
Case 3 150
Case 4 152

Chapter 4
Conduction Blocks 155
What Is a Conduction Block? 156
AV Blocks 157
Summary:: AV Block 166
Bundle Branch Block 167
Summary:: Bundle Branch Block 173
Hemiblocks 174
Summary:: Criteria for Hemiblock 178
Combining Bundle Branch Blocks and Hemiblocks 179
Summary:: Criteria for Bifascicular Block 179
The Ultimate in Playing With Blocks:: Combining AV Blocks, Bundle Branch Blocks, and Hemiblocks 182
Pacemakers 184
Case 5 188

Chapter 5
Preexcitation Syndromes 191
What Is Preexcitation? 192
Wolff-Parkinson-White Syndrome 194
Lown-Ganong-Levine Syndrome 195
Associated Arrhythmias 196
Summary:: Preexcitation 200
Case 6 201

Chapter 6
Myocardial Ischemia and Infarction 203
What Is a Myocardial Infarction? 204
How to Diagnose a Myocardial Infarction 205
Summary:: The EKG Changes of an Evolving Myocardial Infarction 217
Localizing the Infarct 218
Non–Q Wave Myocardial Infarctions 227
Angina 229
Summary:: The ST Segment in Cardiac Disease 231
Limitations of the EKG in Diagnosing an Infarction 232
Stress Testing 233
Case 7 238

Chapter 7
Finishing Touches 245
Electrolyte Disturbances 247
Hypothermia 251
Drugs 252
Other Cardiac Disorders 256
Pulmonary Disorders 260
Central Nervous System Disease 262
The Athlete’s Heart 263
Summary:: Miscellaneous Conditions 264
Case 8 266

Chapter 8
Putting It All Together 269
The 11-Step Method for Reading EKGs 272
Review Charts 274

Chapter 9
How Do You Get To Carnegie Hall?* 291