© Steve Allen/Brand X Pictures/Alamy Images
© Steve Allen/Brand X Pictures/Alamy Images
SECTION 1: Introduction to Arrhythmia Recognition
Chapter 1: Anatomy and Basic Physiology
The Electrical Conduction System
The Atrioventricular (AV) Node
The Left Anterior Fascicle (LAF)
The Left Posterior Fascicle (LPF)
Membrane Channels and Action Potential Phases
Introduction to the Nervous System and Cardiac Function
Peripheral Nervous System (PNS)
Chapter 3: Paper, Tools, and Calculating Rates
Temporal Relationship of Multiple-Lead Strips
Why Is Temporal Spacing Important?
Calipers: The Clinician’s Best Friend
Let’s practice calculating some rates . . .
Chapter 4: Vectors and the Basic Beat
Adding and Subtracting Vectors
The Electrical Axis of the Heart
Leads Are Like Pictures of the Heart
Lead Placement (Where to Put the “Cameras”)
How the Machine Manipulates the Leads
Introduction to Basic Components
Individual Components of the ECG Complex
Chapter 5: Introduction to 12-Lead ECGs
Localizing an Area: Inferior Wall
How to Calculate the Electrical Axis
What Happens If One Side Is Blocked?
Right Bundle Branch Block (RBBB)
Left Bundle Branch Block (LBBB)
Chapter 6: Electrocardiography and Arrhythmia Recognition
Ectopic Foci and Their Morphologies
Ectopic Foci in the Ventricles
The Isolated Electrocardiographic Type of Fusion
Chapter 7: How to Interpret a Rhythm Strip
1. Is the rhythm fast or slow?
4. Are all the P waves the same?
5. Does each QRS complex have a P wave?
6. Is the PR interval constant?
Questions Related to the QRS Complexes
7. Are the P waves and QRS complexes associated with one another?
8. Are the QRS complexes narrow or wide?
9. Are the QRS complexes grouped or not grouped?
10. Are there any dropped beats?
A Final Thought Before We Move On
Chapter 8: Normal Sinus Rhythm
When Is Sinus Bradycardia Considered a Cardiac Emergency?
Nonrespiratory or Nonphasic Sinus Arrhythmia
Some Additional Clinical Points
Chapter 12: Sinus Blocks, Pauses, and Arrests
Chapter 13: Premature Atrial Contraction
Chapter 14: Ectopic Atrial Rhythm
Hint #1: Always Try to Compare Your New Strip to an Old ECG or Rhythm Strip
Hint #2: Always Evaluate the P-Wave Morphology and the PR Interval
Chapter 15: Focal Atrial Tachycardia
Chapter 16: Focal Atrial Tachycardia with Block
P Waves in Focal AT with Block
Chapter 17: Wandering Atrial Pacemaker
Wandering Atrial Pacemaker: The Classical Definition
Wandering Atrial Pacemaker: A Clinical Variation
Chapter 18: Multifocal Atrial Tachycardia
The Making of the Saw-Tooth Pattern
Atrial Flutter and Wide- Complex Tachycardias
Chapter 20: Atrial Fibrillation
Regular Ventricular Response in Atrial Fibrillation
The Morphology of the Complexes in Atrial Fibrillation
The QRS Complex in Atrial Fibrillation
Chapter 21: Introduction to Junctional Rhythms
Junctional Rhythms: An Overview
Chapter 22: Premature Junctional Contraction
Junctional Escape Complexes and Rhythms
Chapter 24: Rapid Junctional Rhythms
Chapter 25: AV Nodal Reentry Tachycardia
Step 1: General Concepts in AV Nodal Reentry
Step 3: Identifying the Arrhythmia
Chapter 26: AV Reentry Tachycardia
Normal Conduction Through an Accessory Pathway
Other Important Clinical Facts
Chapter 27: Narrow-Complex Supraventricular Tachycardia
1. Physiologic Sinus Tachycardia
2. Inappropriate Sinus Tachycardia
4. Multifocal Atrial Tachycardia
5. AV Nodal Reentry Tachycardia
6. Orthodromic AV Reentry Tachycardia
How to Approach a Narrow-Complex SVT
History and Physical Examination
Narrow Complex vs. Wide Complex
P-Wave Morphology and Orientation
AV Node–Dependent vs. –Independent Classification
Electrophysiologic Intervention
Hemodynamic Consequences of a Tachycardia
Focused Treatment Requires Focused Identification
Chapter 28: Atrioventricular Blocks
Mobitz I Second-Degree AV Block or Wenckebach
Mobitz I Second-Degree AV Block: A Final Word
Mobitz II Second-Degree AV Block
Untypable or 2:1 Second-Degree AV Block
High-Grade or Advanced AV Block
Complete or Third-Degree AV Block
SECTION 5: Ventricular Rhythms
Chapter 29: Introduction to Ventricular Rhythms
The P Wave in Ventricular Rhythms
P-Wave Morphology in Ventricular Rhythms
The P:QRS Relationship in Ventricular Rhythms
Ventricular Rhythms: General Overview
Chapter 30: Premature Ventricular Contraction
Compensatory vs. Noncompensatory Pauses
Couplets, Triplets, and Salvos
Chapter 31: Ventricular Escape and Idioventricular Rhythms
Accelerated Idioventricular Rhythm
Chapter 32: Ventricular Tachycardia
Reentry and Other Possible Mechanisms
1. The presence of an electrical circuit with at least two pathways
2. The two pathways must have different properties
General Characteristics of Ventricular Tachycardia
Morphology of the Complexes and Arrhythmia Recognition
Nonsustained Monomorphic Ventricular Tachycardia
Sustained Monomorphic Ventricular Tachycardia
Chapter 33: Polymorphic Ventricular Tachycardia and Torsade de Pointes
Polymorphic Ventricular Tachycardia
Chapter 34: Wide-Complex Tachycardia: The Basics
A Quick Recap and the WCT Umbrella
Wide-Complex Tachycardias: What Makes Them Wide
The Five Groups Comprising the Wide-Complex Tachycardias
2. Supraventricular Tachycardias with Rate-Related Aberrancy
3. SVT-A with Preexisting BBB or IVCD
4. SVT-A Due to Metabolic, Physiologic, Pharmacologic, or Paced Causes (MP3s)
5. SVT-A Due to Conduction Over an Accessory Pathway
Chapter 35: Wide-Complex Tachycardia: The Approach
The Emerging WCT Paradigm Shift
The Emergent Evaluation of WCTs Made Insanely Simple!
Our Rationale: Hemodynamic Status
Our Rationale: VTach, VTach, VTach . . .
How to Manage the Emergent Period
Nonurgent Evaluation of the WCTs
Chapter 36: Wide-Complex Tachycardia: Criteria
Wide-Complex Tachycardias: Nonurgent Stage
History and Physical Examination
Concordance of the QRS Complexes in the Precordial Leads
Other Adjuncts to the Diagnosis of WCT
Chapter 37: Wide-Complex Tachycardia: Putting It All Together
Chapter 38: Ventricular Fibrillation and Asystole
SECTION 6: Additional Rhythms and Information
Chapter 39: Artificially Paced Rhythms
QRS Morphology in a Paced Rhythm
Chapter 40: Putting It All Together
1. Is the Rhythm Fast or Slow?
2. Is the Rhythm Regular or Irregular?
5. Are the P Waves Upright in Lead II?
6. Are the PR Intervals Normal and Consistent?
8. Are the QRS Complexes Narrow or Wide?
9. Are the Complexes Grouped or Not Grouped?
10. Are There Any Dropped P Waves?
How Can I Put It All Together?
Overall Impression of the Rhythm
Question 1: Is the Rhythm Fast or Slow?
Question 2: Is the Rhythm Regular or Irregular?
Question 3: Do You See Any P Waves?
Question 4: Are All of the P Waves the Same?
Question 5: Are the P Waves Upright in Lead II?
Question 6: Are the PR Intervals Normal and Consistent?
Question 7: What Is the P:QRS Ratio?
Question 8: Are the QRS Complexes Narrow or Wide?
Question 9: Are the Complexes Grouped or Not Grouped?