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Index
Cover Title Page Copyright Page Brief Contents Contents Resources Dedications and Biographies Acknowledgments Foreword Chapter 1: Anatomy and Basic Physiology
Beginner’s Perspective Gross Anatomy
Anterior View The Heart in Cross Section
The Heart as a Pump
Pump Function Simplified
Cardiac Output
Passive Pumping Active Pumping
The Electrical Conduction System
Pacemaker Function Pacemaker Settings The Sinoatrial (SA) Node The Internodal Pathways The Atrioventricular (AV) Node The Bundle of His The Left Bundle Branch (LBB) The Right Bundle Branch (RBB) The Left Anterior Fascicle (LAF) The Left Posterior Fascicle (LPF) The Purkinje System
Chapter Review
Chapter 2: Electrophysiology
Beginner’s Perspective Introduction Mechanics of Contraction Ion Movement and Polarity Membrane Channels and Action Potential Phases Introduction to the Nervous System and Cardiac Function
Central Nervous System (CNS) Peripheral Nervous System (PNS)
Chapter Review
Chapter 3: Paper, Tools, and Calculating Rates
Boxes and Sizes Calibration Temporal Relationship of Multiple-Lead Strips
Why Is Temporal Spacing Important?
ECG Tools Calipers: The Clinician’s Best Friend
How to Use Your Calipers Comparing Widths
ECG Rulers Straightedge The Rate Establishing the Rate
Normal and Fast Rates Bradycardic Rates
Let’s practice calculating some rates . . . Calculate the rates . . . Chapter Review
Chapter 4: Vectors and the Basic Beat
Beginner’s Perspective Introduction Adding and Subtracting Vectors The Electrical Axis of the Heart Electrodes and Waves Leads Are Like Pictures of the Heart
Lead Placement (Where to Put the “Cameras”) How the Machine Manipulates the Leads
The Two Lead Systems
The Hexaxial System The Precordial System
The Basic Beat Introduction to Basic Components
Wave Nomenclature
Individual Components of the ECG Complex
The P Wave The Tp Wave The PR Segment The PR Interval The QRS Complex The ST Segment The T Wave The QT interval The U Wave Additional Intervals
Chapter Review
Chapter 5: Introduction to 12-Lead ECGs
Introduction Basic Information
Localizing an Area: Inferior Wall Localizing Other Areas
The Electrical Axis How to Calculate the Electrical Axis Bundle Branch Blocks
What Happens If One Side Is Blocked? Right Bundle Branch Block (RBBB) Left Bundle Branch Block (LBBB)
Chapter Review
Chapter 6: Electrocardiography and Arrhythmia Recognition
Beginner’s Perspective Introduction Artifact Premature Complexes Escape Complexes and Rhythms Ectopic Foci and Their Morphologies
Ectopic Foci in the Ventricles
Aberrancy Fusion
The Isolated Electrocardiographic Type of Fusion Actual Fusion
Chapter Review
Chapter 7: How to Interpret a Rhythm Strip
Introduction 10 Questions General Questions
1. Is the rhythm fast or slow? 2. Is the rhythm regular or irregular? If irregular, is it regularly irregular or irregularly irregular?
Questions Related to P Waves
3. Do you see any P waves? 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 Individual Rhythms
Supraventricular Rhythms
Ventricular Rhythms
Heart Blocks
Beginner’s Perspective Chapter Review
Chapter 8: Normal Sinus Rhythm
Beginner’s Perspective Introduction to Sinus Rhythms Normal Sinus Rhythm The Formation of the ECG Regularity
Regularly Irregular Rhythms Irregularly Irregular Rhythms
ECG Strips Chapter Review
Chapter 9: Sinus Bradycardia
Introduction When Is Sinus Bradycardia Considered a Cardiac Emergency? ECG Strips Chapter Review
Chapter 10: Sinus Tachycardia
Beginner’s Perspective Introduction A Quick Clinical Word Clinical Characteristics
Rate
ECG Strips Chapter Review
Chapter 11: Sinus Arrhythmia
Introduction Respiratory Sinus Arrhythmia Nonrespiratory or Nonphasic Sinus Arrhythmia Some Additional Clinical Points ECG Strips Chapter Review
Chapter 12: Sinus Blocks, Pauses, and Arrests
Beginner’s Perspective Introduction Sinus Block Sinus Pause and Sinus Arrest ECG Strips Chapter Review Section 2 Self-Test
Chapter 13: Premature Atrial Contraction
Beginner’s Perspective Introduction The P-Wave Axis PACs and the PR Interval The Pause The PAC and Aberrancy The Hidden PAC
P Falling on a T
Blocked PACs ECG Strips Chapter Review
Chapter 14: Ectopic Atrial Rhythm
Introduction Diagnostic Challenges 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 ECG Strips Chapter Review
Chapter 15: Focal Atrial Tachycardia
Beginner’s Perspective Introduction ECG Strips Chapter Review
Chapter 16: Focal Atrial Tachycardia with Block
Introduction Diagnostic Criteria P Waves in Focal AT with Block The Problem with Lead II ECG Strips Chapter Review
Chapter 17: Wandering Atrial Pacemaker
Beginner’s Perspective Introduction Wandering Atrial Pacemaker: The Classical Definition Wandering Atrial Pacemaker: A Clinical Variation ECG Strips Chapter Review
Chapter 18: Multifocal Atrial Tachycardia
Introduction Clinical Scenario ECG Strips Chapter Review
Chapter 19: Atrial Flutter
General Overview The Making of the Saw-Tooth Pattern AV Nodal Conduction Rates Atrial and Ventricular Rates Recognizing Atrial Flutter Atrial Flutter and Wide- Complex Tachycardias ECG Strips Chapter Review
Chapter 20: Atrial Fibrillation
General Information How f Waves Are Created Ventricular Response Clinical Implications Regular Ventricular Response in Atrial Fibrillation The Morphology of the Complexes in Atrial Fibrillation
The QRS Complex in Atrial Fibrillation
ST Segments and T Waves ECG Strips Chapter Review Section 3 Self-Test
Chapter 21: Introduction to Junctional Rhythms
A Closer Look at the AV Node The Junction as a Pacemaker Junctional Rhythms: An Overview Chapter Review
Chapter 22: Premature Junctional Contraction
Introduction ECG Strips Chapter Review
Chapter 23: Junctional Rhythm
Beginner’s Perspective Introduction Junctional Escape Complexes and Rhythms ECG Strips Chapter Review
Chapter 24: Rapid Junctional Rhythms
Introduction Pseudo-S and Pseudo-R’ Waves ECG Strips Chapter Review
Chapter 25: AV Nodal Reentry Tachycardia
General Overview Step 1: General Concepts in AV Nodal Reentry Step 2: Reentry and AVNRT Step 3: Identifying the Arrhythmia ECG Strips Chapter Review
Chapter 26: AV Reentry Tachycardia
Introduction Normal Conduction Through an Accessory Pathway AVRT Reentry Circuits Orthodromic AVRT
The P Wave and AVRT Other Important Clinical Facts
Antidromic AVRT ECG Strips Chapter Review
Chapter 27: Narrow-Complex Supraventricular Tachycardia
Beginner’s Perspective Before We Move On What Is an SVT? Review of Narrow-Complex SVTs
1. Physiologic Sinus Tachycardia 2. Inappropriate Sinus Tachycardia 3. Focal Atrial Tachycardia 4. Multifocal Atrial Tachycardia 5. AV Nodal Reentry Tachycardia 6. Orthodromic AV Reentry Tachycardia 7. Junctional Tachycardia 8. Atrial Flutter 9. Atrial Fibrillation
How to Approach a Narrow-Complex SVT
Clinical Presentation History and Physical Examination
Evaluating the Strip or ECG
General Discussion Narrow Complex vs. Wide Complex Rate Conduction Ratio Regularity P-Wave Morphology and Orientation The P-QRS Relationship A Closer Look at RP Interval AV Node–Dependent vs. –Independent Classification Other Things to Watch Out For Pharmaceutical Adjuncts Electrophysiologic Intervention Differential Diagnosis
Hemodynamic Consequences of a Tachycardia
Heart Rate and Hemodynamics A Few Extra Seconds
Focused Treatment Requires Focused Identification Chapter Review
Chapter 28: Atrioventricular Blocks
General Overview First-Degree AV Block ECG Strips Second-Degree AV Block
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 Chapter Review Section 4 Self-Test
Chapter 29: Introduction to Ventricular Rhythms
Introduction Morphology The Ventricle as a Pacemaker The P Wave in Ventricular Rhythms
P-Wave Morphology in Ventricular Rhythms The P:QRS Relationship in Ventricular Rhythms
Ventricular Rhythms: General Overview Chapter Review
Chapter 30: Premature Ventricular Contraction
General Overview Coupling Interval Compensatory vs. Noncompensatory Pauses Unifocal vs. Multifocal PVCs Bigeminy, Trigeminy, and More Couplets, Triplets, and Salvos The P Wave and PVCs Fusion Complexes ECG Strips Chapter Review
Chapter 31: Ventricular Escape and Idioventricular Rhythms
General Overview Ventricular Escape Complexes Idioventricular Rhythm Accelerated Idioventricular Rhythm Capture Beats ECG Strips Chapter Review
Chapter 32: Ventricular Tachycardia
General Overview 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 3. An area of slowing in one of the circuits—just enough to allow the rest of the circuit to get over its refractory period
General Characteristics of Ventricular Tachycardia
Morphology of the Complexes and Arrhythmia Recognition Regularity AV Dissociation Similar Morphology to PVCs
Nonsustained Monomorphic Ventricular Tachycardia Sustained Monomorphic Ventricular Tachycardia Ventricular Flutter ECG Strips Chapter Review
Chapter 33: Polymorphic Ventricular Tachycardia and Torsade de Pointes
General Overview Polymorphic Ventricular Tachycardia Torsade de Pointes
Onset of Torsade de Pointes The Turning of the Points Causes of Torsade de Pointes
ECG Strips Chapter Review
Chapter 34: Wide-Complex Tachycardia: The Basics
Introduction A Quick Recap and the WCT Umbrella Wide-Complex Tachycardias: What Makes Them Wide The Five Groups Comprising the Wide-Complex Tachycardias
1. Ventricular Tachycardia 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
A Final Thought Chapter Review
Chapter 35: Wide-Complex Tachycardia: The Approach
The Emerging WCT Paradigm Shift The Three Clinical Stages 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 Final Thoughts Chapter Review
Chapter 36: Wide-Complex Tachycardia: Criteria
Introduction Wide-Complex Tachycardias: Nonurgent Stage Section I: The Criteria
History and Physical Examination QRS Interval Width Regularity QRS Morphology AV Dissociation Concordance of the QRS Complexes in the Precordial Leads Abnormal Axis Deviation Hemodynamic Status Other Adjuncts to the Diagnosis of WCT
Section II: The Algorithms
The Brugada Algorithm The Vereckei aVR Algorithm
Final Thoughts Chapter Review
Chapter 37: Wide-Complex Tachycardia: Putting It All Together
Introduction Putting It All Together The Worksheet Case 1
Clinical Scenario Final Assessment
Case 2
Clinical Scenario Final Assessment
Case 3
Clinical Scenario Final Assessment
Case 4
Clinical Scenario Final Assessment
Case 5
Clinical Scenario Final Assessment
Chapter 38: Ventricular Fibrillation and Asystole
Ventricular Fibrillation Asystole
Agonal Rhythm
ECG Strips Chapter Review Section 5 Self-Test
Chapter 39: Artificially Paced Rhythms
General Overview Pacemaker Code The Pacemaker Spike QRS Morphology in a Paced Rhythm Popular Pacemaker Modes
Atrial Demand Pacemaker Ventricular Demand Pacemaker AV Sequential Automatic Pacemaker
ECG Strips Chapter Review
Chapter 40: Putting It All Together
Introduction “Patient’s”
The History Physical Examination
“Impression” Top 10 “Questions”
1. Is the Rhythm Fast or Slow? 2. Is the Rhythm Regular or Irregular? 3. Do You See Any P Waves? 4. Are the P Waves the Same? 5. Are the P Waves Upright in Lead II? 6. Are the PR Intervals Normal and Consistent? 7. What Is the P:QRS Ratio? 8. Are the QRS Complexes Narrow or Wide? 9. Are the Complexes Grouped or Not Grouped? 10. Are There Any Dropped P Waves? Have I Mined for Gold? How Can I Put It All Together?
“Points” Let’s Go Through an Example
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? Question 10: Are There Any Dropped Beats? Have I Mined for Gold?
Chapter Review
Final Test 1 Final Test 1 Answers Final Test 2 Final Test 2 Answers Chapter Review Answers Abbreviations Glossary ECG Index Subject Index
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