Electrocardiogram in clinical medicine /
edited by William J Brady, Michael J Lipinski, Andrew Darby, Michael C Bond, Nathan Charlton, Korin Hudson, Kelly Williamson.
- 1 online resource (512 pages).
ABOUT THE AUTHOR William J. Brady, MD, is Professor of Emergency Medicine and Medicine, University of Virginia, Charlottesville, VA, USA.
Michael J. Lipinski, MD, PhD, is Cardiovascular Associates of Charlottesville, Charlottesville, VA, USA.
Andrew E. Darby, MD, FHRS, is Associate Professor of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA.
Michael C. Bond, MD, FACEP, FAAEM, is Associate Professor of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Nathan P. Charlton, MD, is Associate Professor of Emergency Medicine, Division of Medical Toxicology, University of Virginia, Charlottesville, VA, USA.
Korin Hudson, MD, is Associate Professor of Emergency Medicine, MedStar Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC, USA.
Kelly Williamson, MD, is Assistant Residency Program Director, Advocate Christ Medical Center Emergency Medicine Residency; and is Clinical Associate Professor of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Includes bibliographical references and index.
TABLE OF CONTENTS List of Contributors xxi
Section I The ECG in Clinical Practice 1
1 The ECG in Clinical Medicine 3 Brian Kessen and Kelly Williamson
Introduction 3
The ECG as a Clinical Tool 3
Clinical Presentations and the ECG 4
Chest Pain 4
Dyspnea 5
Syncope 6
Toxicology 7
Electrolyte Abnormalities 7
Pacemakers 10
Conclusion 10
References 10
2 History of the Electrocardiogram 13 Trale Permar and Kelly Williamson
References 17
Section II ECG Changes in Myocardial Ischemia 19
1 The Cardiac Action Potential and Changes in the Setting of Acute Coronary Syndrome: How Ischemia and Infarction Impacts the ECG 21 Kirsti A. Campbell and Michael J. Lipinski
Introduction 21
Basic Electrophysiology 21
Action Potentials in Sodium-Dependent Depolarizers 21
Action Potential in Calcium-Dependent Depolarizers 24
Anatomy of the Electrical Conduction System 24
Biochemical Impact of Ischemia 25
ST-Segment Deviation 25
QRS Complex 30
T Waves 31
P Waves 31
U Waves 34
Myocardial Ischemia: Causes Other than Acute Coronary Syndrome 34
Conclusion 34
References 36
2 Ischemic Electrocardiographic Changes and Correlation with Regions of the Myocardium 37 Thibault Lhermusier and Michael J. Lipinski
Introduction 37
Coronary Anatomy 37
Definitions of STEMI and Non-ST Elevation ACS 38
Left Main Coronary Ischemia 39
Anterior STEMI 40
Wellens Syndrome 40
Inferior STEMI 41
Right Ventricular Infarction 41
Lateral STEMI 44
Posterior STEMI 44
Conduction Abnormalities in the Setting of Ischemia 46
Aneurysm of the Left Ventricle 49
ECG in Pharmacological and Mechanical Reperfusion 49
3 ECG in the ICU Patient: Identification and Treatment of Arrhythmias in the Intensive Care Unit 345 Feras Khan
Introduction 345
Common Dysrhythmias in the ICU 345
Other Common Electrocardiographic Findings 352
The Effect of Vasopressors on Cardiac Conduction 352
Consequences of Anti-Arrhythmic Medications 353
Arrhythmias Induced by Central Line Placement 354
Specific Clinical Conditions 354
Conclusion 357
References 357
4 The ECG in Patients with Implanted Cardiac Devices 359 Ali Farzad, Benjamin J. Lawner, and Tu Carol Nguyen
Basics of Pacemakers 359
Electrocardiographic Findings in Normally Functioning Pacemakers 360
Electrocardiographic Findings in Abnormally Functioning Pacemakers 361
Key Points: Electrocardiographic Clues to Pacemaker Malfunction 368
Electrocardiographic Diagnosis of Acute Myocardial Infarction in the Presence of a Paced Rhythm 368
Basics of the Implantable Cardioverter Defibrillator 370
Electrocardiographic Findings after Defibrillation 370
Basics of Left Ventricular Assist Devices 371
References 375
5 Electrocardiographic Manifestations of Cardiac Transplantation 377 Semhar Tewelde
Introduction 377
Cardiac Transplantation 377
Conclusion 80
Key Points 380
References 380
Section VII Electrocardiographic Differential Diagnosis 383
1 Abnormalities of the P Wave and PR Interval 385 Matthew Borloz
The Normal P Wave 385
The Abnormal P Wave 385
The Normal PR Interval 387
The Abnormal PR Interval 387
Conclusion 395
References 395
2 Differential Diagnosis of QRS Complex Abnormalities 397 Matthew Wilson, Michael Ybarra, and Munish Goyal
QRS Complex Abnormalities 397
The Large QRS Complex 397
The Small QRS Complex 398
The Wide QRS Complex 399
References 405
3 Differential Diagnosis of ST Segment Changes 407 Korin Hudson and Norine McGrath
Introduction 407
Describing ST-Segment Changes 407
Acute Coronary Syndrome and Related ST Segment Deviation 408
Nonischemic Causes of ST-Segment Changes 412
Benign Early Repolarization 414
Acute Myocarditis/Pericarditis 415
Ventricular Aneurysm 416
Digitalis 416
Hypothermia 417
Hyperkalemia 417
Brugada Syndrome 417
Tachycardia-Related STD 418
CNS Injury 418
Other Causes 418
References 419
4 ECG Differential Diagnosis of T Wave and QT Interval Abnormalities 421 Sanjay Shewakramani and Kari Gorder
The T Wave 421
Prominent T Waves 421
Benign Early Repolarization 422
T-Wave Inversions 422
The QT Interval 427
QT Prolongation 428
Congenital Long QT Syndrome 429
Short QT Interval 429
Congenital Short QT Syndrome 429
References 429
5 Bradycardia 433 B. Elizabeth Delasobera and Tress Goodwin
Bradycardia Basics 433
Bradycardia Rhythms 433
Rhythms That Can Be Slow 434
Slow Atrial Fibrillation 435
Slow Atrial Flutter 437
AV Blocks 437
First-Degree AV Block 438
Second-Degree AV Block: Mobitz Type 1 (Wenckebach) 438
Second-Degree AV Block: Mobitz Type 2 438
Third-Degree or Complete Heart Block 439
Conclusion 439
6 Rhythms Presenting with Normal Rate 441 Robert Katzer and Janet Smereck
Definitions and Clinical Considerations 441
Regular Rhythms 441
Irregular Rhythms 442
References 447
7 Narrow Complex Tachycardia 449 David J. Carlberg and Rahul Bhat
Introduction 449
Mechanisms for NCTs 449
Approach to NCT 450
Sinus Node Tachycardias 453
Atrial Tachycardias 453
Reentrant Tachycardia Involving the AV Node 457
Junctional Tachycardia 459
Conclusions 459
References 460
8 Wide Complex Tachycardia 461 Scott Young and Rachel Villacorta Lyew
Introduction to Wide Complex Tachycardia 461
Monomorphic WCT 461
Polymorphic WCTs 468
References 470
Index 473
"ECG interpretation is an essential skill in the acute setting; Being able to tell the difference between a comparatively benign and/or temporary rhythmic abnormality and signs of impending cardiac arrest can literally mean the difference between life and death. It's no surprise then that Dr Brady's two books on ECGs for the Emergency Physician have been perennial best-sellers. No less important than being able to recognize clinical emergencies as evidence in ECG tracings is an understanding of the full clinical implications of the ECG reading. Such knowledge enables providers to speed treatment, order further diagnostic tests, call for specialist assistance, and in all ways enhances patient care. As Dr Brady points out, there are currently, several books that present information on ECG interpretation for acute care clinicians, but none addresses clinical medicine from the perspective of the ECG as this book will do. Dr Brady and his colleagues will address any and all interpretative issues regarding the "how do I read this ECG" consideration. BUT, they will take this important information a step further, and address what the clinician should do with this important interpretative data. Many books are rather stale missives addressing ECG interpretation in the vacuum. This book will teach and instruct ECG interpretation in the clinical realm so that readers have a complete and 3-dimensional understanding of the patient's situation, the available treatment options, what additional testing should be done, and more. In short, this book will vastly improve providers' ability to take appropriate clinical action based on ECGs seen most often in the acute setting"-- DESCRIPTION Offers a guide for a complete understanding of the disease and conditions most frequently revealed in ECGs recorded in the acute, critical, and emergency care settings
Electrocardiogram in Clinical Medicine offers an authoritative guide to ECG interpretation that contains a focus and perspective from each of the three primary areas of medical care: acute care, critical care and emergency care. It can be used as a companion with the book ECGs for the Emergency Physician I & II (by Mattu and Brady) or as a stand-alone text. These three books can be described as a cumulative EGG reference for the medical provider who uses the electrocardiogram on a regular basis.
Electrocardiogram in Clinical Medicine includes sections on all primary areas of ECG interpretation and application as well as sections that highlight use, devices and strategies. The medical content covers acute coronary syndromes and all related issues, other diseases of the myocardium, morphologic syndromes, toxicology and paediatrics; dysrhythmias will also be covered in detail. This important resource:
• Goes beyond pattern recognition in ECGs to offer a real understanding of the clinical syndromes evidenced in ECGs and implications for treatment
• Covers the indications, advantages and pitfalls of the use of ECGs for diagnosis in all acute care settings, from EMS to ED to Critical Care
• Examines the ECG in toxic, metabolic and environmental presentations; critical information for acute care clinicians who need to be able to differentiate ODs, poisoning and other environmental causes from MI or other cardiac events
• Facilitates clinical decision-making
Written for practicing ER, general medicine, family practice, hospitalist and ICU physicians and medical students, Electrocardiogram in Clinical Medicine is an important book for the accurate interpretation of EGG results.