ECG at a Glance

Preface 6 Acknowledgements 7 1 Introduction to the ECG 8 2 Strengths and weaknesses of the ECG 10 Part 1 The normal ECG 3 Basis of the ECG 12 4 The normal P wave 16 5 The normal QRS complex 18 6 The T and U waves 20 Part 2 ECG abnormalities 7 Abnormalities in the shape of the P wave – left and right atrial enlargement 22 8 Increased QRS amplitude 24 9 Q waves and loss of R wave height 26 10 QRS axis deviation 28 11 Long PR interval and QRS broadening 30 12 Delta waves 32 13 ST elevation 34 14 ST depression 36 15 Mild T wave flattening 38 16 Deep T wave inversion 40 17 QT interval and U wave abnormalities 42 Part 3 Clinical syndromes 18 Acute chest pain 44 19 Chronic chest pain 46 20 Acute breathlessness 48 21 Chronic breathlessness 51 22 Palpitations 54 23 Syncope 57 24 Hypertension 60 25 Shock 62 26 Stroke 64 27 Emotion and the ECG 66 28 Sudden cardiac death 68 Part 4 Diseases 29 Acute coronary syndromes 70 30 Non-ST segment elevation myocardial infarction 72 31 ST segment elevation myocardial infarction 74 32 Aortic valve disease and hypertrophic cardiomyopathy 76 33 Mitral valve disease 78 34 Cardiomyopathy and myocarditis 80 35 Pulmonary hypertension 82 36 Congenital heart disease 84 37 Endocrine disease and electrolyte disruption 86 38 Psychological disease and its treatment 88 39 Genetic pro-arrhythmic conditions 90 Part 5 Tachyarrhythmias 40 Distinguishing supraventricular from ventricular tachycardia 92 41 Narrow complex tachycardia 95 42 Atrial ectopic beats 98 43 Atrial fibrillation 100 44 Atrial flutter and atrial tachycardia 102 45 Atrioventricular nodal re-entrant tachycardia 104 46 Atrioventricular re-entrant tachycardia 106 47 Ventricular ectopics 108 48 Non-sustained ventricular tachycardia 110 49 Monomorphic ventricular tachycardia 112 50 Polymorphic ventricular tachycardia 114 51 Ventricular fibrillation 116 Part 6 Bradyarrhythmias and related diseases 52 Sinus node disease 118 53 Left bundle branch block 120 54 Right bundle branch block 122 55 First degree atrioventricular block – long PR interval 124 56 Second degree atrioventricular block 126 57 Atrioventricular block – third degree (complete) heart block 128 Part 7 Pacemakers 58 Pacemakers – basic principles 130 59 Anti-bradycardic pacemakers 132 60 Anti-tachycardic and heart failure devices 134 Part 8 ECG-based investigations 61 External and internal loop recorders 136 62 Tilt-table test and carotid sinus massage 138 63 Twenty-four hour ECGs 140 64 The exercise stress test 144 65 Invasive electrophysiological studies 148 Part 9 Self-assessment case studies Case studies and answers 150 Appendix 162 Index 163