Table Of Contents:
Basic Dysrhythmias and Acute Coronary Syndromes

1 Anatomy And Physiology Of The Heart 1(16)

Anatomy And Physiology Of The Heart 2(2)

Anatomy of the Heart 2(1)

Circulation of the Blood Through the Heart 2(1)

Atrial and Ventricular Diastole and Systole 3(1)

Electrical Conduction System Of The Heart 4(3)

Accessory Conduction Pathways 5(1)

Accessory Atrioventricular Pathways 5(2)

Atrio-His Fibers 7(1)

Nodoventricular/Fasciculoventricular Fibers 7(1)

Cardiac Cells 7(1)

Electrophysiology Of The Heart 8(6)

Resting State of the Cardiac Cell 8(1)

Depolarization and Repolarization 8(1)

Threshold Potential 9(1)

Cardiac Action Potential 10(1)

Refractory Periods 10(1)

Dominant and Escape Pacemakers of the Heart 11(1)

Mechanisms of Abnormal Electrical Impulse Formation 12(5)

Enhanced Automaticity 12(1)

Reentry 12(2)

Triggered Activity 14(1)

Autonomic Nervous System Control Of The Heart 14(3)

2 The Electrocardiogram: Basic Concepts And Lead Monitoring 17(10)

Basic ECG Concepts 17(2)

Electrical Basis of the ECG 17(1)

ECG Paper 17(2)

Basic Components Of The Normal ECG 19(1)

ECG Leads 20(7)

The Basics of ECG Leads 20(1)

Bipolar Leads 20(1)

Monitoring Lead II 20(1)

Monitoring Leads I and III 21(2)

Modified Chest Leads (MCL) 23(1)

Monitoring Lead MCL, 23(1)

Monitoring Lead MCL6 23(1)

Unipolar Leads 24(1)

Acquiring a Quality ECG 25(3)

Artifacts 25(1)

ORS Size and Wandering Baseline 25(2)

3 Components Of The Electrocardiogram 27(26)

Waves 28(14)

P Wave 28(5)

Normal Sinus P Wave 28(1)

Characteristics 28(1)

Description 28(1)

Significance 28(1)

Abnormal Sinus P Wave 28(1)

Characteristics 28(1)

Description 28(1)

Significance 31(1)

Ectopic P Wave "P Prime" or "P'" 31(1)

Characteristics 31(1)

Description 31(1)

Significance 33(1)

QRS Complex 33(5)

Normal ORS Complex 33(1)

Characteristics 33(1)

Description 33(1)

Significance 36(1)

Abnormal ORS Complex 36(1)

Characteristics 36(1)

Description 38(1)

Significance 38(1)

T Wave 38(2)

Normal T Wave 39(1)

Characteristics 39(1)

Description 39(1)

Significance 40(1)

Abnormal T Wave 40(1)

Characteristics 40(1)

Description 40(1)

Significance 40(1)

U Wave 40(2)

Characteristics 40(1)

Description 40(1)

Significance 40(2)

Intervals 42(5)

PR Interval 42(3)

Normal PR Interval 42(1)

Characteristics 42(1)

Description 42(1)

Significance 42(1)

Abnormal PR Interval 42(1)

Characteristics 42(1)

Description 43(1)

Significance 45(1)

QT Interval 45(1)

Characteristics 45(1)

Description 46(1)

Significance 46(1)

R-R Interval 46(1)

Characteristics 46(1)

Description 46(1)

Significance 47(1)

Segments 47(6)

TP Segment 47(1)

Characteristics 47(1)

Description 47(1)

Significance 48(1)

PR Segment 48(1)

Characteristics 48(1)

Description 48(1)

Significance 48(1)

ST Segment 48(6)

Normal ST Segment 48(1)

Characteristics 48(1)

Description 48(1)

Significance 48(1)

Abnormal ST Segment 48(1)

Characteristics 48(1)

Description 48(1)

Significance 51(2)

4 Eight Steps To ECG Interpretation And Analysis 53(26)

Systematic Approach To ECG Analysis 54(1)

Step One: Determine The Heart Rate 54(7)

The 6-Second Count Method 55(1)

The Heart Rate Calculator Ruler Method 55(1)

The R-R Interval Method 55(4)

Method 1 55(3)

Method 2 58(1)

Method 3 58(1)

Method 4 58(1)

The Rule of 300 59(2)

Step Two: Determine Regularity 61(2)

Regular 61(1)

Irregular 61(2)

Step Three: Identify And Analyze The P, P', F, Or F Waves 63(5)

Step Four: Determine The PR Or RP' Intervals And Atrioventricular Conduction Ratio 68(5)

Step Five: Identify And Analyze The QRS Complexes 73(1)

Step Six: Determine The Site Of Origin Of The Dysrhythmia 73(4)

Step Seven: Identify The Dysrhythmia 77(1)

Step Eight: Evaluate The Significance Of The Dysrhythmia 77(2)

5 Sinus Node Dysrhythmias 79(11)

Normal Sinus Rhythm 79(2)

Diagnostic Characteristics 79(2)

Clinical Significance 81(1)

Sinus Arrhythmia 81(1)

Diagnostic Characteristics 81(1)

Cause of Dysrhythmia 82(1)

Clinical Significance 82(1)

Sinus Bradycardia 82(2)

Diagnostic Characteristics 82(1)

Cause of Dysrhythmia 82(1)

Clinical Significance 83(1)

Sinus Arrest And Sinoatrial Exit Block 84(2)

Diagnostic Characteristics 84(1)

Cause of Dysrhythmia 84(2)

Clinical Significance 86(1)

Sinus Tachycardia 86(4)

Diagnostic Characteristics 86(1)

Cause of Dysrhythmia 86(1)

Clinical Significance 86(4)

6 Atrial Dysrhythmias 90(16)

Wandering Atrial Pacemaker 90(2)

Diagnostic Characteristics 90(2)

Cause of Dysrhythmia 92(1)

Clinical Significance 92(1)

Premature Atrial Complexes 92(3)

Diagnostic Characteristics 92(3)

Cause of Dysrhythmia 95(1)

Clinical Significance 95(1)

Atrial Tachycardia (Ectopic And Multifocal) 95(3)

Diagnostic Characteristics 95(2)

Cause of Dysrhythmia 97(1)

Clinical Significance 97(1)

Atrial Flutter 98(3)

Diagnostic Characteristics 98(3)

Cause of Dysrhythmia 101(1)

Clinical Significance 101(1)

Atrial Fibrillation 101(5)

Diagnostic Characteristics 101(3)

Cause of Dysrhythmia 104(1)

Clinical Significance 104(2)

7 Junctional Dysrhythmias 106(11)

Premature Junctional Complexes 106(3)

Diagnostic Characteristics 106(2)

Cause of Dysrhythmia 108(1)

Clinical Significance 109(1)

Junctional Escape Rhythm 109(1)

Diagnostic Characteristics 109(1)

Cause of Dysrhythmia 109(1)

Clinical Significance 110(1)

Nonparoxysmal Junctional Tachycardia (Accelerated Junctional Rhythm, Junctional Tachycardia) 110(3)

Diagnostic Characteristics 111(1)

Cause of Dysrhythmia 111(1)

Clinical Significance 111(2)

Paroxysmal Supraventricular Tachycardia 113(4)

Diagnostic Characteristics 113(1)

Cause of Dysrhythmia 113(1)

Clinical Significance 113(4)

8 Ventricular Dysrhythmias 117(18)

Premature Ventricular Complexes 117(4)

Diagnostic Characteristics 117(4)

Cause of Dysrhythmia 121(1)

Clinical Significance 121(1)

Ventricular Tachycardia 121(4)

Diagnostic Characteristics 121(2)

Differentiating Ventricular Tachycardia from Supra ventricular Tachycardia with Wide ORS Complex 123(1)

Cause of Dysrhythmia 123(1)

Clinical Significance 124(1)

Ventricular Fibrillation 125(3)

Diagnostic Characteristics 125(1)

Cause of Dysrhythmia 126(1)

Clinical Significance 127(1)

Accelerated Idioventricular Rhythm (Accelerated Ventricular Rhythm, Idioventricular Tachycardia, Slow Ventricular Tachycardia) 128(3)

Diagnostic Characteristics 128(1)

Cause of Dysrhythmia 128(1)

Clinical Significance 129(2)

Ventricular Escape Rhythm (Idioventricular Rhythm) 131(1)

Diagnostic Characteristics 131(1)

Cause of Dysrhythmia 131(1)

Clinical Significance 131(1)

Asystole 131(4)

Diagnostic Characteristics 133(1)

Cause of Dysrhythmia 133(1)

Clinical Significance 133(2)

9 Atrioventricular Blocks 135(13)

First-Degree AV Block 135(2)

Diagnostic Characteristics 135(2)

Cause of Dysrhythmia 137(1)

Clinical Significance 137(1)

Second-Degree, Type I AV Block (Wenckebach) 137(2)

Diagnostic Characteristics 137(2)

Cause of Dysrhythmia 139(1)

Clinical Significance 139(1)

Second-Degree, Type II AV Block 139(2)

Diagnostic Characteristics 139(1)

Cause of Dysrhythmia 139(2)

Clinical Significance 141(1)

Second-Degree 2:1 And Advanced AV Block 141(2)

Diagnostic Characteristics 141(1)

Cause of Dysrhythmia 141(1)

Wide (>0.12 second) ORS Complex 142(1)

Clinical Significance 142(1)

Third-Degree AV Block (Complete AV Block) 143(5)

Diagnostic Characteristics 143(1)

Cause of Dysrhythmia 143(2)

Clinical Significance 145(3)

10 Clinical Significance And Treatment Of Dysrhythmias 148(32)

Part I 148(15)

Assessing The Patient 148(2)

Stable Versus Unstable 148(2)

Treating The Patient 150(4)

Electrical Therapy 150(1)

Cardioversion and Defibrillation 150(1)

Sedation 150(1)

Transcutaneous Pacing 151(1)

Pharmacologic Therapy 151(1)

Atropine Sulfate 151(1)

Vasopressors 151(1)

Antidysrhythmics 152(1)

Calcium Channel Blockers: Diltiazem and Verapamil 153(1)

Beta-Adrenergic Blockers 154(1)

Oxygen 154(1)

Bradycardias 154(1)

Clinical Significance of Bradycardias 154(1)

Indications for Treatment of Bradycardias 154(1)

Sinus Bradycardia 155(1)

Sinus Arrest/SA Exit Block 155(1)

First-Degree AV Block 155(1)

Second-Degree, Type I AV Block (Wenckebach) 155(1)

Second Degree, 2:1 and Advanced AV block with Narrow ORS Complexes 155(1)

Third-Degree AV Block with Narrow ORS Complexes 155(1)

Second-Degree, Type II AV Block 155(1)

Second-Degree, 2:1 with Advanced AV Block with Wide ORS Complexes 155(1)

Third-Degree AV Block with Wide ORS Complexes 155(1)

Junctional Escape Rhythm 155(1)

Ventricular Escape Rhythm 155(1)

Tachycardias 155(7)

Clinical Significance of Tachycardias 155(1)

Indications for Treatment of Tachycardias 156(1)

Sinus Tachycardia 156(1)

Atrial Tachycardia with Block 156(1)

Narrow-ORS-Complex Tachycardia of Unknown Origin (With Pulse) 156(1)

Atrial Tachycardia Without Block 157(1)

Paroxysmal Supra ventricular Tachycardia with Narrow ORS Complexes (Without Wolff-Parkinson-White Syndrome or Ventricular Preexcitation) 157(1)

Junctional Tachycardia 158(1)

Atrial Flutter/Atrial Fibrillation (Without Wolff-Parkinson-White Syndrome or Ventricular Preexcitation) 158(1)

Atrial Flutter/Atrial Fibrillation (With Wolff-Parkinson-White Syndrome or Ventricular Preexcitation) 159(1)

Wide-ORS-Complex Tachycardia of Unknown Origin (With Pulse) 159(1)

Ventricular Tachycardia, Monomorphic (With Pulse) 159(1)

Ventricular Tachycardia, Polymorphic (With Pulse) 160(1)

Normal Baseline QT Interval 160(1)

Ventricular Tachycardia, Polymorphic (With Pulse) 160(1)

Prolonged Baseline OT Interval Torsades de Pointes (TdP) (With Pulse) 161(1)

Premature Ectopic Beats 162(1)

Premature Atrial Complexes 162(1)

Clinical Significance 162(1)

Indications for Treatment 162(1)

Premature Junctional Complexes 162(1)

Clinical Significance 162(1)

Indications for Treatment 162(1)

Premature Ventricular Complexes 162(1)

Clinical Significance 162(1)

Indications for Treatment 162(1)

Part II 163(17)

Cardiac Arrest 163(1)

Clinical Significance 163(1)

Indications for Treatment 163(1)

Treatment 163(1)

Aystole 163(1)

Clinical Significance 163(1)

Indications for Treatment 163(1)

Treatment 163(1)

Pulseless Electrical Activity 164(1)

Clinical Significance 164(1)

Indications for Treatment 164(1)

Treatment 164(1)

Postresuscitation Management 165(1)

Airway 165(1)

Circulation 165(1)

Neurologic 165(1)

Metabolic 165(1)

Temperature Control 165(1)

Rate and Rhythm Control 165(1)

Summary Of Dysrhythmia Treatment 166(2)

Part I 166(1)

Part II 167(1)

Drugs Used to Treat Dysrhythmias 167(1)

Dysrhythmia Treatment Algorithms 168(12)

Part I 168(9)

Part II 177(3)

11 The 12-Lead Electrocardiogram 180(11)

The 12-Lead ECG 180(1)

The 12-Lead ECG Leads 180(11)

Unipolar Leads 181(1)

Lead Axis 181(1)

Frontal and Horizontal Planes 181(1)

Standard (Bipolar) Limb Leads 181(4)

Augmented (Unipolar) Leads 185(1)

Precordial (Unipolar) Leads 186(1)

Right-Sided Chest Leads 186(3)

Facing Leads 189(2)

12 Electrical Axes And Vectors 191(16)

Electrical Axis And Vectors 191(1)

The Electrical Current, Vectors, And The Lead Axis 192(1)

The Hexaxial Reference Figure 193(3)

The QRS Axis 196(11)

Determining the QRS Axis 198(5)

Emergent Method 198(5)

Steps in Determining an Accurate QRS Axis 203(5)

Step 1 203(1)

Step 2 203(1)

Lead II 203(1)

Lead aVF 204(1)

Lead III 204(1)

Step 3 204(1)

Lead II 204(1)

Lead aVF 205(1)

Lead III 205(1)

Lead aVR 205(2)

13 Bundle Branch And Fascicular Blocks 207(19)

Anatomy And Physiology Of The Electrical Conduction System 208(3)

Anatomy of the Electrical Conduction System 208(1)

Blood Supply to the Electrical Conduction System 208(1)

Physiology of the Electrical Conduction System 209(2)

Pathophysiology Of Bundle Branch And Fascicular Blocks 211(1)

Causes of Bundle Branch and Fascicular Blocks 211(1)

Significance of Bundle Branch and Fascicular Blocks 211(1)

Treatment of Bundle Branch and Fascicular Blocks 212(1)

Right Bundle Branch Block 212(4)

Pathophysiology of Right Bundle Branch Block 212(2)

Causes of Right Bundle Branch Block 214(1)

Significance of Right Bundle Branch Block 214(1)

Treatment of Right Bundle Branch Block 214(1)

ECG Characteristics in Right Bundle Branch Block 214(2)

ORS Complexes 214(1)

Duration 214(1)

ORS Axis 214(1)

Ventricular Activation Time 214(1)

ST Segments 215(1)

T Waves 215(1)

QRS Pattern in Right Bundle Branch Block with Anteroseptal Myocardial Infarction 216(1)

Left Bundle Branch Block 216(3)

Pathophysiology of Left Bundle Branch Block 216(2)

Causes of Left Bundle Branch Block 218(1)

ECG Characteristics of Left Bundle Branch Block 218(1)

ORS complexes 218(1)

Duration 218(1)

ORS Axis 218(1)

Ventricular Activation Time 218(1)

ORS Pattern in Left Bundle Branch Block 218(1)

ST Segments 218(1)

T Waves 218(1)

QRS Pattern in Left Bundle Branch Block with Anteroseptal Myocardial Infarction 219(1)

Hemiblocks 219(1)

Left Anterior Fascicular Block (Left Anterior Hemiblock) 219(2)

Pathophysiology of Left Anterior Fascicular Block 219(1)

Causes of Left Anterior Fascicular Block 220(1)

ECG Characteristics in Left Anterior Fascicular Block 220(1)

ORS Complexes 220(1)

Duration 220(1)

ORS Axis 220(1)

ORS Pattern 220(1)

ST Segments 220(1)

T Waves 221(1)

Left Posterior Fascicular Block (Left Posterior Hemiblock) 221(1)

Pathophysiology of Left Posterior Fascicular Block 221(1)

Causes of Left Posterior Fascicular Block 221(1)

ECG Characteristics in Left Posterior Fascicular Block 222(5)

ORS Complexes 222(1)

Duration 222(1)

ORS Axis 222(1)

ORS Pattern 222(1)

ST Segments 222(1)

T Waves 222(1)

Bifascicular Blocks 222(1)

Intraventricular Conduction Delay 222(4)

14 Pacemaker And Implantable Defibrillator Rhythms 226(10)

Pacemakers 226(1)

Types Of Pacemakers 227(3)

Fixed-Rate or Demand 227(1)

Single-Chamber and Dual-Chambered 227(3)

Single-Chamber Pacemakers 228(1)

Dual-Chambered Pacemakers 229(1)

Pacemaker Rhythm 230(1)

Diagnostic Features 230(1)

Clinical Significance 231(1)

Pacemaker Malfunction 231(1)

Implantable Cardioverter-Defibrillator Therapy 232(4)

ICD Malfunction 233(3)

15 Other Assorted ECG Findings 236(21)

Chamber Enlargement 237(1)

Pathophysiology 237(1)

Dilatation 237(1)

Hypertrophy 237(1)

Right Atrial Enlargement 237(1)

Pathophysiology 237(1)

ECG Characteristics 237(1)

P Waves 237(1)

Left Atrial Enlargement 238(1)

Pathophysiology 238(1)

ECG Characteristics 238(1)

P Waves 238(1)

Right Ventricular Hypertrophy 238(1)

Pathophysiology 238(1)

ECG Characteristics 239(1)

P Waves 239(1)

ORS Complexes 239(1)

ST Segments 239(1)

T Waves 239(1)

Left Ventricular Hypertrophy 239(4)

Pathophysiology 239(1)

ECG Characteristics 239(4)

P Waves 239(1)

ORS Complexes 239(3)

ST Segments 242(1)

T Waves 242(1)

Diagnosis of Left Ventricular Hypertrophy 242(1)

Pericarditis 243(2)

Pathophysiology 243(1)

ECG Characteristics 244(1)

PR Intervals 244(1)

ORS Complexes 244(1)

ST Segments 244(1)

T Waves 244(1)

Electrolyte Imbalance 245(3)

Hyperkalemia 245(1)

Pathophysiology 245(1)

ECG Characteristics 245(1)

P Waves 245(1)

PR Intervals 245(1)

QRS Complexes 245(1)

ST Segments 245(1)

T Waves 245(1)

QT Interval 245(1)

Hypokalemia 245(1)

Pathophysiology 245(1)

ECG Characteristics 246(1)

P Waves 246(1)

QRS Complexes 246(1)

ST Segments 246(1)

T Waves 246(1)

U Waves 246(1)

QT Intervals 246(1)

Hyper Calcemia 246(1)

Pathophysiology 246(1)

ECG Characteristics 246(2)

QT Intervals 246(2)

Hypocalcemia 248(1)

Pathophysiology 248(1)

ECG Characteristics 248(1)

ST Segments 248(1)

QT Intervals 248(1)

Drug Effects 248(2)

Digitalis 248(1)

Pathophysiology 248(1)

ECG Characteristics 248(1)

PR Intervals 248(1)

ST Segments 248(1)

T Waves 248(1)

QT intervals 248(1)

Procainamide 249(1)

Pathophysiology 249(1)

ECG Characteristics 249(1)

QRS Complexes 249(1)

T Waves 249(1)

PR Intervals 249(1)

ST Segments 249(1)

QT Intervals 249(1)

Quinidine 249(1)

Pathophysiology 249(1)

ECG Characteristics 249(1)

P Waves 249(1)

QRS Complexes 249(1)

T Waves 249(1)

PR Intervals 249(1)

ST Segments 249(1)

QT Intervals 249(1)

Acute Pulmonary Embolism 250(1)

Pathophysiology 250(1)

Symptoms 250(1)

Signs 250(1)

ECG Characteristics 250(1)

P Waves 250(1)

QRS Complexes 250(1)

QRS Axis 250(1)

ST Segments/T Waves 250(1)

Chronic COR Rulmonale 250(2)

Pathophysiology 250(2)

ECG Characteristics 252(1)

P Waves 252(1)

QRS Complexes 252(1)

QRS Axis 252(1)

ST Segments/T Waves 252(1)

Early Repolarization 252(1)

Pathophysiology 252(1)

ECG Characteristics 252(1)

QRS Complexes 252(1)

ST Segments 252(1)

T Waves 252(1)

Hypothermia 252(1)

Pathophysiology 252(1)

ECG Characteristics 253(1)

PR Intervals 253(1)

QRS Complexes 253(1)

QT Interval 253(1)

Osborn Wave 253(1)

Preexcitation Syndromes 253(1)

Pathophysiology 253(1)

ECG Characteristics 254(1)

Ventricular Preexcitation (Accessory AV Pathways) 254(1)

PR Intervals 254(1)

QRS Complexes 254(1)

Atria-His Preexcitation (Atrio-His Fibers) 254(1)

PR Intervals 254(1)

ORS Complexes 254(1)

Nodoventricular/Fasciculoventricular Preexcitation (Nodoventricular/Fasciculoventricular Fibers) 254(1)

PR Intervals 254(1)

ORS Complexes 254(1)

Clinical Significance 254(1)

Brugada Syndrome 254(3)

Pathophysiology 254(1)

ECG Characteristics 254(5)

QRS Complexes 254(1)

ST Segments 254(3)

16 Acute Coronary Syndrome-Pathophysiology 257(26)

Coronary Circulation 259(2)

Left Coronary Artery 259(1)

Right Coronary Artery 260(1)

Summary 260(1)

Coronary Heart Disease 261(2)

Pathophysiology of Coronary Atherosclerosis and Thrombosis 261(1)

Stable, Vulnerable, and Unstable Plaques 261(1)

Plaque Erosion and Rupture 262(1)

Thrombus Formation And Lysis 263(3)

Blood Components 263(1)

Platelets 263(1)

Prothrombin 263(1)

Fibrinogen 264(1)

Plasminogen 264(1)

Tissue Components 264(1)

von Willebrand Factor 264(1)

Collagen Fibers 264(1)

Tissue Factor 264(1)

Tissue Plasminogen Activator 264(1)

Phases of Thrombus Formation 264(1)

Phase 1: Subendothelial Exposure 264(1)

Phase 2: Platelet Adhesion 264(1)

Phase 3: Platelet Activation 265(1)

Phase 4: Platelet Aggregation 265(1)

Phase 5: Thrombus Formation 265(1)

Phases of Thrombolysis 265(1)

Phase 1: Activation of Intrinsic and Extrinsic Pathways 265(1)

Phase 2: Plasmin Formation 265(1)

Phase 3: Fibrinolysis 265(1)

Myocardial Ischemia, Injury, And Infarction 266(1)

Myocardial Ischemia 266(1)

Myocardial Injury 266(1)

Myocardial Infarction 267(1)

Acute Coronary Syndromes 267(1)

Angina 267(1)

Stable Angina 267(1)

Unstable Angina 268(1)

Acute Myocardial Infarction 268(1)

Acute Myocardial Infarction 268(15)

Anatomic Locations of Myocardial Infarctions 269(1)

The Four Phases of a Transmural Myocardial Infarction 269(3)

Phase 1 269(2)

Phase 2 271(1)

Phase 3 271(1)

Phase 4 272(1)

ECG Changes in Acute Myocardial Infarction 272(7)

Ischemic T Waves 273(1)

ST Segments Changes 275(1)

ST-Segment Elevation 275(1)

ST-Segment Depression 277(1)

Pathologic Q Waves 277(1)

Physiologic Q Waves 277(1)

Pathologic Q Waves 278(1)

Determining the site of a Myocardial Infarction 279(1)

Complications of Acute Myocardial Infarction 279(4)

17 Diagnostic ECG Changes In Specific Myocardial Infarctions 283(24)

Introduction 284(1)

Septal Myocardial Infarction 284(2)

Coronary Arteries Involved and Site of Occlusion 284(1)

Location of Infarct 284(1)

ECG Changes 284(2)

Anterior Myocardial Infarction 286(2)

Coronary Arteries Involved and Site of Occlusion 286(1)

Location of Infarct 286(1)

ECG Changes 286(2)

Anteroseptal Myocardial Infarction 288(2)

Coronary Arteries Involved and Site of Occlusion 288(1)

Location of Infarct 288(1)

ECG Changes 288(2)

Lateral Myocardial Infarction 290(2)

Coronary Arteries Involved and Site of Occlusion 290(1)

Location of Infarct 290(1)

ECG Changes 290(2)

Anterolateral Myocardial Infarction 292(2)

Coronary Arteries Involved and Site of Occlusion 292(1)

Location of Infarct 292(1)

ECG Changes 292(2)

Extensive Anterior Myocardial Infarction 294(2)

Coronary Arteries Involved and Site of Occlusion 294(1)

Location of Infarct 294(1)

ECG Changes 294(2)

Inferior Myocardial Infarction 296(2)

Coronary Arteries Involved and Site of Occlusion 296(1)

Location of Infarct 296(1)

ECG Changes 296(2)

Posterior Myocardial Infarction 298(2)

Coronary Arteries Involved and Site of Occlusion 298(1)

Location of Infarct 298(1)

ECG Changes 298(2)

Right Ventricular Myocardial Infarction 300(7)

Coronary Arteries Involved and Site of Occlusion 300(1)

Location of Infarct 300(1)

ECG Changes 300(7)

18 Signs, Symptoms, And Diagnosis Of Acute Coronary Syndromes 307(14)

Introduction 308(1)

History Taking In Suspected Acute Coronary Syndromes 309(1)

Chief Complaint 309(1)

Signs And Symptoms Of Acute Coronary Syndromes 310(6)

Symptoms of Acute Coronary Syndromes 310(3)

General and Neurologic Symptoms 310(1)

Cardiovascular Symptoms 311(1)

Pain 311(1)

Palpitations 312(1)

Respiratory Symptoms 312(1)

Dyspnea 312(1)

Cough 313(1)

Wheezing 313(1)

Gastrointestinal Symptoms 313(1)

Signs of Acute Coronary Syndromes 313(3)

General Appearance and Neurologic Signs 313(1)

Vital Signs 313(1)

Pulse 313(1)

Respirations 314(1)

Blood Pressure 314(1)

Appearance of the Skin 314(1)

Appearance of the Veins 314(1)

Cardiovascular Signs 314(1)

Heart Sounds 314(1)

Respiratory Signs 315(1)

Breath Sounds 315(1)

Rales, Rhonchi, and Wheezes 315(1)

Consolidation and Pleural Effusion 316(1)

Appearance of Body Tissues 316(1)

Edema 316(1)

Risk Stratification 316(1)

The 12-Lead ECG 316(1)

ECG Changes 316(1)

ST-Segment Elevation MI 317(1)

Non鈥揝T-Segment Elevation MI 317(1)

Cardiac Markers 317(1)

Making The Diagnosis 318(3)

19 Management Of Acute Coronary Syndromes 321(16)

Goals In The Management Of Acute Coronary Syndromes 322(2)

Medical Systems: EMS Transport 322(1)

Role of EMS to Meet Goal 322(1)

Prehospital ECG 322(1)

Prehospital Fibrinolytic Administration 323(1)

STEMI System Design 323(1)

Role of Emergency Department to Meet Goal 323(4)

Triage 323(1)

ECG Interpretation 324(1)

Determination of Appropriate Therapy 324(1)

Goals In The Management Of St-Elevation Myocardial Infarction 324(1)

Reperfusion Therapy: PCI Versus Fibrinolytics 325(1)

Management Of Acute ST-Elevation Myocardial Infarction 326(1)

Management Of Non鈥揝T-Elevation Myocardial Infarction 327(1)

Acute Coronary Syndrome Management Strategies 327(4)

A. Initial Assessment and Management of Patient with Chest Pain Prehospital/Emergency Department 327(1)

B. Management of Suspected Acute Coronary Syndrome 327(1)

C. Reperfusion Therapy: STEMI Protocol 328(1)

Primary PCI 328(1)

Emergency Department 328(1)

Fibrinolytics 329(1)

Emergency Department 329(1)

D. Management of Congestive Heart Failure 329(1)

Prehospital/Emergency Department 329(1)

E. Management of Cardiogenic Shock 330

Prehospital/Emergency Department 330(1)

Emergency Department 330(1)

Acute Coronary Syndrome Management Algorithms 331(6)

Appendix A: Methods of Determining the QRS Axis 337(13)

Appendix B: Chapter Review Questions Answer Key 350(9)

Appendix C: Rhythm Interpretation: Self-Assessment 359(68)

Appendix D: Self-Assessment Answer Keys 427(18)

Glossary 445(32)

Index 477
Pocket Guide to Basic Dysrhythmias and Acute Coronary Syndromes

Section I ECG Fundamentals, 1(46)

Anatomy Of The Heart, 2(1)

Conduction System Of The Heart, 2(1)

Coronary Circulation, 3(1)

ECG Monitoring Leads, 4(3)

The 12-Lead ECG, 7(3)

Components Of The Electrocardiogram, 10(1)

Waves, 10(1)

Intervals, 10(1)

Segments, 10(1)

Waves, 11(14)

P Wave, 11(4)

Normal Sinus P Wave, 11(1)

Abnormal Sinus P Wave, 12(2)

Ectopic P Wave (P Prime or P'), 14(1)

QRS Complex, 15(5)

Normal QRS Complex, 15(2)

Abnormal ORS Complex, 17(3)

T Wave, 20(4)

Normal T Wave, 20(1)

Abnormal T Wave, 20(4)

U Wave, 24(1)

Intervals, 25(7)

QT Interval, 25(3)

Normal QT Interval, 25(2)

Abnormal QT Interval, 27(1)

R-R Interval, 28(1)

PR Interval, 29(3)

Normal PR Interval, 29(1)

Abnormal PR Interval, 30(2)

Segments, 32(2)

ST Segment, 32(2)

Normal ST Segment, 32(1)

Abnormal ST Segment, 32(2)

PR Segment, 34(13)

Normal ECG Components, 35(1)

The ECG Lead Axes, 36(3)

The Three-Lead Method Of Determining The QRS Axis, 39(5)

Eight Steps To ECG Interpretation, 44(1)

Dysrhythmia Determination, 44(1)

Acute Coronary Syndrome Identification, 45(2)

Section II Dysrhythmia Identification, 47(42)

Normal Sinus Rhythm (NSR), 48(1)

Sinus Dysrhythmia, 49(1)

Sinus Bradycardia, 50(1)

Sinus Arrest And Sinoatrial (SA) Exit Block, 51(1)

Sinus Tachycardia, 52(2)

Wandering Atrial Pacemaker (WAP), 54(1)

Premature Atrial Complexes (PACS), 55(3)

Types Of PACS, 56(2)

Atrial Tachycardia (Ectopic Atrial Tachycardia, Multifocal Atrial Tachycardia [Mat]), 58(2)

Atrial Flutter, 60(1)

Atrial Fibrillation (AF), 61(1)

Junctional Escape Rhythm, 62(2)

Premature Junctional Complexes (PJCS), 64(4)

Types Of PJCS, 66(2)

Nonparoxysmal Junctional Tachycardia (Accelerated Junctional Rhythm, Junctional Tachycardia), 68(2)

Paroxysmal Supraventricular Tachycardia (PSVT), 70(2)

Ventricular Escape Rhythm, 72(1)

Accelerated Idioventricular Rhythm (AIVR), 73(1)

Premature Ventricular Complexes (PVCS), 74(5)

Types Of PVCS, 76(3)

Ventricular Tachycardia (VT), 79(2)

Ventricular Fibrillation (VF), 81(2)

Asystole, 83(1)

First-Degree AV Block, 84(1)

Second-Degree AV Block, Type I AV Block (Wenckebach), 85(1)

Second-Degree AV Block, Type II AV Block, 86(1)

Second-Degree AV Block, 2:1 And Advanced AV Block, 87(1)

Third-Degree AV Block, 88(1)

Section III Dysrhythmia Management, 89(30)

Pharmacological Therapy, 91(1)

Procainamide End Point, 91(1)

Administration Of Calcium Channel Blockers, 91(1)

Administration Of β-Blockers, 91(1)

Cardioversion And Defibrillation, 92(1)

Sedation, 92(1)

Transcutaneous Pacing, 93(1)

Sinus Bradycardia, 94(1)

Sinus Arrest/sinoatrial (SA) Exit Block, 94(1)

Second-Degree, Type I AV Block (Wenckebach), 94(1)

Second-Degree, 2:1 And Advanced AV Block With Narrow QRS Complexes, 94(1)

Third-Degree AV Block With Narrow QRS Complexes, 94(1)

Second-Degree, Type II AV Block, 95(1)

Second-Degree, 2:1 And Advanced AV Block With Wide QRS Complexes, 95(4)

Third-Degree AV Block With Wide QRS Complexes, 99

Junctional Escape Rhythm, 96(1)

Ventricular Escape Rhythm, 96(1)

Sinus Tachycardia, 97(1)

Atrial Tachycardia Without Block, 98(1)

Atrial Tachycardia With Block, 99(1)

Narrow QRS Complex Tachycardia Of Unknown Origin (With Pulse), 100(1)

Paroxysmal Supraventricular Tachycardia (PSVT) With Narrow QRS Complexes (Without Wolff-Parkinson-White Syndrome Or Ventricular Preexcitation), 101(1)

Junctional Tachycardia, 102(1)

Atrial Flutter/atrial Fibrillation (Without Wolffparkinson-White Syndrome Or Ventricular Preexcitation), 103(3)

Atrial Fibrillation >48 Hours Or Of Unknown Duration, 104(2)

Atrial Flutter/atrial Fibrillation (With Wolff- Par Koison White Syndrome Or Ventricular Preexcitatim), Wide QRS Complex Tachycardia Of Unknown Origin (With Pulse), 106(1)

Ventricular Tachycardia (VT), Monomorphic (With Pulse), 107(1)

Ventricular Tachycardia (VT), Polymorphic (With Pulse) Normal Baseline OT Interval, 108(2)

Ventricular Tachycardia (VT), Polymorphic (With Pulse), 110(1)

Prolonged Baseline OT Interval, 110(1)

Torsades De Pointes (TDP) (With Pulse), 110(1)

Premature Atrial Complexes (PACS), 111(1)

Premature Junctional Complexes (PJCS), 111(1)

Premature Ventricular Complexes (PVCS), 112(1)

Ventricular Fibrillation (VF), 113(1)

Pulseless Ventricular Tachycardia (VT), 113(1)

Asystole, 114(1)

Pulseless Electrical Activity, 115(4)

6 HS And 5 TS, 115(1)

Postresuscitation Management, 116(1)

Airway, 116(1)

Circulation, 116(3)

Section IV Bundle Branch And Fascicular Blocks, 119(16)

Right Bundle Branch Block (RBBB), 120(3)

Left Bundle Branch Block (LBBB), 123(4)

Left Anterior Fascicular Block (LAFB), 127(2)

Left Posterior Fascicular Block (LPFB), 129(2)

Bifascicular Blocks鈥擱BBB With LAFB, 131(2)

Bifascicular Blocks鈥擱BBB With LPFB, 133(2)

Section V Other Assorted ECG Changes, 135(30)

Chamber Enlargement, 136(10)

Right Atrial Enlargement, 136(1)

P Waves, 136(1)

Cause Of Right Atrial Enlargement (Right Atrial Dilatation And Hypertrophy), 136(1)

Left Atrial Enlargement, 137(2)

P Waves, 137(1)

Cause Of Left Atrial Enlargement (Left Atrial Dilatation And Hypertrophy), 138(1)

Right Ventricular Hypertrophy (RVH), 139(2)

P Waves, 140(1)

QRS Complexes, 140(1)

ST Segments, 140(1)

QRS Axis, 140(1)

Cause Of RVH, 140(1)

Left Ventricular Hypertrophy (LVH), 141(4)

P Waves, 143(1)

QRS Complexes, 143(1)

QRS Axis, 143(1)

ST Segments, 143(1)

T Waves, 143(1)

Diagnosis Of LVH, 143(1)

Cause Of LVH, 143(1)

Sum Of R And S Waves, 144(1)

Criteria Diagnostic Of LVH, 144(1)

Pericarditis, 145(1)

QRS Complexes, 146(1)

ST Segments, 146(1)

T Waves, 146(1)

QT Intervals, 146(1)

Electrolyte Imbalance, 146(7)

Hyperkalemia, 146(3)

P Waves, 146(2)

PR Intervals, 148(1)

QRS Complexes, 148(1)

ST Segments, 148(1)

T Waves, 148(1)

Cause Of Hyperkalemia, 148(1)

Associated Dysrhythmias, 148(1)

Hypokalemia, 149(2)

P Waves, 150(1)

QRS Complexes, 150(1)

ST Segments, 150(1)

T Waves, 150(1)

U Waves, 150(1)

QT Intervals, 150(1)

Cause Of Hypokalemia, 150(1)

Associated Dysrhythmias, 150(1)

Hypercalcemia, 151(1)

QT Intervals, 152(1)

Cause Of Hypercalcemia, 152(1)

Hypocalcemia, 152(1)

ST Segments, 152(1)

QT Intervals, 152(1)

Cause Of Hypocalcemia, 152(1)

Drug Effect, 153(3)

Digitalis, 153(1)

PR Intervals, 153(1)

ST Segments, 153(1)

T Waves, 153(1)

QT Intervals, 153(1)

Effects Of Digitalis Toxicity, 153(1)

Procainamide, 154(2)

PR Intervals, 154(1)

QRS Complexes, 154(1)

ST Segments, 154(1)

T Waves, 154(1)

QT Intervals, 154(1)

Effects Of Procainamide Toxicity, 154(2)

Pulmonary Disease, 156(6)

Pulmonary Embolism (Acute), 156(2)

P Waves, 157(1)

QRS Complexes, 157(1)

T Waves, 157(1)

ST Segments/T Waves, 157(1)

QRS Pattern, 157(1)

QRS Axis, 157(1)

Associated Dysrhythmlas, 157(1)

Chronic Cor Pulnionale, 158(1)

P Waves, 159(1)

QRS Complexes, 159(1)

ST Segments/T Waves, 159(1)

QRS Axis, 159(1)

Associated Dysrhythmias, 159(1)

Early Repolarization, 159(1)

QRS Complexes, 160(1)

ST Segments, 160(1)

T Waves, 160(1)

Cause Of Early Re Polarization, 160(1)

Hypothermia, 160(2)

PR Intervals, 161(1)

QRS Complexes, 161(1)

QT Intervals, 161(1)

Osborn Wave, 161(1)

Associated Dysrhythmias, 161(1)

Preexcitation Syndromes, 162(3)

Ventricular Preexcitation, 162(1)

PR Intervals, 163(1)

QRS Complexes, 163(1)

Atrio-His Preexcitation, 163(1)

PR Intervals, 163(1)

QRS Complexes, 163(1)

Nodoventrocular/fasciculoventricular Preexcitation, 163(1)

PR Intervals, 163(1)

QRS Complexes, 163(1)

Cause Of Preexcitation Syndromes, 163(1)

Brugada Syndrome, 164(4)

QRS Complexes, 164(1)

ST Segments, 164(1)

Section VI Acute Myocardial Infarction, 165(22)

Locations Of Myocardial Infarction And Arteries Involved, 166(2)

Septal Myocardial Infarction, 168(2)

Early, 168(1)

Late, 169(1)

Anterior (Localized) Myocardial Infarction, 170(2)

Early, 170(1)

Late, 171(1)

Anteroseptal Myocardial Infarction, 172(2)

Early, 172(1)

Late, 173(1)

Lateral Myocardial Infarction, 174(3)

Early, 174(1)

Late, 175(2)

Anterolateral Myocardial Infarction, 177(3)

Early, 177(1)

Late, 178(2)

Inferior Myocardial Infarction, 180(2)

Early, 180(1)

Late, 181(1)

Posterior Myocardial Infarction, 182(2)

Early, 182(1)

Late, 183(1)

Right Ventricular Myocardial Infarction, 184(3)

Early, 185(1)

Late, 185(2)

Section VII Management Of Acute Coronary Syndromes, 187

Signs And Symptoms Of Acute Coronary Syndromes, 188(2)

Symptoms In Acute Coronary Syndrome, 188(1)

Signs In Acute Coronary Syndrome, 188(1)

Risk Stratification, 189(1)

The 12-Lead ECG, 190(1)

Acute Coronary Syndrome Management, 191(2)

A Initial Assessment And Management Of A Patient With Chest Pain, 191(1)

Prehospital/emergency Department, 191(1)

B Initial Treatment And Assessment Of Suspected Acute Mi, 192(1)

Prehospital/emergency Department, 192(1)

C Reperfusion Therapy: Stemi Protocol, 193(1)

Primary PCI, 193(1)

Emergency Department, 193(1)

Fibrinolytic Administration, 194

Emergency Department, 190(7)

D Management Of Congestive Heart Failure, 197(2)

Left Heart Failure Secondary To Left Ventricular Myocardial Infarction, 197(2)

E Management Of Cardiogenic Shock, 199

Prehospital/emergency Department, 199(1)

Emergency Department, 200