| |
| |
| |
| Introduction to Arrhythmia Recognition | |
| |
| |
| |
| Anatomy | |
| |
| |
| 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 | |
| |
| |
| |
| Electrophysiology | |
| |
| |
| 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 | |
| |
| |
| |
| Vectors and the Basic Beat | |
| |
| |
| 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 | |
| |
| |
| R' and S' Waves | |
| |
| |
| 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 | |
| |
| |
| |
| The Rhythm Strip, 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 | |
| |
| |
| Straight Edge | |
| |
| |
| The Rate | |
| |
| |
| Establishing the Rate | |
| |
| |
| Normal and Fast Rates | |
| |
| |
| Bradycardic Rates | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Basic Concepts in Arrhythmia Recognition | |
| |
| |
| 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 | |
| |
| |
| |
| Relevant Topics in Basic Electrocardiography | |
| |
| |
| 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 | |
| |
| |
| |
| Arrhythmias: A Quick Review | |
| |
| |
| Major Concepts | |
| |
| |
| General | |
| |
| |
| P Waves | |
| |
| |
| QRS Complexes | |
| |
| |
| Individual Rhythms | |
| |
| |
| Supraventricular Rhythms | |
| |
| |
| Ventricular Rhythms | |
| |
| |
| Heart Blocks | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Sinus Rhythms | |
| |
| |
| |
| Normal Sinus Rhythm | |
| |
| |
| Introduction to Sinus Rhythms | |
| |
| |
| Normal Sinus Rhythm | |
| |
| |
| The Formation of the ECG | |
| |
| |
| Regularity | |
| |
| |
| Regularly Irregular Rhythms | |
| |
| |
| Irregularly Irregular Rhythms | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Sinus Bradycardia | |
| |
| |
| When is Sinus Bradycardia Considered a Cardiac Emergency? | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Sinus Tachycardia | |
| |
| |
| A Quick Clinical Word | |
| |
| |
| Clinical Characteristics | |
| |
| |
| Rate | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Sinus Arrhythmia | |
| |
| |
| Respiratory Sinus Arrhythmia | |
| |
| |
| Nonrespiratory or Nonphasic Sinus Arrhythmia | |
| |
| |
| Some Additional Clinical Points | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Sinus Blocks, Pauses, and Arrests | |
| |
| |
| Sinus Block | |
| |
| |
| Sinus Pause and Sinus Arrest | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| Section 2 Self-Test | |
| |
| |
| Section 2 Self-Test Answers | |
| |
| |
| |
| Atrial Rhythms | |
| |
| |
| |
| Premature Atrial Contraction | |
| |
| |
| 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 | |
| |
| |
| |
| Ectopic Atrial Rhythm | |
| |
| |
| Diagnostic Challenges | |
| |
| |
| Hint #1 | |
| |
| |
| Hint #2 | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Ectopic Atrial Tachycardia | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Ectopic Atrial Tachycardia with Block | |
| |
| |
| Diagnostic Criteria | |
| |
| |
| P Waves in EAT with Block | |
| |
| |
| The Problem with Lead II | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Wandering Atrial Pacemaker | |
| |
| |
| Wandering Atrial Pacemaker: The Classical Definition | |
| |
| |
| Wandering Atrial Pacemaker: A Clinical Variation | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Multifocal Atrial Tachycardia | |
| |
| |
| Clinical Scenario | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |
| |
| |
| ST Segments and T Waves | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| Section 3 Self-Test | |
| |
| |
| Section 3 Self-Test Answers | |
| |
| |
| |
| Junctional Rhythms | |
| |
| |
| |
| Introduction to Junctional Rhythms | |
| |
| |
| A Closer Look at the AV Node | |
| |
| |
| The Junction as a Pacemaker | |
| |
| |
| Junctional Rhythms: An Overview | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Junctional Rhythm | |
| |
| |
| Junctional Escape Complexes and Rhythms | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Premature Junctional Contraction | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Rapid Junctional Rhythms | |
| |
| |
| Pseudo-S and Pseudo-R' Waves | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| AV Nodal Reentry Tachycardia | |
| |
| |
| General Overview | |
| |
| |
| |
| General Concepts in AV Nodal Reentry | |
| |
| |
| |
| Reentry and AVNRT | |
| |
| |
| |
| Identifying the Arrhythmia | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| AV Reentry Tachycardia | |
| |
| |
| 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 | |
| |
| |
| |
| How to Approach a Narrow-Complex Tachycardia | |
| |
| |
| The Hemodynamic Consequences of a Tachycardia | |
| |
| |
| Heart Rate and Hemodynamics | |
| |
| |
| A Few Extra Seconds... | |
| |
| |
| Focused Treatment Requires Focused Identification | |
| |
| |
| What to Look for in an SVT | |
| |
| |
| Rate | |
| |
| |
| Regularity | |
| |
| |
| The P Wave | |
| |
| |
| The P-QRS Relationship | |
| |
| |
| The Company It Keeps | |
| |
| |
| A Final Word | |
| |
| |
| Chapter Review | |
| |
| |
| Section 4 Self-Test | |
| |
| |
| Section 4 Self-Test Answers | |
| |
| |
| |
| Ventricular Rhythms | |
| |
| |
| |
| Introduction to Ventricular Rhythms | |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |
| |
| |
| |
| Ventricular Escape and Idioventricular Rhythms | |
| |
| |
| General Overview | |
| |
| |
| Ventricular Escape Complexes | |
| |
| |
| Idioventricular Rhythm | |
| |
| |
| Accelerated Idioventricular Rhythm | |
| |
| |
| Capture Beats | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Ventricular Tachycardia | |
| |
| |
| General Overview | |
| |
| |
| Reentry and Other Possible Mechanisms | |
| |
| |
| |
| The presence of an electrical circuit with at least two pathways | |
| |
| |
| |
| The two pathways must have different properties | |
| |
| |
| |
| 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 VTach | |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |
| |
| |
| |
| How to Approach a Wide-Complex Tachycardia | |
| |
| |
| General Overview | |
| |
| |
| The Approach | |
| |
| |
| AV Dissociation | |
| |
| |
| Capture Beats | |
| |
| |
| Fusion Complexes | |
| |
| |
| P Waves | |
| |
| |
| Regular or Irregular? | |
| |
| |
| Morphology | |
| |
| |
| Electrical Axis in the Extreme Right Quadrant | |
| |
| |
| Concordance in the Precordial Leads | |
| |
| |
| History | |
| |
| |
| Physical Examination | |
| |
| |
| Case Discussion | |
| |
| |
| Physical Examination | |
| |
| |
| |
| What do you think of the patient's history? | |
| |
| |
| |
| What do you think of this patient's physical examination? | |
| |
| |
| |
| What do you think of this patient's rhythm? | |
| |
| |
| |
| How can you put it all together? | |
| |
| |
| Chapter Review | |
| |
| |
| |
| Ventricular Fibrillation and Asystole | |
| |
| |
| Ventricular Fibrillation | |
| |
| |
| Asystole | |
| |
| |
| Agonal | |
| |
| |
| ECG Strips | |
| |
| |
| Chapter Review | |
| |
| |
| Section 5 Self-Test | |
| |
| |
| Section 5 Self-Test Answers | |
| |
| |
| |
| Additional Rhythms and Information | |
| |
| |
| |
| Atrioventricular Block | |
| |
| |
| General Overview | |
| |
| |
| First-Degree AV Block | |
| |
| |
| Second-Degree AV Block | |
| |
| |
| |
| Second-Degree AV Block or Wenckebach | |
| |
| |
| Mobitz I Second-Degree AV Block: A Final Word | |
| |
| |
| |
| 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 | |
| |
| |
| |
| 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 | |