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