Essential ECG

PART I: The essentials Chapter 1 The ECG: the what, who, when, where and why 1.1 Overview 1.2 The what 1.3 The who 1.4 The when 1.5 The where 1.6 The why Chapter 2 The normal conduction system of the heart 2.1 Overview 2.2 Thinking about the conduction system Chapter 3 Recording an ECG 3.1 Overview 3.2 How to record an ECG 3.2.1 Equipment 3.2.2 Preparation 3.2.3 Recording the ECG 3.3 ECG leads and their anatomical views 3.3.1 Limb leads 3.3.2 Chest leads 3.4 ECG speed and voltage calibration 3.4.1 Speed calibration 3.4.2 Voltage calibration 3.4.3 Understanding box sizes 3.5 Additional considerations 3.5.1 Posterior leads Chapter 4 The normal ECG 4.1 Overview 4.2 The P wave 4.3 The Q wave 4.4 The R wave 4.5 The S wave 4.6 The QRS complex 4.7 The T wave 4.8 The PR interval 4.9 The QT interval 4.10 The J point 4.11 The ST segment Chapter 5 How to read and report an ECG 5.1 Having a framework 5.2 The basics 5.3 Heart rate 5.4 Heart rhythm 5.5 Heart axis 5.6 Waves, complexes, intervals and segments 5.7 Bringing it all together Chapter 6 Chamber dilatation and hypertrophy 6.1 Overview 6.2 Atrial dilatation 6.2.1 Left atrial dilatation 6.2.2 Right atrial dilatation 6.3 Ventricular hypertrophy 6.3.1 Left ventricular hypertrophy 6.3.2 Right ventricular hypertrophy Chapter 7 Abnormal intervals (PR and QT intervals) 7.1 Overview 7.2 Prolonged QT interval 7.3 Short QT interval 7.4 Prolonged PR interval 7.5 Short PR interval Chapter 8 Bradycardia and bradyarrhythmias 8.1 Overview 8.1.1 Causes 8.1.2 Clinical manifestation 8.1.3 Diagnostic approach 8.1.4 Management 8.2 Sinus node disease 8.2.1 Sinus bradycardia 8.2.2 Sinus arrhythmia 8.2.3 Sinoatrial exit block 8.2.4 Tachycardia-bradycardia syndrome 8.3 Atrioventricular node disease 8.3.1 First-degree AV block 8.3.2 Second-degree AV block: Mobitz I (Wenckebach) 8.3.3 Second-degree AV block: Mobitz II 8.3.4 Third-degree heart block 8.3.5 Third-degree heart block: with atrial fibrillation Chapter 9 Narrow complex tachycardia 9.1 Overview 9.2 Sinus tachycardia 9.3 Atrial fibrillation 9.4 Atrial flutter 9.5 Atrial tachycardia 9.5.1 Focal atrial tachycardia 9.5.2 Multifocal atrial tachycardia 9.6 Supraventricular tachycardia 9.6.1 Atrioventricular nodal re-entrant tachycardia 9.6.2 Atrioventricular re-entry tachycardia Chapter 10 Broad complex tachycardia 10.1 Overview 10.2 Ventricular tachycardia 10.2.1 Monomorphic VT 10.2.2 Polymorphic VT 10.3 Ventricular fibrillation 10.4 Supraventricular tachycardia with aberrancy 10.4.1 Sinus tachycardia with bundle branch block 10.4.2 Antidromic atrioventricular re-entry tachycardia 10.5 Ventricular paced rhythm 10.6 Artefact 10.7 Pre-excited atrial fibrillation Chapter 11 Premature complexes 11.1 Overview 11.2 Premature atrial complexes 11.3 Premature ventricular complexes Chapter 12 Intraventricular conduction delays 12.1 Overview 12.2 Right bundle branch block 12.3 Left bundle branch block 12.3.1 Left fascicular block 12.4 Bifascicular block 12.5 Non-specific interventricular conduction delay 12.6 Trifascicular block Chapter 13 Acute coronary syndromes 13.1 Overview 13.1.1 Types of acute coronary syndrome 13.2 ST elevation myocardial infarction (STEMI) 13.2.1 What is STEMI? 13.2.2 How to localise STEMI? 13.2.3 ECG changes post STEMI 13.2.4 Anterolateral STEMI 13.2.5 Inferior STEMI 13.2.6 Posterior STEMI 13.3 Non-ST elevation myocardial infarction (NSTEMI) 13.3.1 What is NSTEMI? 13.3.2 ST depression 13.3.3 T wave inversion 13.4 Unstable angina 13.5 STEMI equivalents 13.5.1 What are STEMI equivalents? 13.5.2 Wellens' syndrome 13.5.3 De Winter syndrome 13.5.4 Hyperacute T waves 13.6 Left bundle branch block and ACS 13.6.1 Modified Sgarbossa criteria 13.7 Prior myocardial infarction 13.8 Other important things to look out for on ECG in ACS Chapter 14 Pericardial disease 14.1 Pericarditis 14.1.1 Differentiating pericarditis from acute coronary syndrome 14.2 Pericardial effusion Chapter 15 Electrolyte disturbance and medication-induced abnormalities 15.1 Electrolyte disturbance 15.2 Potassium disturbance 15.2.1 Hyperkalaemia 15.2.2 Hypokalaemia 15.3 Calcium disturbance 15.3.1 Hypercalcaemia 15.3.2 Hypocalcaemia 15.4 Medication-induced ECG changes 15.4.1 Digoxin Chapter 16 Non-cardiac disease and the ECG 16.1 Pulmonary embolism 16.1.1 Overview 16.1.2 Possible ECG findings 16.2 Major intracranial event 16.2.1 Overview 16.2.2 Possible ECG findings 16.2.3 Cushing's reflex 16.3 Motion artefact 16.3.1 Overview 16.3.2 Possible ECG findings Chapter 17 Implantable pacemakers and defibrillators 17.1 Overview 17.2 Pacemakers 17.2.1 Right atrial pacing 17.2.2 Right ventricular pacing 17.3 Pacemaker malfunction 17.4 Defibrillators Chapter 18 Lead reversal 18.1 Overview 18.2 Left arm and right arm lead reversal 18.3 Left arm and left leg lead reversal 18.4 Precordial lead misplacement 18.4.1 Interchanging two or more electrodes 18.4.2 Mispositioning of electrodes in relation to anatomical landmarks 18.5 Steps to easily identify lead reversal/misplacement 18.6 Dextrocardia vs. lead reversal Chapter 19 Rare but important ECGs 19.1 Overview 19.2 Brugada syndrome 19.3 Hypertrophic cardiomyopathy 19.4 Arrhythmogenic cardiomyopathy 19.5 Athletic ECG 19.6 Dextrocardia PART II: Test yourself 50 ECGs that are common,critical or potentially life-threatening, each paired with a concise interpretation and diagnostic insight