Rapid ECG Interpretation by M. Gabriel Khan MD FRCP(London) FRCP(C) FACP FACC

By M. Gabriel Khan MD FRCP(London) FRCP(C) FACP FACC

The ECG is the oldest cardiologic attempt, yet even a hundred years after its inception, it maintains because the most typically used cardiologic attempt. regardless of the appearance of high-priced and complex possible choices, the ECG is still the main trustworthy software for the conÞrmation of acute myocardial infarction (MI). The ECG -- no longer the CK-MB, troponins, echocardiogram, or SPECT or puppy test -- dictates the well timed management of lifesaving PCI or thrombolytic treatment. there is not any attempt to rival the ECG within the analysis of arrhythmias, that's a typical and bothersome medical cardiologic challenge. during this new 3rd variation, fast ECG Interpretation provides a scientific step by step process that offers protocols in keeping with adjustments in cardiology perform during the last decade. All diagnostic ECG standards are given with proper and instructive ECGs, delivering a brief overview or refresher for talent checks and for physicians getting ready for the ECG element of the Cardiovascular ailments Board exam. one of the additions to this re-creation is a brand new bankruptcy, ECG Board overview Quiz, whichh presents eighty one chosen ECG tracings which may still sharpen the talents of all who which to Interpret ECGs.

Authoratative and well timed, speedy ECG Interpretation, 3rd variation, is an essestial reference for cardiologists, cardiology fellows, internists, citizens in inner medication, relatives practicioners, and citizens in kin practice.

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2-5. Vectors I, II, and III, labeled V(I), V(II), and V(III), underlie the genesis of the normal QRS complex. (From Khan, M. ) AV node Right bundle branch block L R V(I) V(II) V(III) Electrode V6 V(II) Electrode V1 V(III) V(I) R R' R r′ V(III) S V(II) S Variable M-shaped complex Slurred S wave V6, lead 1 Fig. 2-6. Genesis of the QRS complex in right bundle branch block. (From Khan, M. ) 40 Rapid ECG Interpretation A Fig. 2-7. 12 second; RSR′ (M-shaped complex) in V1; and wide, slurred S wave in leads 1, V5, and V6 indicate right bundle branch block.

2-16. Assess: • For pathologic Q waves, which, with the prior assessment of the ST segment should determine the presence or absence of new or old MI. • Search the V leads for the loss of R waves or poor R wave progression, which may indicate MI, lead placement errors, or other cause (see later discussion, figures in this chapter, and Chapter 6). Step 6: see Figs. 2-21 and 2-22. Assess: • P waves for atrial hypertrophy. Step 7: see Fig. 2-24. Assess: • For left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH).

B, ECG patterns of myocardial ischemia. *Upsloping ST depression is nonspecific; commonly seen with tachycardia. (From Khan, M. ) C, Leads V4 through V6 show ST segment depression; V4 through V6 are in keeping with myocardial ischemia from a patient known to have unstable angina. Chapter 2 / Step-by-Step Method for Accurate ECG Interpretation 51 V1 V2 V3 C Fig. 2-14. Continued • Elevation of the ST segment may occur as a normal variant (Fig. 2-15). See Chapters 5 and 6 for further discussion of ST segment abnormalities and MI.

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