Simon James MBBS MRCP
Consultant Electrophysiologist James Cook University Hospital
Middlesbrough, UK
Katharine Nelson MBBS MRCP
Specialty Trainee in Cardiology James Cook University Hospital
Middlesbrough, UK
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9781907816031
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5Foreword
It is just over one hundred years since the very first recording that we would recognise as a modern electrocardiogram (ECG) was made by Willem Einthoven in 1903. This technique has since become one of the most useful clinical investigations available. There is an ECG machine on almost every hospital ward, in almost every doctor's office or practice, and in many emergency service vehicles. Almost every patient will at some time get an ECG, and since we are all likely to be patients at some stage in our life we shall all have our very own ECG recorded.
It is surprising, however, that very few of the doctors that record and use ECGs are really comfortable with interpreting the trace, and the majority rely on a machine-read analysis of the ECG or on a manual over-read by an expert colleague. Some ECG machine manufacturers have speculated that such is the general ignorance of the medical profession about how to read an ECG that the trace itself could be dispensed with and only the machine report might be produced. Those of us who do read ECGs, however, know that ECG machines often misdiagnose the trace, particularly when no clinical information or previous recordings are accessible to aid the diagnostic process. It therefore seems necessary that most of us who use the ECG should understand its normal configuration and the way it changes in the presence of disease.
There are already many ECG manuals, notebooks, primers and multivolume texts. Why is this new book a worthwhile contribution? The reason is that it is written by young and enthusiastic authors with a passion to educate and teach. Simon James and Katharine Nelson have written a small book that fits in the pocket and takes the reader from A to Z as far as the ECG is concerned. 6It can be read from cover to cover or used as a reference when needed. It is illustrated beautifully and it is a real pleasure and education to read.
John Camm
British Heart Foundation Professor of Clinical Cardiology
St. George's University of London
London, United Kingdom
7Preface
We're going to stick our necks out and declare that, history and examination aside, the 12-lead electrocardiogram (ECG) is the best diagnostic test available in modern medicine. This humble piece of A4 paper costs little, takes seconds to acquire, and presents no risk to the patient, yet it provides reliable, reproducible, internationally understood information concerning the human heart. From acute myocardial infarction to potentially fatal arrhythmias, the instant diagnosis made by ECG allows prompt delivery of life-saving treatment. A single 12-lead ECG can identify individuals at risk of ischaemic heart disease and stroke, two of the biggest killers in the western world. In the case of cardiac arrhythmias the ECG can identify those with potentially curable conditions as well as those at risk of sudden death, thereby allowing preventative measures to be taken.
In this book we attempt to teach the interpretation of ECGs from step one. A sound knowledge of the anatomy and physiology of the heart, together with a solid understanding of how the ECG is constructed, provides the clinician with the building blocks required for its interpretation up to the highest levels. These are provided in chapters 1–3. Theoretical understanding, however, is no substitute for seeing examples of ‘real life’ ECGs. For this reason, the main body of this book (chapters 4–12) is made up of clinical examples covering a broad range of important cardiac conditions. Each condition is described on a double page spread: short descriptive text and a labelled ECG facing each other on adjacent pages for ease of use.
We hope that you will enjoy reading this book and that the knowledge you gain will guide you in providing thoughtful, thorough and informed patient care.
Simon James
Katharine Nelson
May 2011
11Acknowledgements
Thanks to the cardiology team at James Cook University Hospital for their help and support. Also to Paul Mayhew and Richard Furn at JP Medical Publishers for their indispensable guidance and patience. Thanks to Kerry, Lewis and Emily for looking after me and keeping me sane.
SJ
Thanks to all of my friends and colleagues for their help, advice and support. Also to JP Medical Publishers for their guidance and their patience throughout the writing and editorial process. Finally, my love and gratitude to Stuart, without whom very little would be possible.
KN
We gratefully acknowledge Prof ABM Abdullah whose book ECG in Medical Practice, Third Edition, published by Jaypee Brothers Medical Publishers (P) Ltd provided the source for 29 of the redrawn ECGs in this book.
SJ, KN