Concerned mainly with basic concepts, abnormalities in cardiac disease and 150 tracings of ECG for practice
ECG in Medical Practice
Third EditionABM Abdullah MRCP (UK), FRCP (Edin) Professor of Medicine Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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ECG in Medical Practice
© 2010, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2004
Second Edition: 2006
Third Edition: 2010
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
To my parents for their never-ending blessings, love and encouragement
The value of experience is not in seeing much but in seeing wisely
By the good grace of Almighty Allah and blessings of my well-wishers, I have been able to bring out the third edition of this book. Immense popularity and wide acceptability of this book among the students and doctors have encouraged me to prepare this edition.
While I have written this book, my intention was to improve the understanding and interpretation of common ECG in an easy and simple way. Emphasis has been given on the importance of clinical correlation. To what extent this goal has been achieved, only the valued readers and time will tell. However, I can assure that a sincere attempt has been made by me to fulfill this purpose. Many new ECG tracings have been included in this present edition.
In spite of my best efforts, I believe there is still scope of further improvement of this book and make it even better. Any constructive suggestions and criticisms will be highly welcomed and appreciated.
ABM AbdullahPreface to the First Edition
Despite the advent of many high-tech diagnostic procedures, ECG still remains one of the most basic, useful and easily available tools for the early diagnosis and evaluation of many cardiac problems.
In spite of lot of books on this topic, I have written another new book, which is simple, concise, easy and a practical one that will help any physician, specially the beginners with little knowledge or experience on ECG.
The aim of this book is to guide the students and doctors about the basic concepts in ECG, its interpretation and recognition of cardiac abnormalities. It is also my intention to include common abnormalities in ECG and common cardiac problems that will help the students in any specialty of medicine, specially those who will appear in any examination.
To simplify and also to practice, I have arranged this book in three chapters:
- Chapter I—contains the basic principles of ECG along with normal ECG pattern and the abnormalities.
- Chapters II—contains the ECG abnormalities in different cardiac and extra-cardiac diseases.
- Chapter III—contains 100 ECG tracings of varying difficulty (from simple to more complex) for self practice. Interpretation of these ECG are written in the last few pages (I would advise first to interpret the ECG by yourself, then compare the findings).
Whenever you are going through an ECG, always proceed systematically. Never leave anything to chance and never assume anything. Always describe the basic things and finally look for any abnormality.
Being an internist, I have prepared this book after going through dozens of different ECG books and have tried my best to fill up the gaps, I have noticed in those during my long teaching experience. It is my students and doctor colleagues who have constantly inspired and insisted me to prepare such a book so that they can have a complete and easy grasp over the topic in a short-time. I believe, this book will not only fulfill their demand, but also be of great help for those who are willing to self-learn the basic concepts of ECG.
I was always careful not to overburden the busy clinicians and practitioners with the unnecessary details.
I would like to emphasise that efficiency, skill and fluency in interpreting ECG will only be achieved by going through the ECG tracings repeatedly and reviewing the topics frequently.
I would always appreciate and welcome constructive criticism from the valued readers about this book.
My heartiest gratitude and respect to those patients who were kind enough to agree to let me publish their ECG tracings in this book.
I express my sincere gratitude to Prof Pran Gopal Datta, MCPS, ACORL (Odessa), PhD (Kiev), MSc in Audiology (UK), FCPS, FRCS (Glasgow-UK), Vice Chancellor, Bangabandhu Sheikh Mujib Medical University, for his encouragement and valuable suggestions in preparing this book.
I am also highly grateful to Dr Ahmed-Al-Muntasir-Niloy, Medical Officer, BSMMU, Dr Omar Serajul Hasan, MD, internist (USA) and Dr Tanjim Sultana, MD, internist (USA). They have worked almost as co-authors, going through the whole manuscript and making necessary corrections and modifications.
I also acknowledge the contribution of my colleagues, doctors and students who have helped me by providing advice, corrections and encouragement:
- Prof N Islam, IDA, DSc, FRCP, FRCPE, FCGP, FAS, National Professor, Founder and Vice Chancellor, University of Science and Technology, Chittagong.
- Prof Munir Uddin Ahmed, frcp (London and Glasgow).
- Prof MN Alam, frcp (Glasgow), fcps.
- Prof Tofayel Ahmed, FCPS (BD), FCPS (Pak), FCCP, FACP (USA), MRCP, FRCP (Edin, Glasgow, Ireland).
- Prof Md. Fazlul Hoque, FCPS (BD), FRCP (Edin), FRCP (Glasgow), FCPS (Pak), FACP (USA).
- Prof MU Kabir Chowdhury, FRCP (Glasgow).
- Prof Md. Gofranul Hoque, FCPS.
- Prof Taimur AK Mahmud, mcps, fcps.
- Prof Md Abdul Wahab, dtcd, mrcp, frcp.
- Dr Tahmida Hassan, ddv, md.
- Dr Tazin Afrose Shah, FCPS.
- Dr Shahnoor Sharmin, MCPS, FCPS, MD (Cardiology)
- Dr Md. Razibul Alam, MBBS, MD.
- Dr Samprity Islam, MBBS.
- Dr Monirul Islam Khan, MBBS.
- Dr Sadi Abdullah, MBBS.
I would like to thank Mr Saiful Islam, Kh. Atiqur Rahman (Shamim) and Md. Oliullah for their great help in computer composing and graphic designing of this book.
My special thanks to Shri Jitendar P Vij (Chairman and Managing Director), Mr Tarun Duneja (Director-Publishing), Mr KK Raman (Production Manager), Mr Sunil Dogra, Mrs Yashu Kapoor, Mr Akhilesh Kumar Dubey and Mr Manoj Pahuja of M/s Jaypee Brothers Medical Publishers (P) Ltd., who have worked tirelessly for the timely publication of this book.
Last but not the least, I would like to express my gratitude to my wife and children for their constant support, sacrifice and encouragement. Otherwise, it would have been impossible for me to write this book.