Rapid ECG Interpretation M Gabriel Khan
INDEX
Page numbers followed by f refer to figure and t refer to table.
A
Abdominal electrodes 347
Accelerated junctional rhythm 342f
Acquired heart diseases 77
Acquired immunodeficiency syndrome 99, 126
Adenosine 172
increases AV block 199
intravenous 203
Alcohol abuse 153
Amiodarone 172, 217
Amyloid 22
Amyloidosis 128, 130
Angina
severe 102
unstable 103
Anteroseptal infarction 22
diagnosis of 110
Antiarrhythmic agents 83
Antidromic
anterograde conduction 203
circus movement tachycardia 207
tachycardia 203
Antifungal agents 172, 217
Arm electrodes 16f, 347
interchanged 66f
Arm leads reversed 19f
Arrhythmias 4, 33, 104, 179, 180
assess 64
Arrhythmogenic, right ventricular dysplasia 75
Artifacts 348f
preclude accurate interpretation 346
Astemizole 172, 217
Atrial bigeminy 343f
Atrial demand pacing 177
Atrial fibrillation 66f, 72, 84f, 205, 209f, 211f, 216f, 213, 337f, 338f, 340f, 344f
ECG diagnostic points 205
Atrial flutter 204, 206f, 207f, 208f, 213, 340f, 341f, 342f
rapid ventricular rate 205f
Atrial hypertrophy 134f
bilateral 135
left 71f, 72f, 341f
atrial hypertrophy 131
right 71f, 341f
and left 54f
atrial 133
typical features of 70f
Atrial premature beat 180, 181f, 182f
ECG diagnostic points 180
pair of 181
Atrial septal defect 77, 167, 168
diagnostic sign 168f
large 62f
secundum 76
Atrial tachycardia 198f, 345f
differentiation of 198
multifocal 72
causes of 200
ECG diagnostic points 199
nature of 198
Atrial trigeminy 181f
Atrioventricular
block 197
junction 180
nodal reentrant tachycardia 77, 193, 196f, 197f
node 5
Atrium
left 67
right 67
Augmented leads 12
AV dissociation 212
AV nodal reentrant tachycardia 195f
B
Battery power failure 179
Beats, multifocal 185f
Bifascicular block 165f
diagnosis 164f
Bradyarrhythmias 64, 184, 217
complete atrioventricular block 191
first-degree atrioventricular block 184
second-degree atrioventricular block 185, 188
Brugada syndrome 75, 76, 77, 340f
diagnosis of 31
typical features of 76f
Bulb suction cup 65
Bundle branch block 73
Bundle of His 8
C
Cardiac electrocardiogram 86
Cardiac enzyme confirmation 89
Cardiac tumors 128
primary 153
secondary 153
Cardiomyopathy 76, 82, 83, 105, 128, 153, 163
Carotid sinus massage 199
diagnosis based on 203
Catecholamines, effects of 5
Cell
depolarized 3f
repolarization of 3f
resting 3f
Cerebral hemorrhage 105
Cerebrovascular disease 172
Chagas disease 76, 126, 128, 163
Chaotic atrial tachycardia 199
Chest
deformity 128
leads 13
placement 65f
V1 through V6 29f
mirror-image positions 63
trauma to 128
Chloroquine 172, 217
Circumflex branch occlusion 95
Coarctation of aorta 76
Cocaine abuse 99, 114, 153, 217
Collapse, episodes of 76f
Complex tachycardia
narrow 64
wide 64
Conduction defects 162
Constrictive pericarditis 104, 130
Cor pulmonale 76, 77, 134
Cornell voltage criteria 137
Coronary artery 114
aneurysm 114
disease 76, 82
spasm 46, 87, 88, 97
severe 114
Coronary heart disease 82
Coronary syndrome, acute 100
Creatine kinase-MB 346
determination of 27
Crista supraventricularis 77
D
Deep T wave inversion 152f
in V2 through V5 58f
Deep wide Q waves 23f, 24f
Degenerative diseases 82
Delta waves 199f
Depolarization 1
Depression 42
Dextrocardia 159, 167, 174
diagnostic
confirmation 175
criteria 174
pitfalls 175
mirror-image 175f
Dextroposition 140, 176
Diffuse myocardial diseases 130
Digitalis 174
effect 174
intoxication 172
toxicity 167, 174
Digoxin 5, 105
Diphasic in V1 70
Disopyramide 172, 217
E
Einthoven's
equilateral triangle 156f
hypothesis 347
Eisenmenger syndrome 140f
Electrical alternans 167, 176
causes 176
Electrical axis 60t, 155, 158t
assess 59
left-axis deviation 157
right-axis deviation 159
Electrical recovery 9
Electrocardiogram 6, 22
basic concepts 1
board self-assessment 218f
changes 62f
features of left ventricular hypertrophy 136f
hallmarks of ventricular tachycardia 214f
interpretation 155
new method 26
step-by-step method for accurate 34f, 36f, 40f, 42f, 47f, 53f, 57f, 59f, 61f, 87, 107f, 143, 158, 168
intervals and parameters 30t
new electrode placement 348f, 349f
normal 18, 19f, 20, 33
produced, waves of
P wave 7
PR interval 7
QRS complex 8
ST segment 9
T wave 9
U wave 9
superior quality 346
technique 65
typical 75
voltage criteria 135
waveform 27
Electrode
placement, new 347
positions 11f
produce 3f
Electrolyte
abnormalities 104, 172
imbalance 153
Electronic pacemaker 177f, 178f
Electronic pacing 168, 176, 339f
atrial pacing 177
atrioventricular sequential pacing 177
malfunction 179
pacemaker malfunction 178
presence of 40
ventricular pacing 176
Emphysema 111, 128, 159
Erythromycin 172
F
Fascicular block 161
bifascicular block 166
left anterior 60, 73, 111, 155, 164f
hemiblock 161
left posterior 155, 159f, 165f
Fat sensors 65
Fibro-fatty degeneration 75
Fibrosis 22
Functional bundle branch block 207
G
Gallbladder disease 153
Genesis of
left bundle branch block 39f
normal QRS complex 17f, 37f
QRS complex 37f, 74, 79f
H
Heart
block, complete 191f, 341f
contraction of 1
disease
congenital 82, 83, 133, 134
evidence of structural 75
history of 104f
electrical activation of 1, 2f, 6f
failure 83
congestive 82
muscle 6
position, vertical versus horizontal 13
rate, determination of 35
rhythms 4
Hemiblock 60, 155, 158
patterns 161f
Hemodynamic deterioration 89
Hexaxial reference system derived 156
High amplitude 70
Holter monitor 188f
Hypercalcemia 154, 168, 172
Hyperkalemia 128, 167, 173, 337f
diagnostic criteria 173
ECG signs of 174f
mild 173
severe 173
Hyperparathyroidism 172
Hypertension, severe 154
Hypertensive heart disease 82, 83, 163
Hyperthermia 168
Hypertrophic cardiomyopathy 99, 126, 141, 339f, 343f
Hypertrophy, atrial and ventricular 131
Hyperventilation 105, 153
Hypocalcemia 168, 172
Hypokalemia 154, 167, 172, 217
diagnostic criteria 172
Hypomagnesemia 217
Hypothermia 168
Hypothyroidism 172
I
Idioventricular rhythm 173
Infarction
acute 88, 119, 120, 121
anterior 120
anteroapical 121
anterolateral 89, 121
anteroseptal 89, 121
inferior 89, 119
location of 119
old 119, 121
posterior 89, 121
Insecticide poisoning 217
Intervals and blocks, assess 34
Intracranial hemorrhage 154
Intraventricular conduction
defects 104, 153
delay 41f, 82
causes of 82
diagnosis of 83f
nonspecific 82
Intraventricular septum 6
Ionic exchange, concept of 4
Ischemia 96, 100, 146, 149, 151
Ischemic heart disease 133, 172
acute 163
chronic 163
J
Junctional P waves 182
Junctional rhythm 69f
Junctional tachycardia 341f
K
Kawasaki disease 114
Khan method 16f
L
Leads and electrodes 10
Left atrial, enlargement 31, 53f, 132
Left bundle branch block 31, 36, 46, 79, 88, 128
and infarction 129
causes of 82
diagnostic criteria 79
genesis of QRS complex 79
loss of 85f
with infarction 129
Left main coronary artery, diagnosis of 93
Left ventricle, depolarization of 79
Left-axis deviation 159f, 162f
Limb electrodes, placement of 347
Limb leads 38f, 56f, 66f, 101f, 196f, 202f
new, placements for 16, 346
normal ECG 29f
tracing 68
standard bipolar 12
unipolar 156f
Liquid protein diets 172
Long QT interval 167, 170
causes 172
diagnostic criteria 171
Low-voltage QRS 129
causes of 130
criteria for 130
M
Macrolides 172
Malignancy, feature of 172
Mimics dextrocardia 338f
Mitral regurgitation 133
Mitral stenosis 77, 133
Mitral valve prolapse 153, 172
Mobitz type I block 185
Mobitz type II block 188, 190, 337
Muscular dystrophy 77
Myocardial infarction 45, 77, 81, 106, 114, 143f
acute 86, 346
anterior 94f, 116
diagnosis of 27
inferior 94f, 97
anterior 98f, 125f
anteroapical 90f
anterolateral 348
anteroseptal 128
lateral 159
nonatheromatous, cause of 114
old 123
posterior 140
posterolateral 124f
Myocardial ischemia
ECG patterns of 45f
severe 339f, 340f
Myocardial necrosis 114
Myocarditis 76, 104, 126, 128, 149, 163, 172
acute 99
Myxedema 130
N
Nodal premature beats 182
ECG diagnostic points 182
Noncardiac conditions 128
O
Obesity 130
Obstructive coronary artery disease 101f
Obstructive pulmonary disease
chronic 128, 130, 164
severe chronic 111, 138
Organophosphate insecticides 172
Orthodromic circus movement tachycardia 203, 207
Orthodromic tachycardia 203
P
P terminal force 131
P wave
abnormal, features of 67
abnormalities 67
inverted in leads 69f
morphology 26
normal features of 67
notching of 70
Pacemaker
artificial 61
impulse 176
rhythm 63
Pancreatitis, acute 128, 153
Paroxysmal atrial tachycardia 197
Pectus excavatum 77
Pentamidine 172, 217
Percutaneous coronary intervention 88, 346
Pericardial
effusion 130
fluid 170
Pericarditis 76, 86, 104, 128, 149, 169
acute 87, 97, 62, 62f, 167, 337f
characteristic features of 170f
clues suggestive of acute pericarditis 169
diagnostic criteria 169
Persistent atrial tachycardia 198, 203
ECG diagnostic points 198
Phenothiazines 172, 217
Pheochromocytoma 153
Pleural effusion 130
Pneumothorax 128, 153
Positron emission tomography scan 346
Post-Stokes-Adams attack 149
Post-supraventricular tachycardia 149
Potassium efflux 7, 27
Precordial
chest leads, position of 15f
electrodes 13
lead 97
lead electrodes 63f
Prinzmetal angina 97
Procainamide 172, 217
Prolonged QT syndrome 61
congenital 172
Pseudoinfarction 128f
Pseudoinferior infarction resulting 66f
Pulmonary embolism 76, 77, 105, 128, 149, 159, 168, 179
Pulmonary hypertension 134
Pulmonary stenosis 134
Q
Q waves 19
abnormalities 106, 114
assess for pathologic 46
criteria for normal and abnormal 106
deep pathologic 118f
for pathologic 32
in leads, wide pathologic 122f
myocardial infarction, mimics of 126
normal parameters 106
QRS complex 8, 9, 14, 18, 20, 155
genesis of 16
morphology 25, 26
QRS interval 26
QRS normal variants and abnormalities 18
QRS notching, wide 85f
QRS regular tachycardia 203
Qrs tachycardia
differential diagnosis of 64f
irregular wide 213
narrow 192
regular wide 207
wide 64, 205
wide regular 214f
QRS vector 156f
QRS voltage, high 139f
QT intervals 61t
Quinidine 172, 217
uses 154
R
R wave
loss of 47, 49f, 51f, 120
progression 52f
poor 113f
Rabbit ear 184f, 211
Radial artery access 349
Reciprocal depression 44f, 90f, 94f, 97, 349f
presence of 91f
Regular rhythm 35
Renal disease, chronic 172f
Repolarization 2, 142
changes 144
Restrictive cardiomyopathy 130
Rheumatic fever
Rheumatic heart disease 76
Rhythm and rate, assess 33
Rhythm strip 190f
Right bundle branch block 31, 35, 37f, 40, 62, 73, 77 84f
and infarction 129
causes of 76
diagnostic criteria 73
genesis of QRS 73
incomplete 76
presence of 140
RSr′ variant 77
typical 75f
Romhilt-Estes scoring system 138
RSr′ and rSR′ in V1 78f
S
Sarcoid 22
Sarcoidosis 128
Sawtooth pattern, causes 208f
Scapular 346
Scleroderma 128
Septal depolarization 74
Single photon emission computed tomography 346
Sinoatrial node 1, 2f, 5, 67
Sinus
arrhythmia 20
bradycardia 72, 80f, 123f, 341f
rhythm 29f, 30f, 41f, 71, 72, 84f, 123f, 124f, 144f, 343f, 344f
tachycardia 78f, 135, 169, 179, 170, 189f, 192, 194f, 342f, 343f
Situs inversus 63f, 174, 175f
Sodium influx 7, 27
Sokolow-Lyon voltage criteria 136
Sotalol 172, 217
ST segment
abnormalities 86
depression
down-sloping 101f
progressive 172
elevation in
leads 90f
presence of 114
V1 through V4 93f
widespread 170f
scrutiny of 344f
STEMI 88f, 91f, 95f, 99f, 100f, 114, 342f
diagnostic criteria 89
infarct size 93
mimics of 97
value of lead AVR in diagnosis of 93
Straight back syndrome 77
Strain pattern 136f, 343f
Subarachnoid hemorrhage 105, 153, 217
Subendocardial infarction 96
Sudden death, causes of 31
Supraventricular
arrhythmias 212f
tachycardia 337f, 338f
Switching sequence 33
Syncope, episodes of 76f
T
T wave 144f
abnormalities of 142, 145
changes
assess pattern of 57
assessment of 143
interpretation of 142
inversion in
symmetric 153
V2 through V4 148
V2 through V5 146
V4 through V6 148f
Tachyarrhythmias 64
Tachycardia, clues during 201
Tall R waves in
leads V1 and V2 41f
V1 and V2 40t
Tall T waves 153
Terfenadine 172, 217
Terminal negative deflection 131
Tetralogy of Fallot 76
Thorax, left 15
Thrombolytic 346
Thrombolytic, treatment of 93
Thyrotoxicosis 154
Torsades de pointes 213, 217f
Tricuspid regurgitation 134
Tricuspid stenosis 134
Tricyclic antidepressants 83, 172, 217
Trigger atrial tachycardia 180
Trioventricular nodal reentrant tachycardia 344f
Troponins 100, 346
U
U waves 154
abnormal 154
causes 154
normal 154
Undersensing malfunction 178
Unipolar pacing mode 176
V
Valvular heart disease 133
advanced 82
severe 83
Vector forces 17
vector 17, 18
Ventricles, recovery period of 142
Ventricular activation
left 74
right 74
Ventricular aneurysm 98f
left 88, 8f
Ventricular bigeminy 186f
Ventricular capture rate 178f
Ventricular complexes
multiform premature 124
premature 123f
Ventricular demand pacing 177
Ventricular depolarization 178
Ventricular dysplasia, right 31, 76, 77
Ventricular fibrillation 173, 217
Ventricular hypertrophy 135, 153
assess for left 55
assess for right 55
left 32, 55, 71f, 87, 99, 102, 128, 132f, 337f
diagnosis of 133, 138
right 32, 55, 56f, 77, 134, 140, 155, 159
diagnosis of 140
Ventricular infarction, right 92f, 121
Ventricular muscle mass
large, left 6
small, right 6
Ventricular muscle replacement of 22
Ventricular pacing 176
Ventricular premature beat 84f, 135f, 183f, 184f, 184, 186, 338f, 340f
ECG diagnostic points 183
multifocal 188f
Ventricular rhythm 191
Ventricular septal defect 76
Ventricular septum, causes 22, 23f
Ventricular systole, total duration of 170
Ventricular tachycardia 149, 155, 173, 187, 207, 209, 213f, 215f
short run of 187
signs of 215f
Voltage of R wave in V5 or V6 137f
W
Wenckebach phenomenon, typical 189f, 190f
Wolff-Parkinson-White syndrome 31, 39f, 40, 77, 126f, 127f, 128, 140, 200
ECG diagnostic criteria 200
features of 201f
mimic inferior infarction 202f
tachycardia, types of 203
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Rapid ECG Interpretation
Rapid ECG Interpretation
Fourth Edition
(Late) M Gabriel Khan MD FRCP (London) FACC FRCPC MB BCh (Queen's Belfast) Former Associate Professor Department of Medicine and Division of Cardiology University of Ottawa The Ottawa Hospital Ottawa, Ontario, Canada
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Rapid ECG Interpretation
Third Edition: 2008, Springer (Humana Press)
Fourth Edition: 2020
9789389188585
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