12-Lead EKG Confidence: A Step-by-Step Guide, Second Edition PDF
Preview 12-Lead EKG Confidence: A Step-by-Step Guide, Second Edition
12-LEAD EKG CONFIDENCE Second Edition About the Authors Jacqueline M. Green, MS, RN, APN-C, CNS, CCRN Jacqueline Green received her BS in Nursing from Kean University. She attended Rutgers University where she received an MS in Nursing. She is presently a Clinical Nurse Specialist–Cardiac Services at Robert Wood John- son University Hospital in New Brunswick NJ. Anthony J. Chiaramida, MD, FACC Dr. Chiaramida received his BS in Chemistry from Fordham University. He attended the University of Southern California School of Medicine, where he graduated with honors as a member of AOA. He completed his internship and residency at Cornell Cooperating Hospitals (North Shore–Memorial Sloan Kettering). He completed his training in Cardiology at Emory University and is a Fellow of the American College of Physicians and the American College of Cardiology. Since completing his studies in Cardiology at Emory Univer- sity, he has taught the monthly fourth-year medical student EKG elective to Robert Wood Johnson Medical School students. He makes teaching rounds daily in the CCU and ICU with students, nurses, respiratory therapists, dieti- cians, interns, and residents. 12-LEAD EKG CONFIDENCE A Step-by-Step Guide Second Edition Jacqueline M. Green, MS, RN, APN-C, CNS, CCRN Anthony J. Chiaramida, MD, FACC Copyright © 2010 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or other- wise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rose- wood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Margaret Zuccarini Production Editor: Barbara A. Chernow Cover design: Steve Pisano Composition: Agnew’s, Inc. Ebook ISBN: 978-0-8261-0473-1 09 10 11 12/ 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Green, Jacqueline M. 12-lead EKG confidence : a step-by-step guide / Jacqueline M. Green, Anthony J. Chiaramida. — 2nd ed. p. ; cm. Includes index. ISBN 978-0-8261-0472-4 1. Electrocardiography. I. Chiaramida, Anthony J. II. Title. III. Title: Tweleve-lead EKG confidence. [DNLM: 1. Electrocardiography—methods—Programmed Instruction. WG 18.2 G796z 2009] RC683.5.E5.G685 2009 616.1'207547—dc22 2009028242 Printed in the United States of America by Bang Printing. The authors and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base continues to expand. Therefore, as new information be- comes available, changes in procedures become necessary. We recommend that the reader always consult current research and specific institutional policies before performing any clinical procedure. The authors and publisher shall not be liable for any special, consequen- tial, or exemplary damages resulting, in whole or in part, from the readers’ use of, or re- liance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet Web sites referred to in this publication and does not guarantee that any content on such Web sites is, or will remain, accurate or appropriate To my children, Caroline and Conor, with Love always . . . And to you Phil, who encouraged me, read every paper I ever wrote, and who sacrificed the most . . . Thank You —J.G. To my mom, who taught me how. And to my dad, who taught me why . . . and to my children, Jennifer, Joseph, and Matthew, who teach me anything else that really matters. —A.C. This page intentionally left blank CONTENTS Preface xi Acknowledgments xiii Need and Use xv 12 Critical Concepts xvii Section I: Overview of Heart Function and the EKG CHAPTER 1 Anatomy Review of the Human Heart 3 CHAPTER 2 Physiology Review of the Heart’s Conduction System 17 CHAPTER 3 Basics of the 12-Lead EKG 23 Section II: Methodology: Measurements and Their Clinical Significance CHAPTER 4 Heart Rate 33 Worksheets 44 CHAPTER 5 The PR, QRS, and QT Intervals 49 Worksheets 68 CHAPTER 6 Axis—The Science of Direction 73 Worksheets 114 SECTION II Worksheets 118 Section III: Common Clinical Arrhythmias CHAPTER 7 Atrial Arrhythmias 125 Worksheets 130 CHAPTER 8 Ventricular Arrhythmias 133 Worksheets 138 CHAPTER 9 Junctional Rhythm, Heart Block, and Pacemakers 143 Worksheets 152 SECTION III Worksheets 154 vii viii Contents Section IV: EKG Changes Related to Conduction Abnormalities CHAPTER 10 Hemiblock 165 Worksheets 174 CHAPTER 11 Right Bundle Branch Block 179 Worksheets 190 CHAPTER 12 Left Bundle Branch Block 195 Worksheets 208 SECTION IV Worksheets 212 Section V: The Ischemic Disorders: EKG Changes Related to Ischemia and Myocardial Infarction (MI) CHAPTER 13 The Partially-Occluded Artery: Angina and Non-ST Elevation MI 219 Worksheets 239 CHAPTER 14 The Totally Occluded Artery: ST Elevation MI 243 Worksheets 260 CHAPTER 15 Prolonged Arterial Occlusion: Q Waves and Equivalents 265 Worksheets 281 SECTION V Worksheets 285 Section VI: The Non-Ischemic Disorders: EKG Changes Related to Hypertrophy CHAPTER 16 Atrial Abnormalities 293 Worksheets 301 CHAPTER 17 Left Ventricular Hypertrophy 305 Worksheets 319 CHAPTER 18 Right Ventricular Hypertrophy 323 Worksheets 334 SECTION VI Worksheets 338 Contents ix Section VII: The Non-Ischemic Disorders: EKG Changes Related to Drugs, Electrolyte Abnormalities, and Other Diseases CHAPTER 19 Drug and Electrolyte Effects 345 Worksheets 360 CHAPTER 20 Clinical Conditions That Affect the EKG 365 Worksheets 387 SECTION VII Worksheets 391 Section VIII: Self-Assessment SECTION VIII Worksheets 399 Answers to EKG Worksheets 409 Index 417
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