Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment

424 Pages·2006·17.33 MB·English

by  David H. Bennett

Cardiac Arrhythmias
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Cardiac Arrhythmias
Practical notes on interpretation
and treatment
Seventh edition
David H. Bennett MD, FRCP, FACC, FESC
Consultant Cardiologist,
Regional Cardiac Centre,
Wythenshawe Hospital,
Manchester, UK
First published in Great Britain in 1981
Second edition 1985
Third edition 1989
Fourth edition 1993
Fifth edition 1997
Sixth edition 2002
This seventh edition published in 2006 by
Hodder Arnold, an imprint of Hodder Education, a member of the Hodder Headline Group,
338 Euston Road, London NW1 3BH
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© 2006 David H. Bennett
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going to press, neither the author nor the publisher can accept any legal responsibility or liability
for any errors or omissions that may be made. In particular (but without limiting the generality
of the preceding disclaimer) every effort has been made to check drug dosages; however it is
still possible that errors have been missed. Furthermore, dosage schedules are constantly being
revised and new side-effects recognized. For these reasons the reader is strongly urged to
consult the drug companies’ printed instructions before administering any of the drugs
recommended in this book.
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ISBN-10 0 340 92562 0
ISBN-13 978 0 340 92562 1
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CONTENTS
Preface to the seventh edition vii
Preface to the first edition ix
Introduction xi
1 Sinus rhythm 1
2 Ectopic beats 6
3 Escape beats 16
4 Bundle branch blocks 19
5 The supraventricular tachycardias 27
6 Atrial fibrillation 33
7 Atrial flutter 50
8 Atrial tachycardia 59
9 Atrioventricular junctional re-entrant tachycardias 64
10 Wolff–Parkinson–White syndrome 78
11 Ventricular tachyarrhythmias 90
12 Monomorphic ventricular tachycardia 91
13 Polymorphic ventricular tachycardia and ventricular fibrillation 115
14 Tachycardias with broad ventricular complexes 130
15 Atrioventricular block 141
16 Sick sinus syndrome 154
17 Neurally mediated syncope 161
18 Arrhythmias due to myocardial infarction 169
19 Antiarrhythmic drugs 182
20 Sudden cardiac death 202
21 Cardioversion 206
22 Ambulatory ECG monitoring 214
23 Temporary cardiac pacing 228
24 Long-term cardiac pacing for bradycardias 236
25 Automatic implantable cardiovertor defibrillator 280
26 Catheter ablation 300
27 Arrhythmias for interpretation 326
Index 405
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PREFACE TO THE SEVENTH EDITION
There are several large textbooks which comprehensively cover the field of cardiac
arrhythmias with thorough referencing of scientific papers. This book does not
attempt to replicate these texts. The purpose of this seventh edition remains the same
as its predecessors: to provide a concise, practical guide to the diagnosis, investigation
and management of the main cardiac arrhythmias with particular emphasis on the
problems commonly faced in practice.
Much new information in the areas of sudden cardiac death, heart failure, cardiac
pacing and implantable defibrillators has been acquired since the last edition.
Accordingly, the text has been updated.
In order to gain confidence in interpretation of arrhythmias it is necessary to exam-
ine a variety of examples of each rhythm disturbance. For this reason, it has always
been a purpose of this book to present a large number of electrocardiograms. In this
edition there are many new additional electrocardiograms and the quiz section has
been revised and enlarged to provide a challenge to those who may be familiar with
previous editions.
In recent years there has been a trend to sub-specialization in cardiology. Whatever
the sub-specialty, cardiac arrhythmias will frequently be encountered. A thorough
appreciation of the significance and management of cardiac arrhythmias is required
of all who treat patients with cardiac disease.
I am most grateful to my technical and medical colleagues for their help, and to
the staff at Hodder Arnold for their expertise.
D.H.B.
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PREFACE TO THE FIRST EDITION
The purpose of this book is to describe the main cardiac arrhythmias, with particu-
lar emphasis on the problems commonly encountered in their interpretation, and to
discuss the practical aspects of current methods of investigation and treatment.
Information of purely academic value has not been included.
This book is intended to fill the gap between those textbooks that cover only the
basics of arrhythmias and those that are written for the cardiac electrophysiologist. It
has been written with junior hospital doctors in mind. They receive little formal train-
ing in the management of cardiac arrhythmias and yet, because prompt action is often
required, the onus of diagnosis and treatment usually falls on them. It should also be
of interest to medical students, who themselves will soon be responsible for dealing
with arrhythmias, to nurses working in coronary and intensive care units and to
physicians who want a brief review of the practical aspects of cardiac arrhythmias.
I would like to thank the cardiac technicians, coronary care nurses and medical
staff at Wythenshawe Hospital for their help. I am particularly grateful to my col-
leagues, Dr Colin Bray and Dr Christopher Ward. Thanks are also due to Mrs Mary
Rooney for typing the manuscript and to the Wythenshawe Hospital Medical
Illustration Department.
Finally, I would like to acknowledge the distractions provided by my family,
Irene, Samantha and Sally, to whom this book is dedicated.
D.H.B.