ECG-2014-Pocket Brain

572 Pages·2013·21.9 MB·English

by  Ken Grauer

Section 00.1 - Table of CONTENTS -
00.1 – Table of CONTENTS
00.2 – Front Matter: TITLE Page
00.3 – Acknowledgements/Copyright
00.4 – About ECG-2014-ePub
00.5 – About the Author/Other Material by the Author
00.6 – ECG Crib Sheet
00.7 – The 6 Essential Lists
01.0 – Review of Basics
01.1 – Systematic Approach to 12-Lead ECG Interpretation
01.2 – The 2 Steps to Systematic Interpretation
01.3 – WHY 2 Separate Steps for Interpretation?
02.0 – Rate & Rhythm
02.1 – Assessing the 5 Parameters of Rhythm
02.2 – Calculating Rate: The Rule of 300
02.3 – How to Define Sinus Rhythm?
02.4 – FIGURE 02.4-1: Is the Rhythm Sinus?
02.5 – Sinus Mechanism Rhythms/Arrhythmias
02.6 – Norms for Children: Different than Adults
02.7 – Sinus Arrhythmia
02.8 – FIGURE 02.8-1: What Happens to the P in Lead II?
02.9 – FIGURE 02.9-1: When there is NO long Lead II Rhythm Strip ...
02.10 – Advanced POINT: What is a Wandering Pacemaker?
02.11 – FIGURE 02.11-1: Why is this NOT Wandering Pacer?
02.12 – Other Supraventricular Rhythms
02.13 – FIGURE 02.13-1: Why is this Rhythm Supraventricular?
02.14 – Atrial Fibrillation
02.15 – Advanced POINT: Very Fast AFib — Think WPW!
02.16 – Multifocal Atrial Tachycardia
02.17 – FIGURE 02.17-1: Why is this Not AFib?
02.18 – Atrial Flutter
02.19 – FIGURE 02.19-1: Easy to Overlook AFlutter ...
02.20 – How NOT to Overlook AFlutter (Figure 02.19-1)
02.21 – FIGURE 02.21-1: Vagal Maneuvers to Confirm AFlutter
02.22 – FIGURE 02.22-1: Some KEY Aspects about AFlutter
02.23 – TRACING B: AFlutter with 3:1 AV Conduction
02.24 – TRACING C: AFib-Flutter
02.25 – TRACING D: AFlutter vs Artifact
02.26 – Use of VAGAL Maneuvers (Carotid Massage, Valsalva)
02.27 – FIGURE 02.27-1: Clinical Response to Vagal Maneuvers
02.28 – Using ADENOSINE = “Chemical” Valsava
02.29 – PSVT/AVNRT
02.30 – FIGURE 02.30-1: Retrograde Conduction with PSVT
02.31 – The “Every-other-Beat” Method (for fast rates)
02.32 – Junctional Rhythms
02.33 – Junctional Rhythms: P Wave Appearance in Lead II
02.34 – Junctional Rhythms: Escape vs Accelerated
02.35 – Low Atrial vs Junctional Rhythm?
02.36 – VENTRICULAR (= wide QRS) Rhythms
02.37 – Slow IdioVentricular Escape Rhythm
02.38 – AIVR
02.39 – Ventricular Tachycardia
02.40 – ESCAPE Rhythms: ECG Recognition
02.41 – PRACTICE TRACINGS: What is the Rhythm?
02.42 – PRACTICE: Tracing A
02.43 – PRACTICE: Tracing B
02.44 – PRACTICE: Tracing C
02.45 – PRACTICE: Tracing D
02.46 – PRACTICE: Tracing E
02.47 – LIST #1: Regular WCT
02.48 – List #1: KEY Points
02.49 – Suggested Approach to WCT/Presumed VT
02.50 – Use of the 3 Simple Rules
02.51 – FIGURE 02.51-1: 12 Leads are BETTER than One
02.52 – LIST #2: Regular SVT
02.53 – The Regular SVT: — Differential Diagnosis?
02.54 – Suggested Treatment Approach for a Regular SVT
02.55 – FIGURE 02.55-1: Which SVT is present?
02.56 – Premature Beats
02.57 – ESCAPE Beats: Timing is Everything ...
02.58 – Narrow-Complex Escape Beats
02.59 – PVC Definitions: Repetitive Forms and Runs of VT
02.60 – Blocked PACs/Aberrant Conduction
02.61 – PRACTICE Tracings-2: What is the Rhythm?
02.62 – PRACTICE: Tracing F
02.63 – PRACTICE: Tracing G
02.64 – PRACTICE: Tracing H
02.65 – PRACTICE: Tracing I
02.66 – PRACTICE: Tracing J
02.67 – AV Blocks / AV Dissociation
02.68 – Blocked PACs: Much More Common than AV Block
02.69 – The 3 Degrees of AV Block
02.70 – 1st Degree AV Block
02.71 – The 3 Types of 2nd Degree AV Block
02.72 – Mobitz I 2nd Degree AV Block (= AV Wenckebach)
02.73 – Mobitz II 2nd Degree AV Block
02.74 – 2-to-1 AV Block: Mobitz I or Mobitz II?
02.75 – 3rd Degree (Complete) AV Block
02.76 – PEARLS for Recognizing/Confirming Complete AV Block
02.77 – AV Dissociation
02.78 – FIGURE 02.78-1: Is there any AV Block?
02.79 – SUMMARY: Complete AV Block vs AV Dissociation
02.80 – High-Grade 2nd-Degree AV Block
02.81 – Ventricular Standstill vs AV Block
02.82 – Hyperkalemia vs AV Block
02.83 – FIGURE 02.83-1: Is there any AV Block at all?
03.0 – Doing an ECG / Technical Errors
03.1 – Limb Leads: Basic Concepts/Placement
03.2 – Why 10 Electrodes but 12 Leads?
03.3 – Derivation of the Standard Limb Leads (Leads I,II,III)
03.4 – The 3 Augmented Leads (Leads aVR,aVL,aVF)
03.5 – The Hexaxial Lead System
03.6 – Precordial Lead Placement
03.7 – Use of Additional Leads
03.8 – Technical Errors: Angle of Louis and Lead V1
03.9 – Technical Mishaps: Important Caveats
03.10 – Important Concepts: Lead Misplacement/Dextrocardia
03.11 – Dextrocardia: ECG Recognition
03.12 – PRACTICE: Identifying Technical Errors
03.13 – PRACTICE: Tracing A
03.14 – PRACTICE: Tracing B
03.15 – PRACTICE: Tracing C
03.16 – PRACTICE: Tracing D
03.16.1 – ADDENDUM: Prevalence/Types of Limb Lead Errors
03.16.2 – ECG Findings that Suggest Limb Lead Misconnection
03.17 – PRACTICE: Tracing E
03.18 – PRACTICE: Tracing F
03.19 – PRACTICE: Tracing G
03.20 – PRACTICE: Tracing H
03.21 – PRACTICE: Tracing I
03.22 – PRACTICE: Tracing J
03.23 – PRACTICE: Tracing K
04.0 – Intervals (PR/QRS/QT)
04.1 – What are the 3 Intervals in ECG Interpretation?
04.2 – The PR Interval: What is Normal?
04.3 – The PR Interval: Clinical Notes
04.4 – Memory Aid: How to Recall the 3 ECG Intervals
05.0 – Bundle Branch Block/IVCD
05.1 – The QRS Interval: What is Normal QRS Duration?
05.2 – IF the QRS is Wide: What Next? (BBB Algorithm)
05.3 – FIGURE 05.3-1: Why the Need for the BBB Algorithm?
05.4 – Typical RBBB: Criteria for ECG Recognition
05.5 – RBBB: Clinical Notes
05.6 – Typical LBBB: Criteria for ECG Recognition
05.7 – FIGURE 05.7-1: LBBB alters Septal Activation
05.8 – FIGURE 05.8-1: Clinical Example of Complete LBBB
05.9 – LBBB: Clinical Notes
05.10 – Incomplete LBBB: Does it Exist?
05.11 – IVCD: Criteria for ECG Recognition
05.12 – IVCD: Clinical Notes
05.13 – FIGURE 05.13-1: Clinical Example of IVCD
05.14 – ST-T Wave Changes: What Happens with BBB?
05.15 – FIGURE 05.15-1: Assessing ST-T Wave Changes with BBB
05.16 – RBBB Equivalent Patterns
05.17 – FIGURE 05.17-1: Is this RBBB?
05.18 – Incomplete RBBB: How is it Diagnosed?
05.19 – PRACTICE: Bundle Branch Block
05.20 – PRACTICE: Tracing A
05.21 – PRACTICE: Tracing B
05.22 – PRACTICE: Tracing C
05.23 – PRACTICE: Tracing D
05.24 – Diagnosing BBB + Acute MI
05.25 – Begin with the ST Opposition Rule
05.26 – RBBB: You Can See Q Waves!
05.27 – Underlying RBBB: How to Diagnose Acute MI?
05.28 – Underlying LBBB: How to Diagnose Acute MI?
05.29 – FIGURE 05.29-1: Acute STEMI despite LBBB/RBBB?
05.30 – Diagnosing BBB + LVH
05.31 – LBBB: What Criteria to Use for LVH/RVH?
05.32 – RBBB: What Criteria to Use for LVH/RVH?
05.33 – Brugada Syndrome
05.34 – ECG Recognition: Distinction Between Type I and II
05.35 – WHAT to DO? - when a Brugada Pattern is Found?
05.36 – WPW (Wolff-Parkinson-White)
05.37 – WPW: Pathophysiology / ECG Recognition
05.38 – WPW: The “Great Mimic” of other Conditions
05.39 – FIGURE 05.39-1: Recognizing WPW on a 12-Lead
05.40 – FIGURE 05.40-1: Recognizing WPW
05.41 – FIGURE 05.41-1: Atypical RBBB or WPW?
05.42 – WPW Addendum #1: How to Localize the AP?
05.43 – WPW: The Basics of AP Localization
05.44 – FIGURE 05.44-1: Where is the AP?
05.45 – FIGURE 05.45-1: Where is the AP?
05.46 – FIGURE 05.46-1: Where is the AP?
05.47 – Addendum #2: Arrhythmias with WPW
05.48 – PSVT with WPW: When the QRS During Tachycardia is Narrow
05.49 – Very Rapid AFib with WPW
05.50 – Atrial Flutter with WPW
05.51 – PSVT with WPW: When the QRS is Wide
05.52 – FIGURE 05.52-1: VT or WPW? What to Do?
06.0 – QT Interval / Torsades de Pointes
06.1 – How to Measure the QT
06.2 – LIST #3: Causes of QT Prolongation
06.3 – A Closer Look at LIST #3: Drugs – Lytes – CNS
06.4 – Conditions Predisposing to a Long QT/Torsades
06.5 – The QTc: Corrected QT Interval
06.6 – Torsades: WHY Care about QT Prolongation?
06.7 – FIGURE 06.7-1: Torsades vs PMVT vs Something Else?
06.8 – FIGURE 06.8-1: Is the QT Long?
06.9 – FIGURE 06.9-1: Is the QT Long?
06.10 – QTc Addendum: Using/Calculating the QTc
06.11 – BEYOND-the-Core: Estimating the QTc Yourself
06.12 – FIGURE 06.12-1: Approximate the QTc
06.13 – FIGURE 06.13-1: Approximate the QTc
07.0 – Determining Axis / Hemiblocks
07.0 – Determining Axis / Hemiblocks
07.1 – Overview: Limb Lead Location
07.2 – AXIS: The Quadrant Approach
07.3 – AXIS: The Concept of Net QRS Deflection
07.4 – FIGURE 07.4-1: How to Rapidly Determine Axis Quadrant
07.5 – AXIS: Refining the Quadrant Approach
07.6 – FIGURE 07.6-1: What is the Axis?
07.7 – FIGURE 07.7-1: What is the Axis?
07.8 – FIGURE 07.8-1: What is the Axis?
07.9 – Hemiblocks: LAHB and LPHB
07.10 – Hemiblocks: Anatomic Considerations
07.11 – Advanced Concept: LSFB (a 3rd type of Fascicular Block)
07.12 – Hemiblocks: An Approach to Rapid ECG Diagnosis
07.13 – LAHB: ECG Diagnosis = “pathologic” LAD
07.14 – FIGURE 07.13-1: Is there LAD? IF so — Is there LAHB?
07.15 – SUMMARY: ECG Diagnosis of LAHB in ‹3 Seconds
07.16 – Bifascicular Block
07.17 – Definition/Types of Bifascicular Block
07.18 – RBBB/LAHB: ECG Recognition
07.19 – The Meaning of “Axis” when there is RBBB
07.20 – Clinical Implications of Bifascicular Block
07.21 – RBBB/LPHB: ECG Recognition
07.22 – RBBB/LPHB: Finer Points on ECG Recognition
07.23 – FIGURE 07.23-1: Is there Bifascicular Block?
07.24 – FIGURE 07.24-1: Is there Bi-or Tri-Fascicular Block?
07.25 – FIGURE 07.25-1: Isolated LPHB vs Right Axis Deviation?
08.0 – LVH: Chamber Enlargement
08.1 – ECG Diagnosis of LVH: Simplified Criteria
08.2 – LVH: Physiologic Rationale for Voltage Criteria
08.3 – LVH: ECG Diagnosis using Lead aVL
08.4 – FIGURE 08.4-1: Is there Voltage for LVH?
08.5 – Standardization Mark: Is Standardization Normal?
08.6 – LVH: Additional Voltage Criteria
08.7 – LVH: Voltage Criteria for Patients Less than 35
08.8 – FIGURE 08.8-1: Which Leads for What with LVH?
08.9 – LV “Strain”: ECG Recognition
08.10 – LV “Strain”: Voltage for LVH vs True Chamber Enlargement
08.11 – FIGURE 08.11-1: Is there True Chamber Enlargement?
08.12 – Can there be both LV “Strain” and Ischemia?
08.13 – Strain “Equivalent” Patterns: Clinical Implications
08.14 – Atrial Enlargement
08.15 – Terminology: Enlargement vs Abnormality?
08.16 – FIGURE 08.16-1: ECG Criteria for RAA/LAA
08.17 – Physiologic Rationale for Normal P Wave Appearance
08.18 – A Closer Look: The P Wave with Normal Sinus Rhythm
08.19 – ECG Diagnosis of RAA: P Pulmonale
08.20 – ECG Diagnosis of LAA: P Mitrale
08.21 – FIGURE 08.21-1: Is there ECG Evidence of RAA/LAA?
08.22 – FIGURE 08.22-1: Is there ECG Evidence of RAA/LAA?
08.23 – RVH/Pulmonary Disease
08.24 – ECG Diagnosis of RVH: Simplified Criteria
08.25 – ECG Diagnosis: Review of Specific RVH Criteria
08.26 – RVH: Review of Additional Criteria
08.27 – Schamroth’s Sign for RVH: A Null Vector in Lead I
08.28 – RVH: Tall R Wave in V1; RV “Strain”
08.29 – Schematic FIGURE 08.29-1: Example of RVH + RV “Strain”
08.30 – Schematic FIGURE 08.30-1: Example of “Pulmonary” Disease
08.31 – Pediatric RVH: A few Brief Thoughts ...
08.32 – FIGURE 08.32-1: Is there RVH?
08.33 – FIGURE 08.33-1: Is there RVH?
08.34 – Acute Pulmonary Embolus
08.35 – Acute PE: Key Clinical Points
08.36 – FIGURE 08.36-1: Should You Look for an S1-Q3-T3?
08.37 – FIGURE 08.37-1: The Cause of Anterior T Inversion?
08.38 – FIGURE 08.38-1: Is there Acute Anterior STEMI?
09.0 – Q-R-S-T Changes
09.1 – FIGURE 09.1-1: Assessing Q-R-S-T Changes
09.2 – Septal Depolarization: Reason for Normal Septal Q Waves
09.3 – Precordial Lead Appearance: What is Normal?
09.4 – Basic Lead Groups: Which Leads look Where?
09.5 – R Wave Progression: Where is Transition?
09.6 – Old Terminology: R Wave Progression – CW, CCW Rotation
09.7 – FIGURE 09.7-1: Poor R Wave Progression
09.8 – FIGURE 09.8-1: Anterior MI vs Lead Placement Error?
09.9 – FIGURE 09.9-1: What is the Cause of PRWP?
09.10 – FIGURE 09.10-1: QS in V1,V2 vs Anterior MI?
09.11 – FIGURE 09.11-1: PRWP from LVH vs Anterior MI?
09.12 – FIGURE 09.12-1: Normal Q Waves; Normal T Inversion
09.13 – FIGURE 09.13-1: Inferior Infarction/Ischemia?
09.14 – ST Elevation: Shape/What is the Baseline?
09.15 – ST Elevation or Depression: What is the Baseline?
09.16 – J-Point ST Elevation: Recognizing the J-Point
09.17 – SHAPE of ST Elevation: More Important than Amount!
09.18 – HISTORY: Importance of Clinical Correlation
09.19 – FIGURE 09.19-1: Early Repolarization or Acute MI?
09.20 – What is EARLY REPOLARIZATION?
09.21 – Early Repolarization: Variations in the Definition
09.22 – ERP: Is Early Repolarization Benign?
09.23 – FIGURE 09.23-1: Acute MI or Repolarization Variant?
09.24 – FIGURE 09.24-1: Acute MI or Repolarization Variant?
09.25 – ST Segment Depression
09.26 – LIST #4: Causes of ST Depression
09.27 – ST-T Wave Appearance: A Hint to the Cause
09.28 – FIGURE 09.28-1: What is the Cause(s) of ST Depression?
09.29 – Recognizing Subtle ST Changes: ST Segment Straightening
09.30 – FIGURE 09.30-1: Are the ST Segments Normal?
09.31 – Clinical Uses of Lead aVR
09.32 – Lead aVR: Recognizing Lead Misplacement/Dextrocardia
09.33 – Lead aVR: in Acute Pulmonary Embolus
09.34 – Lead aVR: in Acute Pericarditis
09.35 – Lead aVR: in Atrial Infarction
09.36 – Lead aVR: in Supraventricular Arrhythmias
09.37 – Lead aVR: for Definitive Diagnosis of VT
09.38 – Lead aVR: in TCA Overdose
09.39 – Lead aVR: in Takotsubo Syndrome
09.40 – Lead aVR: Severe CAD/Left Main Disease
10.0 – Acute MI / Ischemia
10.1 – The Patient with Chest Pain: WHY Do an ECG?
10.2 – What is a “Silent” MI?
10.3 – The ECG in Acute MI: What are the Changes?
10.4 – ECG Indicators: 1) ST Segment Elevation
10.5 – ECG Indicators of Acute MI: 2) T Wave Inversion
10.6 – ECG Indicators of Acute MI: 3) Q Waves
10.7 – Q Waves: Why Do they Form?
10.8 – ECG Terminology: Distinction between Q, q and QS waves?
10.9 – Summary: When are Q Waves Normal?