ECG Masters Collection. Favorite ECGs From Master Teachers Around The World

644 Pages·2017·31.56 MB·English

ECG Masters’ Collection F E
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Favorite ECGs from Master Teachers Around the World t
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E ECG Masters’
Editors: C
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Mohammad Shenasa, MD • Mark E. Josephson, MD • N. A. Mark Estes III, MD
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Ezra A. Amsterdam, MD • Melvin Scheinman, MD f
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230 exceptional electrocardiogram case studies curated from the libraries of 60

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internationally recognized master teachers of ECG interpretation are brought together
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in this one-of-a-kind resource for student and teacher alike. s
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Organized by disease type, ECG case studies are presented in a clinical context fol-
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lowed by questions and discussion. Medical students, residents, fellows, physicians T
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l Favorite ECGs from
— anyone who is involved in caring for patients with various cardiovascular diseases a e
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and other systemic pathologies — will find this unique collection with a global h c
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perspective useful and practical in developing the skills necessary to reading ECGs. t Master Teachers
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Key Topics r n Around the World
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n Conduction Disturbances: Sinus Node Disease/Sick Sinus Syndrome, AV Conduction n
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Disturbances, AV Blocks, Bundle Branch Blocks, and Fascicular Blocks

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n Miscellaneous Phenomena: Concealed Conduction, Superabnormalities, Aberrancy h
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Editors:
Conduction, Premature Atrial and Ventricular Contractions (PACs and PVCs)
W
n Preexcitation Syndromes
o
Mohammad Shenasa
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n Early Repolarization l
d
n Long and Short QT Syndromes Mark E. Josephson
n Brugada Syndrome
N. A. Mark Estes III
n Narrow QRS Complex Arrhythmias
n Wide Complex Arrhythmias
Ezra A. Amsterdam
n Ischemia and Infarction
Shenasa
n Electrolyte Disturbances, Pharmacological and Recreational Agents Melvin Scheinman
Josephson
n Paced Rhythms and Device Troubleshooting
Estes
n Heart Failure, LVH, and Cardiomyopathies
Amsterdam
n Congenital Heart Diseases
Scheinman
n Special Considerations: Age, Race, Gender, and Athletes Forewords by
n Syncope and ECG Troubleshooting
Francis E. Marchlinski
and Samuel Lévy
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ECG Masters’ Collection
Favorite ECGs from Master Teachers
Around the World
Mohammad Shenasa, MD
Mark E. Josephson, MD
N. A. Mark Estes III, MD
Ezra A. Amsterdam, MD
Melvin Scheinman, MD
Minneapolis, Minnesota
© 2017 Mohammad Shenasa, Mark E. Josephson, N. A. Mark Estes III, Ezra A. Amsterdam, Melvin Scheinman
Cardiotext Publishing, LLC
3405 W. 44th Street
Minneapolis, Minnesota 55410
USA
www.cardiotextpublishing.com
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used only to identify the products or services of those owners.
This book is intended for educational purposes and to further general scientific and medical knowledge, research,
and understanding of the conditions and associated treatments discussed herein. This book is not intended to
serve as and should not be relied upon as recommending or promoting any specific diagnosis or method of
treatment for a particular condition or a particular patient. It is the reader’s responsibility to determine the proper
steps for diagnosis and the proper course of treatment for any condition or patient, including suitable and
appropriate tests, medications or medical devices to be used for or in conjunction with any diagnosis or
treatment.
Due to ongoing research, discoveries, modifications to medicines, equipment and devices, and changes in
government regulations, the information contained in this book may not reflect the latest standards,
developments, guidelines, regulations, products or devices in the field. Readers are responsible for keeping up to
date with the latest developments and are urged to review the latest instructions and warnings for any medicine,
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Except for the publisher’s website associated with this work, the publisher is not affiliated with and does not
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Unless otherwise stated, all figures and tables in this book are used courtesy of the authors.
Library of Congress Control Number:  2017937042
ISBN: 978-1-942909-08-8
eISBN: 978-1-942909-18-7
Printed in The United States of America
Dedication
We dedicate this book in memory of Mark E. Josephson, MD (January 27, 1943 – January 11, 2017),
who inspired and mentored many of us. He gave the electrogram a new look - “ECG as a mapping
tool.” He is also the senior editor on this book.
Contents
Contributors ...........................................................................................................................vii
Forewords ...............................................................................................................................xv
Dr. Francis Marchlinski
Dr. Samuel Lévy
Preface ...................................................................................................................................xix
Abbreviations ........................................................................................................................xxi
Video Legends .....................................................................................................................xxiii
Section 1 Introduction to the Interpretation of the Electrocardiogram ...........................1
Section 2 Conduction Disturbances: Sinus Node Disease/Sick Sinus Syndrome,
AV Conduction Disturbances, AV Blocks, Bundle Branch Blocks, and
Fascicular Blocks ...................................................................................................3
Section 3 Miscellaneous Phenomena: Concealed Conduction, Superabnormalities,
Aberrancy Conduction, Premature Atrial and Ventricular
Contractions (PACs and PVCs) ............................................................................41
Section 4 Preexcitation Syndromes ...................................................................................77
Section 5 Early Repolarization (ECG Pattern and the Syndrome) ..................................135
Section 6 Long and Short QT Syndromes ........................................................................153
A. Long QT Syndrome .....................................................................................153
B. Short QT Syndrome ....................................................................................173
C. Torsades de Pointes ....................................................................................175
D. Other Proarrhythmias .................................................................................193
Section 7 Brugada Syndrome ...........................................................................................197
Section 8 Narrow QRS Complex Arrhythmias .................................................................227
A. Inappropriate Sinus Tachycardia ................................................................227
B. Sinus Node Reentrant Tachycardia ............................................................229
C. Atrial Tachycardia/Atrial Flutter .................................................................231
D. Atrioventricular Nodal Reentrant Tachycardia ..........................................255
E. Atrioventricular Reentrant Tachycardia .....................................................283
F. Atrial Fibrillation .........................................................................................287
G. Junctional Rhythms ....................................................................................295
v
Section 9 Wide Complex Arrhythmias .............................................................................297
A. Ventricular Tachycardia/Fibrillation ...........................................................297
B. Supraventricular Tachycardia (SVT) with Bundle Branch Block (BBB) ......355
C. Preexcited Tachycardia ...............................................................................371
D. Idioventricular Rhythm ...............................................................................373
Section 10 Ischemia and Infarction ....................................................................................375
Section 11 Electrolyte Disturbances, Pharmacological and Recreational Agents ..........413
Section 12 Paced Rhythms and Device Troubleshooting .................................................425
Section 13 Heart Failure, LVH, and Cardiomyopathies .....................................................459
A. Arrhythmogenic Right Ventricular
Dysplasia/Cardiomyopathy (ARVD/C) .........................................................459
B. Hypertrophic Cardiomyopathy (HCM) .......................................................479
C. Dilated Cardiomyopathy (DCM) .................................................................495
D. Chagas Cardiomyopathy ............................................................................501
E. Takotsubo (Stress) Cardiomyopathy ...........................................................511
F. Non-Compaction Cardiomyopathy ............................................................523
G. Pericarditis ...................................................................................................525
H. Other Cardiomyopathies ............................................................................529
Section 14 Congenital Heart Diseases ...............................................................................533
Section 15 Special Considerations: Age, Race, Gender, and Athletes .............................583
Section 16 Syncope and ECG Troubleshooting .................................................................593
Appendix ..............................................................................................................................621
vi u Contents
Contributors
Editors Contributors
Mohammad Shenasa, MD, FACC, FHRS, Ahmed Abdel Aziz, MD, PhD
FAHA, FESC Professor, Critical Care Medicine Department,
Attending Physician, Department of Cairo University Hospitals, Cairo, Egypt
Cardiovascular Services, O’Conner Hospital;
Heart & Rhythm Medical Group, San Jose, Simon Abou Jaoude, MD
California Cardiology Department, Hotel-Dieu de France,
Saint Joseph University, Beirut, Lebanon
Mark E. Josephson, MD, FACC, FHRS, FAHA
Director, Harvard-Thorndike Electrophysiology Baris Akdemir, MD
Institute and Arrhythmia Service; Cardiac Electrophysiology Fellow, Cardiology,
Chief Emeritus, Division of Cardiovascular University of Minnesota, Minneapolis,
Medicine, Beth Israel Deaconess Medical Minnesota
Center; Herman C. Dana Professor of Medicine,
Jason Andrade, BSc, MD, FRCPC, FHRS
Harvard Medical School, Boston,
Clinical Assistant Professor, Department of
Massachusetts
Medicine, University of British Columbia,
Vancouver, British Columbia, Canada; Adjunct
N. A. Mark Estes III, MD, FACC, FHRS,
Professor, Université de Montréal, Clinical
FAHA, FESC
Professor of Medicine, Tufts University School Electrophysiology Service, Montreal Heart
of Medicine; Director, New England Cardiac Institute, Montreal, Quebec, Canada
Arrhythmia Center, Tufts Medical Center,
Samuel J. Asirvatham, MD, FACC, FHRS
Boston, Massachusetts
Consultant, Department of Cardiovascular
Medicine, Division of Pediatric Cardiology,
Ezra A. Amsterdam, MD
Distinguished Professor, Associate Chief Department of Physiology and Biomedical
(academic affairs), Division of Cardiovascular Engineering; Professor of Medicine and
Medicine, University of California, Davis, Pediatrics, Mayo Clinic College of Medicine;
Medical Center, Sacramento, California Program Director, EP Fellowship Program,
Mayo Clinic, Rochester, Minnesota
Melvin Scheinman, MD, FACC, FHRS
Professor of Medicine, Walter H. Shorenstein Nitish Badhwar, MD, FACC, FHRS
Endowed Chair in Cardiology; Chief of Director, Cardiac Electrophysiology Training
Cardiology Genetics Arrhythmia Program, Program, Professor of Medicine, University of
University of California, San Francisco, California, San Francisco, San Francisco,
San Francisco, California California
vii
Adrian Baranchuk, MD, FACC, FRCPC, FCCS Catalin A. Buzea, MD, PhD
Professor of Medicine (Tenure), Head, Heart Cardiology Consultant, Cardiology
Rhythm Service, Queen’s University, Kingston, Department, Colentina University Hospital;
Ontario, Canada Associate Professor, “Carol Davila” University of
Medicine, Bucharest, Romania
Raimundo Barbosa-Barros, MD
Chief of Coronary Center, Messejana Hospital David J. Callans, MD, FHRS
Dr. Carlos Alberto Studart Gomes, Fortaleza, Professor of Medicine, Perelman School of
Ceará, Brazil Medicine; Associate Director of
Electrophysiology, University of Pennsylvania
Antoni Bayés de Luna, MD, PhD, FESC, FACC Health System, Philadelphia, Pennsylvania
Senior Investigator, Catalan Institute of
Cardiovascular Sciences, St. Pau Hospital, Francesc Carreras Costa, MD
Barcelona, Spain Cardiology Department, Hospital Santa Creu
i Sant Pau, Universitat Autónoma de Barcelona,
Bernard Belhassen, MD, FHRS Barcelona, Spain
Department of Cardiology, Tel-Aviv Sourasky
Medical Center; Sackler Faculty of Medicine, Lily Chen, MD
Tel-Aviv University, Tel-Aviv, Israel Resident of Internal Medicine, University
of California, Davis, Medical Center,
David G. Benditt, MD, FACC, FHRS, FRCPC, Sacramento, California
FESC
Cardiac Arrhythmia Center, Cardiovascular Alan Cheng, MD, FACC, FHRS, FAHA
Division, University of Minnesota Medical Associate Professor of Medicine, Associate
School, Minneapolis, Minnesota Professor of Pediatrics, Johns Hopkins
University School of Medicine, Baltimore,
Dan Blendea, MD, PhD, FHRS Maryland
Cardiac Arrhythmia Service, Department of
Medicine, Massachusetts General Hospital, Paolo China, MD
Boston, Massachusetts Unit of Electrophysiology and Cardiac Pacing,
Ospedale Dell’Angelo, Venice, Italy
Pedro Brugada, MD, PhD
Chairman, Cardiovascular Division, UZ Xavier Copie, MD
Brussel, Brussels, Belgium Cardiologist, Arrhythmia Department, Centre
Cardiologique du Nord, Saint-Denis, France
Jonathan Bui, MD
Research Assistant, Division of Cardiovascular Jane E. Crosson, MD
Medicine, University of California, Davis, Associate Professor, Pediatrics, Johns Hopkins
Medical Center, Sacramento, California Hospital, Baltimore, Maryland
Haran Burri, MD Mohammad Dalili, MD
Assistant Professor, Cardiology Department, Rajaie Cardiovascular Medical and Research
University Hospital of Geneva, Geneva, Center, Iran University of Medical Sciences,
Switzerland Tehran, Iran
viii u Contributors
Andrei G. Dan, MD, PhD, FESC, FAHA, Andrew E. Epstein, MD, FACC, FHRS, FAHA
FEHRA Professor of Medicine, Electrophysiology
Head of Cardiology Department and Internal Section, Cardiovascular Division, University of
Medicine Clinic, Colentina University Hospital; Pennsylvania, Philadelphia, Pennsylvania
Professor, “Carol Davila” University of
Medicine, Bucharest, Romania Sabine Ernst, MD, PhD, FESC
Consultant Cardiologist, Reader in Cardiology,
Judith Daniels, RN, CRDS, CEPS Lead EP Researcher, Royal Brompton Hospital,
Registered Nurse, EP Lab, Milpark Hospital, National Heart and Lung Institute, Imperial
Johannesburg, Gauteng, South Africa College, London, United Kingdom
Luiz Carlos de Abreu, PhD Luis Alberto Escobar Robledo, MS
Chief, Design of Studies and Scientific Writing Fellow, Catalan Institute of Cardiovascular
Laboratory, ABC School of Medicine, Santo Sciences, St. Pau Hospital, Barcelona, Spain
André, São Paulo, Brazil; Program in Molecular
and Integrative Physiological Sciences (MIPS), Tamer S. Fahmy, MD, PhD
Associate Professor, Critical Care Medicine
Department of Environmental Health, Harvard
Department, Cairo University Hospitals, Cairo,
T. H. Chan School of Public Health, Boston,
Egypt
Massachusetts
Guy Fontaine, MD, PhD, HDR
Arnaud Denis, MD
Centre Hospitalier Pitié-Salpêtrière and
Hôpital Cardiologique du Haut Lévèque, CHU
Université Pierre et Marie Curie, Department of
de Bordeaux, Université de Bordeaux and
Rhythmology, Paris, France
LYRIC Institute, Bordeaux, France
Robert Frank, MD
Nicolas Derval, MD
Institut de Cardiologie, Hopital Pitié
Hôpital Cardiologique du Haut Lévèque, CHU
Salpétrière, Paris, France
de Bordeaux, Université de Bordeaux and
LYRIC Institute, Bordeaux, France
Javier García-Niebla, RN
Servicios Sanitarios del Area de Salud de El
Marc Dubuc, MD, FRCPC, FACC, FHRS
Hierro, Valle del Golfo Health Center, Canary
Associate Professor of Medicine, Université de
Island, Spain
Montréal; Clinical Electrophysiology Service,
Montreal Heart Institute, Montreal, Quebec,
Diego Goldwasser, MD
Canada
Institut Cátala de Ciences Cardiovasculars, Sant
Pau Hospital; Cardiology Department, Hospital
Kenneth A. Ellenbogen, MD, FHRS
Quiron Barcelona, Barcelona, Spain
Kontos Professor of Medicine, Chair, Division
of Cardiology, Virginia Commonwealth
Judith A. Groeneweg, MD, PhD
University, Pauley Heart Center, Richmond,
University Medical Center Utrecht, The
Virginia
Netherlands
Contributors u ix
Majid Haghjoo, MD, FACC, FESC Heikki V. Huikuri, MD, PhD
Director, Department of Cardiac Professor, Medical Research Center Oulu,
Electrophysiology, Rajaie Cardiovascular Research Unit of Internal Medicine, University
Medical and Research Center, Tehran, Iran of Oulu and Oulu University Hospital, Oulu,
Finland
Michel Haïssaguerre, MD, PhD
Hôpital Cardiologique du Haut Lévèque, CHU James E. Ip, MD
de Bordeaux, Université de Bordeaux and Assistant Professor of Medicine, Division of
LYRIC Institute, Bordeaux, France Cardiology, Cardiac Electrophysiology
Laboratory, Cornell University Medical Center,
Frederick T. Han, MD, FACC, FHRS New York Presbyterian Hospital, New York,
Assistant Professor of Medicine, Division of New York
Cardiovascular Medicine, University of Utah
Health Sciences Center, Salt Lake City, Utah Pierre Jaïs, MD, PhD
Hôpital Cardiologique du Haut Lévèque, CHU
Richard N. Hauer, MD, PhD, FESC de Bordeaux, Université de Bordeaux and
Professor of Cardiology, Netherlands Heart LYRIC Institute, Bordeaux, France
Institute, University Medical Center Utrecht,
The Netherlands Mohammad-Ali Jazayeri, MD
Division of Cardiovascular Diseases, University
Shahriar Heidary, MD, FACC of Kansas Hospital & Medical Center, Kansas
Adjunct Clinical Instructor, Department of City, Kansas
Internal Medicine, Division of Cardiovascular
Medicine, Stanford University Medical School, Mohammad-Reza Jazayeri, MD
Stanford, California Heart, Lung & Vascular, Bellin Health, Green
Bay, Wisconsin
Hein Heidbuchel, MD, PhD, FESC, FEHRA
Professor and Chair, Department of Cardiology, Charles Jazra, MD, FACC, FESC
Antwerp University Hospital, Antwerp, Cardiology Department, Saint Joseph Hospital,
Belgium; Guest Professor, Cardiology, Hasselt Bauchrieh, Beirut, Lebanon
University, Hasselt, Belgium
Juhani Junttila, MD, PhD
Mélèze Hocini, MD Associate Professor, Medical Research Center
Hôpital Cardiologique du Haut Lévèque, CHU Oulu, Research Unit of Internal Medicine,
de Bordeaux, Université de Bordeaux and University of Oulu and Oulu University
LYRIC Institute, Bordeaux, France Hospital, Oulu, Finland
Henry H. Hsia, MD, FACC, FHRS Gautham Kalahasty, MD
Health Science Professor of Medicine, Program Director, Cardiology Fellowship
University of California, San Francisco; Program, Virginia Commonwealth University,
Chief, Arrhythmia Service, VA Medical Center, Pauley Heart Center, Richmond, Virginia
San Francisco, California
x u Contributors