ECG WORKOUT EXERCISES IN ARRHYTHMIA INTERPRETATION EIGHTH EDITION ECG WORKOUT EXERCISES IN ARRHYTHMIA INTERPRETATION Jane Huff , RN, CCRN Arrhythmia Instructor, Unity Health Systems Unity Health White County Medical Center Searcy, Arkansas EIGHTH EDITION Acquisitions Editor: Jonathan Joyce/Jodi L. Rhomberg Development Editor: Maria M. McAvey Editorial Coordinator: Remington Fernando Production Project Manager: Frances M. Gunning Manager, Graphic Arts & Design: Stephen Druding Manufacturing Coordinator: Kathleen Brown Marketing Manager: Amy Whitaker Prepress Vendor: Straive 8th Edition Copyright © 2023 Wolters Kluwer Copyright © 2017 Wolters Kluwer (7e); Copyright © 2011 (6e) Lippincott Williams & Wilkins; Copyright © 2005 (5e) Lippincott Williams & Wilkins; Copyright © 2001 (4e) Lippincott Williams & Wilkins; Copyright © 1996 (3e) Lippincott Williams & Wilkins; Copyright © 1993 (2e) Lippincott Williams & Wilkins, a Wolters Kluwer business. All rights reserved. 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To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at shop.lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in Mexico Cataloging-in-Publication Data available on request from the Publisher ISBN 978-1-9751-7454-5 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. shop.lww.com Not authorised for sale in United States, Canada, Australia, New Zealand, Puerto Rico, and U.S. Virgin Islands. Acquisitions Editor: Jonathan Joyce/Jodi L. Rhomberg Development Editor: Maria M. McAvey Editorial Coordinator: Remington Fernando Production Project Manager: Frances M. Gunning Manager, Graphic Arts & Design: Stephen Druding Manufacturing Coordinator: Kathleen Brown Marketing Manager: Amy Whitaker Prepress Vendor: Straive 8th Edition Copyright © 2023 Wolters Kluwer Copyright © 2017 Wolters Kluwer (7e); Copyright © 2011 (6e) Lippincott Williams & Wilkins; Copyright © 2005 (5e) Lippincott Williams & Wilkins; Copyright © 2001 (4e) Lippincott Williams & Wilkins; Copyright © 1996 (3e) Lippincott Williams & Wilkins; Copyright © 1993 (2e) Lippincott Williams & Wilkins, a Wolters Kluwer business. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at shop.lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China (or the United States of America) Cataloging-in-Publication Data available on request from the Publisher ISBN 978-1-9751-7454-5 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. shop.lww.com This book is dedicated to my children, Scott and Brandy, and my grandchildren, Reece, Isabella, and Novell. Preface ECG Workout: Exercises in Arrhythmia Interpretation, eighth edition, was written to assist physicians, nurses, medical and nursing students, paramedics, emergency medical technicians, telemetry technicians, and other allied health personnel in acquiring the knowledge and skills essential for identifying basic arrhythmias. It may also be used as a reference for ECG review for those already knowledgeable in ECG interpretation. The goal of this book is to simplify difficult subject matter in such a manner that learning is easy and fun. Each chapter is designed to build on the knowledge base from the previous chapters so that the beginning student can quickly understand and grasp the basic concepts of electrocardiography. An effort has been made not only to provide good-quality ECG tracings but also to provide a sufficient number and variety of ECG practice strips, so the learner feels confident in arrhythmia interpretation. There are over 600 practice strips— more than any book on the market. Chapters 1 through 5 include information that is essential to understanding how the heart works and to develop specific skills in order to be able to interpret a rhythm strip. Chapters 6 through 9 are individual rhythm chapters, which describe each rhythm in that group, the specific characteristics of each rhythm, examples, causes, management protocols if applicable, and rhythm practice. Current advanced cardiac life support (ACLS) guidelines are incorporated into each arrhythmia chapter as applicable to the rhythm discussion. Each rhythm chapter has approximately 100 practice strips. Also in Chapters 7, 8, and 9, there is a skill builder section of mixed strips, a mix of rhythms strips from that chapter and the preceding chapter(s). Practice with mixed strips will enhance your ability to differentiate between rhythm groups as you progress through the book. Other “helps” in the back of the book include the arrhythmia summary pull-out tables for each group and the flash card pull-outs. Chapter 10 presents a general discussion of cardiac pacemakers (types, indications, function, pacemaker terminology, malfunctions, and pacemaker strip analysis). Chapter 11 is a posttest consisting of a mix of