ECGs for Beginners

299 Pages·2014·24.83 MB·English

by  Bayés de Luna

ECGs for Beginners

ECGs for
Beginners
Antoni Bayés de Luna
Emeritus Professor of Cardiology, Autonomous University of Barcelona
Senior Investigator, Institut Català Ciències Cardiovasculars
Hospital Sant Pau
Senior Consultant, Hospital Quiron
Barcelona, Spain
Copyright © 2014 by John Wiley & Sons, Inc. All rights reserved
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Published simultaneously in Canada
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Library of Congress Cataloging-in-Publication Data:
Bayés de Luna, Antoni, 1936– author.
ECGs for beginners / Antoni Bayés de Luna.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-118-82131-2 (pbk.)
I. Title.
[DNLM: 1. Electrocardiography–methods. 2. Heart Diseases–diagnosis. WG 330]
RC683.5.E5
616.1'207547–dc23
2014012635
Cover image courtesy of the author
Contents
Preface, vii
Forewords to Previous Editions, ix
Foreword, x
Part I: The Normal Electrocardiogram, 1
1 Anatomical and Electrophysiological Bases, 3
2 The ECG Curve: What Is It and How Does It Originate?, 11
3 Recording Devices and Techniques, 33
4 ECG Interpretation, 40
Part II: Morphological Abnormalities in the ECG, 59
5 Atrial Abnormalities, 61
6 Ventricular Enlargements, 68
7 Ventricular Blocks, 84
8 Ventricular Preexcitation, 102
9 Myocardial Ischemia and Necrosis, 111
Part III: The ECG in Arrhythmias, 161
10 Concepts, Classification, and Mechanisms of Arrhythmias, 163
11 ECG Patterns of Supraventricular Arrhythmias, 179
12 ECG Patterns of Ventricular Arrhythmias, 193
13 The ECG Patterns of Passive Arrhythmias, 208
14 How to Interpret ECG Tracings with Arrhythmia, 217
Part IV: ECG in Clinical Practice, 221
15 From Symptoms to the ECG: ECGs in the presence of precordial pain or other
symptoms, 223
16 The ECG in Genetically Induced Heart Diseases and Other ECG Patterns with
Poor Prognosis, 231
17 ECG Recordings in Other Heart Diseases and Different Situations, 246
18 Abnormal ECG Without Apparent Heart Disease and Normal ECG in Serious
Heart Disease, 258
Bibliography, 262
Index, 267
v

Preface
It is my pleasure to present this ECG book for My objective has been to decode the electrocar-
beginners, a book that I would have liked to own diographic curve into an understandable sequence
when I began to study electrocardiography. It has representing the electrical activation of the heart so
been written with beginners in mind, therefore it that it may be followed step-by-step, from the
is a book for ‘readers with little knowledge of the initial stimulus in the sinus node to the ventricular
subject’ who want to learn ‘quickly and didacti- myocardium. I explain how the P wave, the QRS
cally’, uncovering what appears to be complex or complex, and the T wave morphologies originate,
mysterious because in fact it is an essential part of and how they occur in both normal and pathologic
their professional work. Figures and diagrams, conditions. It is not advisable to memorize the ECG
many of them already published in my previous patterns, but rather understand deductively how
books, in combination with a succinct text have they occur. With this in mind, I have included more
been carefully put together for this purpose. figures and less text.
I am proud to be able to help these readers so The book is comprised of four parts and 18 chap-
that the study of the ECG may be easier for them. ters. The first part outlines the basic normal ECG;
It is something I have always tried to do in my the second the typical morphologies in different
nearly 50 years as a university professor, and some- pathologies; the third the ECG patterns of arrhyth-
thing my students have often remarked on. I have mias and the fourth part deals with the important
written previous and more extensive ECG books in to use correctly the ECG in the clinical context of
English, Catalan and Spanish in the last 40 years, the patient. This is really the most important aim
which have been translated into eight languages of modern clinical electrocardiography.
with more than 20 editions. However, this new If a certain concept is not fully understood, the
book is special because it contains the essentials of reader should not despair. A second reading
the ECG: the cheapest, the quickest and most is often all that is needed. I am also happy to
useful technique that has existed in medicine for help through internet correspondence. Comple-
over 100 years. mentary resources are available as well, including
This book contains text in bold that indicates our recent volumes ‘Clinical Arrhythmology’ and
certain points that I feel are especially important. ‘Clinical Electrocardiography’ (Wiley-Blackwell,
The reader will also find letters in the margins that 2011 and 2012, respectively). These books are
refer to key concepts for a correct understanding more extensive and include exhaustive reference
of the ECG. At the end of each chapter, these sections, while this book lists only the essential
reference points are used in a short quiz for self- references.
assessment. In this way, residents of any medical Finally, I would like to add one important last
specialization, not only cardiology, but also general piece of advice. The clinical context is extremely
practitioners, intensivists, anesthesiologists, pedia- relevant in the interpretation of ECGs, and is often
tricians, medical students, and nurses will be able the deciding factor when interpreting a case. As a
to understand normal and pathologic ECG mor- rule we should not assume that if a normal ECG is
phologies, recognizing the patterns and under- present we can rule out heart disease, just as
standing how they originate. we should not become too alarmed with certain
vii
viii Preface
isolated pathological ECG patterns because they Viñolas and many others, because all of them have
may represent something nonspecific. been my greatest source of inspiration and support.
I would like to thank each and every reader for I also thank Montserrat Saurí and Joan Crespo
their interest in this book. I would also like to and in the last period Esther Gregoris, my secre-
express my respect and admiration for those tariat team, who are so hard-working and always
authors whose books helped in my training: Drs. cheerful. I would also lie to thank the Menarini Co,
Grant and Marriot in the U.S., Dr. Stock in the namely and especially Dr. M. Ballarin, for their
U.K., Drs. Sodi and Cabrera in Mexico, Dr. Tranchesi logistical support. I lovingly thank my wife Maria
in Brazil, and Drs. Rosenbaum and Elizari in Argen- Clara, who has always tolerated my hectic pace, as
tina and others whom I have consulted, and who well as my five children and 13 grandchildren, who
are listed in the Bibliography. I am very grateful to know that I will always be there for them . . . albeit
my close collaborators: Drs. J. Riba, M. Fiol, A. with pen in hand.
Bayés-Genís, and also to J. Guindo, D. Goldwasser,
A. Baranchuk, J. García Niebla and D. Conde, as Antoni Bayés de Luna
well as my previous fellows W. Zareba, R. Brugada, Cathedral Square. Vic. Christmas 2014
I. Cygankiewicz, P. Iturralde, R. Baranowski and X. [email protected]