Field Guide to the Arrhythmias PDF
Preview Field Guide to the Arrhythmias
FIELD GUIDE TO THE Arrhythmias Tomyfamily FIELD GUIDE TO THE Arrhythmias ELLIS W. LADER, MD, FACC, FAHA, FACP MidValleyCardiology,Kingston,and AdjunctAssistantProfessorofClinicalMedicine NewYorkUniversitySchoolofMedicine NewYork,NY,USA AJohnWiley&Sons,Ltd.,Publication Thiseditionfirstpublished2013(cid:2)C 2013byJohnWiley&SonsLimited Wiley-BlackwellisanimprintofJohnWiley&Sons,formedbythemergerofWiley’sglobalScientific,Technicaland MedicalbusinesswithBlackwellPublishing. 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LibraryofCongressCataloging-in-PublicationData Lader,EllisW. Fieldguidetothearrhythmias/EllisW.Lader,MD,FACC,FAHA,FACP,MidValleyCardiology,adjunct assistantprofessorofclinicalmedicine,NewYorkUniversitySchoolofMedicine,NewYork,NY,USA. pagescm Includesbibliographicalreferencesandindex. ISBN978-1-118-38609-5(pbk.:alk.paper) 1.Arrhythmia. I.Title. RC685.A65L332013 616.1(cid:3)28–dc23 2012047266 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmaynotbe availableinelectronicbooks. Coverimageandcartoons:JaneFallows CoverdesignbyAndyMeaden Setin9.5/11.5ptMinionbyAptaraInc.,NewDelhi,India 1 2013 Contents KeytotheArrhythmias,insidefront/backcovers Preface,vi Acknowledgments,viii Abbreviations,ix PART1: THERHYTHMS,1 NormalSinusRhythm,3 Preexcitation,4 SinusBradycardia,6 SinusTachycardia,7 SinusArrhythmia,8 WanderingAtrialPacemaker,9 MultifocalAtrialTachycardia,10 JunctionalRhythm,12 Asystole,14 HeartBlock:FirstDegree,SecondDegree(MobitzIandII),andThird Degree(Complete),16 PrematureBeats(BlockedandOtherwise),20 AtrialFibrillation,23 AtrialFlutter,25 Supraventricular(ParoxysmalAtrial)Tachycardia,28 PacemakerRhythms,30 VentricularTachycardia,33 AcceleratedIdioventricularRhythm,36 ProlongedQT/TorsadesdePointes,38 VentricularFibrillation,41 PART2: MULTIPLECHOICEQUESTIONS,43 v Preface Iftheinnocentoruninitiatedweretowanderthroughthecardiacunit,telemetry unit,orinfactthroughanyunitwhereECGmonitoringisinuse(wewillstick withtheEnglishElectroCardioGramspelling),heorshewouldlikelyencounter rhythmswhichwereunfamiliar.Itisevenpossiblesuchrhythmsmightberudely thrustintoone’sfacewitharequesttoevaluatethemoreventakedrasticaction: “Should I shock him?” or “Do you think this is Mobitz I second degree SA exit block?” In fact, traveling through a unit in such fashion may be likened to a wanderer strolling through a forest, unsure of the names of the trees or wildflowers,orthesignificanceofcertaintracks(seebelowfigure). TrackofBrotozoumgiganteum,generallybestavoided(withsize11humanfootprints,for scale) Whenoneisinthewoodsitgreatlyincreasesthepleasureandpossiblythe safetyofthetripifthehikerhasaFieldGuidewhichenablesthewandererto safelyidentifythevariousfloraandfaunaencounteredalongtheway.Itshould thentakethereaderjustamomenttorealize,carryingthemetaphoronlyalittle further,theneedforasimilarFieldGuidetotheArrhythmias,asonenavigates thevarioushazardsofthetypicalcardiacunit.Hencethiswork. This Guide is intended for the student, the casual explorer, making his or herfirstforaysintotheRealmoftheCardiacMonitor.1 Atrainedcardiologist won’tneedit,beingabletoidentifyanarrhythmiausingonlyafragmentofa 1Weassume,gentlereader,thatyouhavemasteredtheverybasicsoftheECG:i.e.,youcan tellwhichsideoftherhythmstriporECGisup,knowthattherhythmisrecordedfromleft toright,canidentifytheP,QRS,andTwaves,andknowtheirnormalwidthsandintervals. Otherwise,Ihaveincludedtwoofmyfavoritereferencesbelow,oryoucangoasktheHead Nursepolitely.DubinD.RapidInterpretationofEKGs:AnInteractiveCourse,6thedn.Tampa, FL:CoverPublishingCo.,2000.WagnerGS.Marriott’sPracticalElectrocardiography,11thedn. Philadelphia,PA:LippincottWilliams&Wilkins,2007. vi PREFACE vii Pwave,akintoabotanistwhoonlyneedsapetalandafewstamenstoiden- tifyasubspeciesofgoldenrod.Afewcardiologists,surprisingly,haveexpressed displeasurewiththisGuide.Theyclaimeditwastoooffbeatandirreverentfor theirserioustastes.Personally,IsuspecttheysecretlyfeartheGuidemaydoaway withtheneedfortheirservices!Actually,exceptforthefewremainingclinical cardiologists,manyofthemmightactuallyneedabasicguidethemselves.Some oftheinterventionalistsIknowhaven’tlookedatanECGinyears. But seriously, the cardiac unit is a jungle, inhabited by fierce nurses, killer intensivists,maraudingattendings,variousflesh-eatingspecialists,sickpatients, andlotsofarrhythmias.Beingabletoquicklyandeasilyidentifythearrhythmias oneislikelytoencounterthere(oranywhereelse)islikelytomakeone’stravels theremoreenjoyableandprobablysafer.SogatherupyourGuide,bringalong yourbutterflynet,magnifyingglass,calipers,andanextrapairofsocks,andlet’s getstarted! Acknowledgments I would like to acknowledge the invaluable electrocardiographic teaching I received early in my training from Dr. Bertha Rader, the Queen of Electro- cardiographyatBellevueHospital,NewYork.ImustalsothankAliceLopezand Pat Curtis, the giants of our practice’s and Benedictine Hospital’s arrhythmia services,alongwithourICUandstep-downunitnurses,andmonitortechsin the“warroom,”allofwhomhelpedsupplytherhythmstripsandinspiresome ofthescenariosthatmadethisworkpossible. viii Abbreviations AIVR Acceleratedidioventricularrhythm AV Atrioventricular CCU CoronaryCareUnit CPR Cardiopulmonaryresuscitation CT Computedtomography ECG Electrocardiogram ICU IntensiveCareUnit PAC Prematureatrialcomplex PVC Prematureventricularcomplex SVT Supraventriculartachycardia VT Ventriculartachycardia ix PART 1 The Rhythms FieldGuidetotheArrhythmias,FirstEdition.EllisW.Lader. (cid:2)C 2013JohnWiley&Sons,Ltd.Published2013byBlackwellPublishingLtd.
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