Just the Facts: ECG Interpretation

303 Pages·2004·1.49 MB·English

by  Springhouse

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JUST
THE
FACTS
ECG
Interpretation
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3416 FM.qxd 8/28/08 5:03 PM Page iii
JUST
THE
FACTS
ECG
Interpretation
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STAFF The clinical treatments described and recom-
mended in this publication are based on re-
Executive Publisher search and consultation with nursing, medical,
Judith A. Schilling McCann, and legal authorities. To the best of our knowl-
RN, MSN edge, these procedures reflect currently accept-
ed practice. Nevertheless, they can’t be consid-
Editorial Director ered absolute and universal recommendations.
William J. Kelly For individual applications, all recommenda-
tions must be considered in light of the patient’s
Clinical Director
clinical condition and, before administration of
Joan M. Robinson, RN, MSN new or infrequently used drugs, in light of the
latest package-insert information. The authors
Senior Art Director
and publisher disclaim any responsibility for
Arlene Putterman any adverse effects resulting from the suggested
Editorial Project Manager procedures, from any undetected errors, or from
the reader’s misunderstanding of the text.
Ann E. Houska
© 2005 by Lippincott Williams & Wilkins. All
Clinical Project Manager
rights reserved. This book is protected by copy-
Mary Perrong, RN, CRNP, MSN, right. No part of it may be reproduced, stored in
APRN,BC, CPAN a retrieval system, or transmitted, in any form
or by any means—electronic, mechanical, pho-
Editor
tocopy, recording, or otherwise—without prior
Catherine E. Harold written permission of the publisher, except for
Clinical Editors brief quotations embodied in critical articles
and reviews and testing and evaluation materi-
Karen A. Hamel, RN, BSN; als provided by publisher to instructors whose
Pamela Kovach, RN, BSN schools have adopted its accompanying text-
Copy Editors book. Printed in the United States of America.
For information, write Lippincott Williams &
Kimberly Bilotta (supervisor), Wilkins, 323 Norristown Road, Suite 200,
Tom DeZego Ambler, PA 19002-2756.
Designers JTFECG010704—021106
Linda Franklin (project
manager), Will Boehm (book Library of Congress
designer) Cataloging-in-Publication Data
Digital Composition Services Just the facts : ECG interpretation.
Diane Paluba (manager), p. ; cm.
Joyce Rossi Biletz, Includes bibliographical references and index.
Donna S. Morris 1. Electrocardiography—Handbooks, manuals,
etc. 2. Cardiovascular system—Diseases—Nurs-
Manufacturing ing—Handbooks, manuals, etc. I. Lippincott
Patricia K. Dorshaw (director), Williams & Wilkins. II. Title: ECG interpretation.
Beth J. Welsh [DNLM: 1. Electrocardiography—Handbooks.
2. Electrocardiography—Nurses' Instruction.
Editorial Assistants 3.Arrhythmia—diagnosis—Handbooks. 4.
Megan L. Aldinger, Arrhythmia—diagnosis—Nurses' Instruction. 5.
Tara L. Carter-Bell, Linda K. Ruhf Heart Diseases—diagnosis—Handbooks. 6.
Heart Diseases—diagnosis—Nurses' Instruction.
Indexer WG 140 J96 2004]
Barbara Hodgson RC683.5.E5J87 2004
616.1'207547—dc22
ISBN13 978-1-58255-341-2
ISBN10 1-58255-341-6 (alk. paper) 2004005312
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Contents
Contributors and consultants vii
Foreword ix
1 Basic electrocardiography 1
2 Sinus node arrhythmias 31
3 Atrial arrhythmias 53
4 Junctional arrhythmias 83
5 Ventricular arrhythmias 97
6 Atrioventricular blocks 141
7 ECG effects of electrolyte imbalances 155
8 ECG effects of antiarrhythmics 167
9 Pacemakers and implantable
cardioverter-defibrillators 177
10 Basic 12-lead electrocardiography 209
11 Advanced electrocardiography 225
Appendices
Quick guide to cardiac arrhythmias 260
Cardiac drug overview 272
Best monitoring leads 280
Depolarization-repolarization cycle 282
Action potential curves 283
Cardiac conduction system 284
Selected references 285
Index 286
v
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Contributors and consultants
Linda S. Baas, RN, PhD, ACNP Dale Tomlinson Link, RN, MN,
Associate Professor and CNS
Director, Acute Care Graduate Clinical Care Coordinator,
Program Cardiovascular Services
University of Cincinnati College University of Alabama at
of Nursing Birmingham
Nancy Bekken, RN, MS, CCRN Catherine Pence, RN, MSN, CCRN
Staff Educator Assistant Professor
Spectrum Health Good Samaritan College of
Grand Rapids, Mich. Nursing
Cincinnati
Deirdre Herr Byers, RN, BSN,
CCRN Janis Smith-Love, ARNP-C, MSN,
Staff Nurse, CCU CCRN, CEN
Southeast Georgia Regional Cardiology Nurse Practitioner
Medical Center Private Practice of David E.
Brunswick Perloff, MD, FACC, FACP
Fort Lauderdale, Fla.
Mary Lou Fisher, RN, BSN, MSN,
CRNP, CCRN Demetra C. Zalman, RN, BSN,
Adult Nurse Practitioner CCRN
Johns Hopkins University Staff Nurse
Hospital Hospital of the University of
Baltimore Pennsylvania
Philadelphia
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Foreword
Most nurses and other health care professionals don’t learn a lot
about electrocardiography in school. But practitioners in virtually
every clinical setting need at least a basic understanding of elec-
trocardiography and its implications in practice.
Over the years, many students and clinicians have asked me to
recommend a book that covers electrocardiogram (ECG) interpre-
tation quickly and simply but with enough detail to build knowl-
edge and confidence. Until now, I haven’t had much to recom-
mend because most ECG books are so complicated and
impractical that even interested nurses lose heart.
That’s why I’m delighted with Just the Facts: ECG Interpreta-
tion.Here’s a book with an unusual combination of traits: It’s
both compact and comprehensive. The information is tightly tar-
geted on essential facts and practical advice, all presented in a
handy combination of bulleted lists and illustrations. This book
was written with the clinician in mind. It includes not only the
key information you need to interpret an ECG strip, but also the
practical approach you need to respond appropriately in a clini-
cal setting.
The first chapter, Basic electrocardiography,offers an introduc-
tion that covers leads, planes, types of ECG recordings and moni-
toring systems, electrode placement, waveform components, and
an 8-step method for interpreting the ECG. This 8-step tool sys-
tematically simplifies rather than needlessly complicates the de-
tails of ECG interpretation.
Chapters 2 through 6 address the full spectrum of arrhythmia
interpretation—including sinus node, atrial, junctional, and ven-
tricular arrhythmias and atrioventricular blocks. For each ar-
rhythmia, you’ll find a concise description of key traits, an ECG
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x Foreword
strip, and a full review of causes, clinical significance, signs and
symptoms, interventions, and management.
Chapters 7, 8, and 9 offer practical advice on detecting and re-
sponding to electrolyte effects, drug effects, and pacemaker and
implantable cardioverter-defibrillator effects on the ECG. The fi-
nal two chapters contain essential facts about 12-lead and ad-
vanced electrocardiography.
And there’s more. Throughout the book, a special “Red flag”
icon draws your attention to especially important information.
Six helpful appendices are included: Quick guide to cardiac ar-
rhythmiassummarizes the details of 20 arrhythmias; Cardiac
drug overviewcovers commonly used cardiac drugs; Best moni-
toring leads shows the most beneficial leads to monitor for the
most challenging arrhythmias; Depolarization-repolarization cycle
explains the five phases of this cardiac cycle; Action potential
curvesreviews the cellular changes that occur during the depo-
larization-repolarization cycle; and Cardiac conduction system
reviews how electrical impulses affect heart function.
This clear, concise, and interesting new book is a wonderful
reference for nurses, nurse practitioners, nursing students, and
other health care professionals who need to understand electro-
cardiography from a clinician’s viewpoint. With this book, any
health care professional can achieve a rapid—and thorough—
grasp of this sophisticated and increasingly important field.
Shu-Fen Wung, RN, PHD, ACNP
Associate Professor
University of Arizona
Tucson