The Only EKG Book You'll Ever Need

313 Pages·2012·11.42 MB·English

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Printed in China
Library of Congress Cataloging-in-Publication Data
Thaler, Malcolm S.
The only EKG book you’ll ever need / Malcolm S. Thaler. — 7th ed.
p. ; cm.
Includes index.
ISBN 978-1-4511-1905-3
I. Title.
[DNLM: 1. Electrocardiography. 2. Heart Diseases—diagnosis. WG
140]
616.1’207547—dc23
2011041429
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presented and to describe generally accepted practices. However, the
authors, editors, and publisher are not responsible for errors or omissions
or for any consequences from application of the information in this book
and make no warranty, expressed or implied, with respect to the
currency, completeness, or accuracy of the contents of the publication.
Application of the information in a particular situation remains the
professional responsibility of the practitioner.
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ensure that drug selection and dosage set forth in this text are in
accordance with current recommendations and practice at the time of
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Dedication

To Nancy, Ali, and Jon—of course
Preface

New content! New cases! New color! New clinical pearls! Yet even as we keep
adding, changing, and improving, the fundamentals remain. It’s been about 25
years since the first edition of this little book, and we have remained resolute to
the principles outlined in that very first preface:
This book is about learning. It’s about keeping simple things simple and
complicated things clear, concise and, yes, simple, too. It’s about getting from
here to there without scaring you to death, boring you to tears, or intimidating
your socks off. It’s about turning ignorance into knowledge, knowledge into
wisdom, and all with a bit of fun.
We must be doing something right, because each year The Only EKG Book
You Will Ever Need becomes more popular, more widely translated, and adopted
and used in more medical and other professional schools.
This edition offers a host of revisions and refinements:
A whole new palette of colors to make the models, illustrations, and
tracings clearer than ever
New clinical cases to expand on one of the most important distinctions of
the book: to put everything into its proper clinical context (you are put right
into the middle of real-life clinical situations) and to make the information
usable
Expanded sections on subjects where new developments have made deeper
understanding possible, including atrial fibrillation, long QT syndrome,
apical ballooning syndrome, and others
Greater clarity where it is called for, new tracings where they help
illuminate the points we are trying to make, and—wherever possible—
shortening and simplifying
As ever, hats off to Glenn Harper, M.D., the world’s greatest cardiologist,
whose help was invaluable in ensuring the text is up-to-date, clear, and accurate.
And remove two more hats for Kerry Barrett and Sonya Seigafuse, who continue
to lead the Lippincott Williams & Wilkins team that—year after year, edition
after edition—produces the best-looking, most readable EKG book that one
could hope for.
To those of you who are picking up this book for the first time and for those
of you who are making a return visit, I hope The Only EKG Book You Will Ever
Need will provide you with everything you need to read EKGs quickly and
accurately.
Malcolm Thaler, M.D.
Contents

Getting Started
Chapter 1
The Basics
Electricity and the Heart
The Cells of the Heart
Time and Voltage
P Waves, QRS Complexes, T Waves, and Some Straight Lines
Naming the Straight Lines
Summary: The Waves and Straight Lines of the EKG
Making Waves
The 12 Views of the Heart
A Word About Vectors
The Normal 12-Lead EKG
Summary: Orientation of the Waves of the Normal EKG
Coming Attractions
Chapter 2
Hypertrophy and Enlargement of the Heart
Definitions
Axis
Summary: Axis
Axis Deviation, Hypertrophy, and Enlargement
Atrial Enlargement
Summary: Atrial Enlargement
Ventricular Hypertrophy
Secondary Repolarization Abnormalities of Ventricular Hypertrophy
Summary: Ventricular Hypertrophy
CASE 1
CASE 2
Chapter 3
Arrhythmias
The Clinical Manifestations of Arrhythmias
Why Arrhythmias Happen
Rhythm Strips
How to Determine the Heart Rate From the EKG
The Five Basic Types of Arrhythmias
Arrhythmias of Sinus Origin
Ectopic Rhythms
Reentrant Rhythms
The Four Questions
Supraventricular Arrhythmias
Summary: Supraventricular Arrhythmias
Ventricular Arrhythmias
Summary: Ventricular Arrhythmias
Supraventricular Versus Ventricular Arrhythmias
Summary: Ventricular Tachycardia (VT) Versus PSVT With
Aberrancy
Programmed Electrical Stimulation
Implantable Defibrillators
External Defibrillators
CASE 3
CASE 4
CASE 5
Chapter 4
Conduction Blocks
What Is a Conduction Block?
AV Blocks
Summary: AV Blocks
Bundle Branch Block
Summary: Bundle Branch Block
Hemiblocks
Combining Right Bundle Branch Block and Hemiblocks
Blocks That Underachieve
The Ultimate in Playing With Blocks: Combining AV Blocks, Right
Bundle Branch Block, and Hemiblocks
Pacemakers
CASE 6
CASE 7
Chapter 5