The Only EKG Book You’ll Ever Need

260 Pages·2015·14.88 MB·English

by  Malcolm S. Thaler

The Only
EKG Book
You'll Ever Need
EIGHTH EDITION
Malcolm S. Thaler, M.D.
Physician, Internal Medicine, One Medical Group
Clinical Instructor in Medicine, Weill Cornell Medical College
Medical Staff, New York Presbyterian Hospital
New York, New York
Executive Editor: Rebecca Gaertner
Senior Product Development Editor: Kristina Oberle
Production Project Manager: Bridgett Dougherty
Marketing Manager: Stephanie Manzo
Design Coordinator: Elaine Kasmer
Senior Manufacturing Coordinator: Beth Welsh
Prepress Vendor: SPi Global

8th edition

Copyright © 2015 Wolters Kluwer

© 1988 by Lippincott Williams & Wilkins; © 1995 by J.B. Lippincott; © 1999, 2002, 2007, 2010, 2012 by Lippincott Williams & Wilkins
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Printed in China
Library of Congress Cataloging-in-Publication Data
Thaler, Malcolm S., author.
The only EKG book you'll ever need / Malcolm S. Thaler. — Eighth edition.
p. ; cm.
Includes index.
ISBN 978-1-4511-9394-7
I. Title.
[DNLM:1. Electrocardiography.2. Case Reports.3. Heart Diseases—diagnosis. WG 140]
RC683.5.E5
616.1'207547—dc23
2014035785
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accuracy, comprehensiveness, or currency of the content of this work.

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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.

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LWW.com
Dedication
To Nancy, Ali, and Jon with love, and to everyone who tries to make the lives of others just a little
bit better
Preface
More than 25 years have passed since the first edition of this little book, and our devotion to the
principles outlined in the very first pages of that very first book remains just as strong today as ever:
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.
So now you hold in your hands the eighth edition of this book, and once again we have tried to
make it even better than the ones that came before. We've added material where new developments
call for it, shortened and simplified whenever possible, and continued to make sure that everything is
discussed in its proper clinical context by putting you right in the middle of real life clinical
situations.
Very special thanks to Dr. Felix Yang, M.D., Associate Director of Cardiac Electrophysiology at
Maimonides Medical Center in New York City, whose impeccable commentary and insightful edits
went way beyond the extraordinary and ensure that you will be reading the most up-to-date, clear and
accurate text that anyone could hope for.
Special thanks as always to the wonderful folks at Lippincott Williams & Wilkins who always
manage to produce the most attractive, most readable EKG book one could ever hope for. And a
particularly special tip of the hat to Kristina Oberle and Rebecca Gaertner of making this process
such a civilized pleasure.
For those of you who are picking up this book for the first time—as well as 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
Summary: 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 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
Case 8
Chapter 5
Preexcitation Syndromes
What Is Preexcitation?
Wolff–Parkinson–White Syndrome
Lown–Ganong–Levine Syndrome
Associated Arrhythmias
Summary: Preexcitation
Case 9
Chapter 6
Myocardial Ischemia and Infarction
What Is a Myocardial Infarction?
How to Diagnose a Myocardial Infarction
Summary: The EKG Changes of an Evolving Myocardial Infarction
Localizing the Infarct
Non–Q-Wave Myocardial Infarctions
Apical Ballooning Syndrome
Angina
Summary: The ST Segment in Ischemic Cardiac Disease
Limitations of the EKG in Diagnosing an Infarction
Stress Testing
Case 10
Case 11
Chapter 7
Finishing Touches
Electrolyte Disturbances
Hypothermia
Drugs
More on the QT Interval
Other Cardiac Disorders
Pulmonary Disorders
Central Nervous System Disease
Sudden Cardiac Death
The Athlete's Heart
Preparticipation Screening for Athletes
Sleep Disorders
The Preoperative Evaluation
Summary: Miscellaneous Conditions
Case 12
Case 13
Chapter 8
Putting It All Together
The 11-Step Method for Reading EKGs
Review Charts
Chapter 9
1
How Do You Get to Carnegie Hall?
Index
Getting Started
In this chapter you will learn:
1
not a thing, but don't worry. There is plenty to come. Here is your chance to turn a few
pages, take a deep breath or two, and get yourself settled and ready to roll. Relax. Pour
some tea. Begin.
On the opposite page is a normal electrocardiogram, or EKG. By the time you have finished this
book—and it won't take very much time at all—you will be able to recognize a normal EKG almost
instantly. Perhaps even more importantly, you will have learned to spot all of the common
abnormalities that can occur on an EKG, and you will be good at it!