Textbook of Basic and Advanced Electrocardiography Baren Chakraborty
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flow chart, and t refer to table.
A
Abdominal process, acute 108
Accessory pathway
concealed 328
localization of 332
location of 326b
manifest 328
types of 327b
Acetylcholine 317
Acidosis 31, 108, 317
Action potential shortens 398
Addison's disease 392
Adenovirus 375, 384
Ajmaline 309, 320
Alcohol 174, 181
consumption, excessive 199
Aldosterone deficiency 392
Alkalosis 108
Ambulatory electrocardiogram 496
monitoring 496
Ambulatory rhythm monitoring 453
American College of Cardiology 58
American Heart Association 5
Amiloride 392
Aminophylline 181
Amiodarone 30, 223, 286, 301, 304, 317, 321, 432, 433
Amitriptyline 31, 181, 313, 317, 321, 430
Amphetamines 181
Amyloidosis 304, 365
Andersen-Tawil syndrome 313, 321
Anemia 35, 78, 92, 98, 108, 491
Aneurysm, dissecting 484
Angina
unstable 98, 99, 113, 484
variant 111, 114
Anginal pain 98
Angioplasty, primary 98
Anomalous pulmonary venous connection 435
Antiarrhythmic drugs 223, 271, 312f, 432, 433
Antiarrhythmic medications 425
Antibacterials 223
Antibiotics 313, 321, 385
Antidepressant 313, 317, 321
overdose 320
Antidromic atrioventricular reentrant tachycardia 335f
Antidromic supraventricular tachycardia 342
Antifungal drugs 313, 321
Antihistamines 313, 317, 321
Antihypertensive agents 271
Anti-inflammatory drugs, nonsteroidal 392
Antipsychotics 313, 317, 321
Anxiety 35
and stress 174
Aorta, coarctation of 435, 450, 452f, 455
Aortic aneurysm, dissecting 320
Aortic coarctation 450
Aortic regurgitation 90
chronic 78
Aortic stenosis 259, 267
severe 484
Aortic valve
annulus calcification 285
insufficiency 491
stenosis 435, 491
Aortic valvular
disease 268
lesions 493
Apical ballooning syndrome 368
Apical cardiomyopathy 351, 360f
Apical endocardial lead 466
Apical hypertrophic cardiomyopathy 351, 370
Arrhythmia 55, 98, 150, 168, 174, 183, 211, 322, 328, 342, 392, 394, 409, 426, 475, 496, 498
complexity of 318
development of malignant 59
exercise-induced supraventricular 318
frequency 170
hallmark of 200f
patterns of 322
provocation 484
related symptoms 312
supraventricular 149, 150, 415, 418
temporal pattern of 199
treatment for 484
Arrhythmogenic right ventricular
cardiomyopathy 92, 220, 309, 345, 365, 367f, 370
dysplasia 238, 365, 367f, 370
Arterial occlusions, proximal 125
Arteriovenous shunts, peripheral 78, 92
Artery
infarct-related 145, 161
region, circumflex 487
Artifacts
reduce movement 473
shivering 420
Ashman aberrancy, typical 201
Ashman beats 204f
Ashman phenomenon 201, 204f
Astemizole 313, 317, 321
Atheroma 112
Athletes 286
Athletic training 301
Atrial abnormalities 84, 93
left 73, 84, 93
right 85, 93, 454
Atrial activity 14
loss of 430
recipient 416
Atrial arrhythmias 411
Atrial bigeminy 175f
Atrial complex
characteristics of premature 192
premature 172174, 192, 192b, 193t, 193
single premature 173f
Atrial component, right 88f-90f
Atrial depolarization wave 14
Atrial ectopic activity 409
Atrial enlargement 453
left 72, 84, 85f, 88f, 93, 94, 349
right 84, 85, 88f, 93, 94, 417, 479
Atrial extrasystoles 406
Atrial fibrillation 33, 174, 195, 197, 197, 203f, 213, 271, 281, 322, 325, 335, 337f, 360f, 387, 397, 411, 420, 435, 496
causes of 197, 213b
cardiac 197
noncardiac 199
classification of 199, 213, 213b
fast 412f
lone 201, 213
mechanisms of 197
nonvalvular 213
slow 279f
typical 198f
Atrial flutter 195, 202, 207f, 213, 397, 406, 420, 435
atypical 202, 205f
classical 202
typical 202
waves 202
Atrial hypertrophy 84, 473
combined 473
Atrial impulse 282
Atrial infarct, diagnostic criteria for 157
Atrial infarction 149, 149b
clinical 149
depression in 149f
Atrial myocardium 425
Atrial overload 84
Atrial pacemaker 466
wandering 66
Atrial pacing 460, 460f, 469, 470
Atrial premature
beat 173, 415
complex 173, 418
Atrial pressure 196
Atrial rhythm, low 55
Atrial rupture 149
Atrial septal defect 80, 94, 267, 285, 435, 440b, 454
crochetage sign in 454
diagnosis of 435
ostium primum 454
ostium secundum 454
sinus venosus 454
types of 435, 437
Atrial spikes, electrocardiogram displays 464f, 465f
Atrial strain 84
Atrial tachyarrhythmias 453
Atrial tachycardia 206, 208, 211, 212f, 215, 397, 433
multifocal 66, 195, 196, 197f, 213, 406
Atrioventricular block 150, 282, 286, 292t, 293, 304, 313, 387, 475
diagnosis of 497
first degree 282, 482
in athletes 293
in children, high grade 478
Mobitz I 286
second-degree 285, 303
Mobitz II 286
second-degree 286, 304
second-degree 282, 285, 286
third-degree 282, 294, 304
types of 303b
Atrioventricular conduction, variable 207f
Atrioventricular dissociation 230
Atrioventricular junction 217
Atrioventricular nodal re-entrant tachycardia 195, 207, 208, 209f, 210, 214, 214b, 214t, 331, 342
types of 208
Atrioventricular node 2f, 3, 14, 195, 242, 282, 325
part of 338
Atrioventricular reentrant tachycardia 195, 206, 209, 210, 211f, 212f, 214, 214t, 328, 332f, 333f, 334f, 342
antidromic 214
orthodromic 214
Atrium
left 453
right 2, 279, 460
Autism spectrum disorders 313
Autoimmune diseases 286, 304, 385
Autoimmune pericarditis 375
Autonomic dysfunction 281
Axillary line
anterior 5
posterior 8
Axis deviation 58
Azithromycin 313, 317, 321, 432, 433
B
Bacterial infection 382
Bacterial pericarditis, cause of 375
Bayesian algorithm 237
Bayesian approach 236
Bazett's formula 28, 32f, 36, 315
Beta-adrenergic
antagonists 430
blockers 271
Beta-agonists 174
Beta-blocker 281, 286, 301, 304, 317, 318, 425, 430, 433
therapy 317
Biatrial abnormality 85
Biatrial enlargement 85, 94
Bicuspid aortic valve 450
Bifascicular block 243, 259, 260f, 261f, 262f, 268
causes of 268
Binge drinking 199
Bipolar lead 2
Bipolar limb leads, intersection of standard 2f
Blood pressure response 489
Body temperature, low 410f
Bradyarrhythmia 150, 433
severe 278f
Bradycardia 161, 223, 293f, 402, 453
causing 409
effects of longstanding 480
severe 413f
Breathing 188
Breathlessness 195
Bretylium 223
Broken heart syndrome 368, 371
Bronchospasm, acute 407
Bruce protocol 484
Brucella 384, 389
Brugada's algorithm 235, 235fc, 237
Brugada's criterion, ultra simple 237
Brugada's electrocardiogram
type 2 309f, 310f
types of 311f
Brugada's pattern 320, 430
electrocardiograms, types of 308
Brugada's population 309
Brugada's syndrome 138, 140, 153, 156, 227, 307, 308, 308f, 310, 312, 319, 320b, 321b, 420
arrhythmias in 320
diagnosis of 308, 312b
electrocardiogram 308f
diagnosis of 320b
type 1 307f, 308f, 309f
types of 311f
Brugada's sign 240, 307f, 312f
Bundle of His 4
Bundle of Kent 327
Bundle-branch block 98, 134, 217, 242, 387
basic principles 242
depolarization in 243f
diagnostic criteria of 267b
pattern 55, 101f
presence of 134
types of 243
Bundle-branch Purkinje system 295
Bundle-branch reentry 220
Bypass tract 325f
C
Cabrera's sign 137f, 466, 468
Cabrera's system 40
Caffeine 181
excess 174
Calcium
effect of 398
homeostasis 307
Calcium-channel blockers 271, 281, 286, 301, 304, 425
Camel hump 24
T waves 27f
Canadian Cardiovascular Society 488f
Capture beats 231
Cardiac abnormality 415
Cardiac activation, sequences of 4fc
Cardiac apex 126
Cardiac arrest 318, 322, 401
Cardiac arrhythmias 406, 496, 499
diagnosing 18
Cardiac axis 39
calculation of 40f
Cardiac causes 37, 181
Cardiac chamber
enlargement 68
hypertrophy 68
interaction 382
Cardiac channelopathy 307
diagnosis of 307
Cardiac conduction 432
system 294
Cardiac cycle 6
Cardiac diseases 307
Cardiac dysfunction 345
Cardiac electrical axis 39, 39f
Cardiac impulse 2
Cardiac inflammatory conditions 375, 390b
Cardiac ion channelopathy 312
Cardiac magnetic resonance imaging 85
Cardiac pacemaker cells 409
Cardiac resynchronization therapy 469, 471
Cardiac rhythm, respiratory variation of 56f
Cardiac skeleton, left side of 285
Cardiac surgery 176
after 286, 482
Cardiac tamponade 383, 384f, 390
Cardiac timing intervals 11
Cardiac trauma 113
Cardiomyopathy 37, 113, 181, 238, 267, 268, 280, 345, 369
diagnosis of 345
dilated 363f
dilated 44, 197, 238, 267, 345, 361, 370, 382, 460
hypertensive 345
ischemic 345
dilated 364f
normal and hypertrophic 346f
stress-induced 368
Cardiopulmonary
disease 196
resuscitation 415
Cardiotoxins 113
Cardiovascular complications, risks of 76
Cardiovascular disease 43, 213
Cardiovascular entities 345
Cardiovascular system 409, 420, 473
Cardioverter-defibrillator, implantable 355, 501f
Catastrophic bradycardias 431
Catecholamine 317
effect of 31
Catecholaminergic polymorphic ventricular tachycardia, diagnosis of 318, 322
Central nervous system 24, 409, 421
Cephalosporins 385
Cerebellar ataxia 415
Cerebellum 415
Cerebral T waves 313
Cerebrovascular accidents 108
acute 412
Cervical sympathetic denervation 318
Chagas disease 282, 386
Chamber enlargement 68
Chamber size 478
Chapman's sign 137, 137f
Chemotherapeutic agents 113
Chest
compressions 415
lead placement positions 6f
pain 113, 117, 188, 195, 387, 480
acute 98
attack of 111
recurrent 112f
severe central 490f
posterior 9f
Chloroquine 223, 317
Chlorpromazine 31
Ciprofloxacin 432
Cisapride 223, 317
Clarithromycin 31, 313, 317, 321, 432, 433
Clockwise rotation, causes of 44, 50
Clomipramine 317
Clozapine 317, 385
Cocaine 113, 181
Collagen vascular diseases 285
Compensatory pause
complete 174f
incomplete 175f
Concave morphology 120
Conduction abnormality 402
Conduction block 426
Conduction system
degenerative disease of 267, 285
normal 325
of heart, anatomy of 2f
Congenital abnormality 280
Congenital defect 455
Congenital syndrome 223
Congestive heart failure 197, 213, 382, 498, 500f
Connective tissue diseases 417
Consciousness, loss of 499f
Convex morphology 120
Cor pulmonale 42, 92, 244, 267
Cornell criteria, modified 87
Coronary angiogram 115
Coronary artery 377
disease 98, 115, 174, 197, 208, 213, 223, 268, 280, 282, 286, 368, 484, 485
absence of obstructive 368
diagnosis of 331
left anterior descending 104
left main 114
nonobstructive 112, 113b, 114
occlusion
left main 140
right 143
right 127, 145, 149, 487
spasm 139, 153
Coronary disease 268
Coronary syndrome, acute 20, 35, 68, 98, 113, 247, 404
Coronary vasospasm 115, 138, 139, 156
Coronary vein, posterolateral 469
Coronary venous system 469
Corynebacterium diphtheriae 384, 389
Counter-clockwise rotation, causes of 50
Coxsackievirus 375, 382, 387, 389
Crescendo angina 98
Crochetage sign 437, 438f-440f, 454, 454b
Cryptogenic stroke 498, 502
Culprit artery, identification of 156
Cushing reflex 413
Cyanotic episodes 480
Cytomegalovirus 375
D
de Winter's T and Wellens’ syndrome, significance of 157b
Deep vein thrombosis 406
Degenerative disease, primary 259, 267
Delta wave 326
Dengue fever 386
Descending artery
left anterior 149
occlusion, left anterior 141
Desipramine 31
Developmental disorders 313
Dextrocardia 42, 435, 446, 455
mirror-image 449, 449f
technical 450, 451f, 455
Dextroposition 449
Diarrhea 394, 401
Diastole, electrocardiogram representation of 3
Digitalis 425, 433
administration 491
toxicity 426
Digoxin 108, 181, 271, 281, 286, 301, 304, 425, 429, 433, 491
administration 493
effect 25, 99, 425, 426
sign of 425f
toxicity 174, 425, 429f, 430
Diphtheria 282, 301, 386
Discordance, appropriate 135
Disopyramide 30, 223, 309, 317, 432, 433
Distal conduction system 247
Diuretic drugs 394
Dizziness 188
Dofetilide 30, 432
Dothiepin 317
Doxepin 317
Dressler's syndrome 375, 382, 387
Drinking iced water 37
Droperidol 317
Drug 29
challenge 309
toxicities 237
Dual-chamber pacing 462, 465f, 470, 471
Duchenne's muscular dystrophy 320, 415, 421
Dysplasia 320
triangle of 365
Dyspnea, exertional 384
Dysrhythmia 426, 429
E
Early repolarization 156
benign 138, 139
pattern 58, 61, 66, 156, 377, 380, 382, 389, 420
syndrome 320
Ebstein's anomaly 94, 206, 435, 446, 447f, 448f, 453, 455
Echocardiography, two-dimensional 346f
Echovirus 375, 387
Ectopic beat 172, 174, 192194, 194t
Ectopic ventricular beats 398
Einthoven's law 6
Einthoven's triangle 1f, 10
Eisenmenger syndrome 450, 452, 453f, 456
Electrical activity, posterior 131
Electrical conduction within heart, abnormal 11
Electrical system, parts of 3
Electricity conducting cells 2
Electrocardiogram 1, 5, 9, 35f, 39, 52f, 55, 98, 149, 195, 196f, 197f, 229, 247f, 272f, 301f, 315, 339f, 342, 376f, 380, 382, 389, 392, 404, 408f, 415
abnormal axis on 41
abnormalities 308
adult 480b
basic 379f
causes of
low voltage 382b
motion artifacts in 421b
changes 421
classical 375f
common 421
criteria, diagnostic 114
determination of 40f
drugs on 425
findings, possible 421
in children, normal 481b
interpret 459
machine, standard calibration of 10f
normal 1f
axis on 41
variant 55
pacing spikes documentation on 469b
paper, calculation of voltage on 10f
pretest 486f, 487f
standard 13
strip 278f
tracing 4
typical 256f
pediatric 476f
waves and segments of normal 3f
waves of 3
Electrocardiographic
changes during exercise, normal 485
criteria 87
diagnosis 309
Electrocardiography 98
Electrode placement 6, 7
Electrolyte
abnormalities 108, 181, 392, 480
disturbances 181, 223, 285
imbalance 199, 237, 286
multiple 401
Electrophysiological phenomena 201
Elevated atrial pressure 208
Emphysema 42, 382
Endocarditis 389, 390
diagnosis of 387
infective 282
Endocardium 375
Endocrine abnormalities 108
Epicardial infarct artery 161
Epicardial vessel 161
Episodic pacing 462f
Episodic ventricular pacing, displays 461f
Epstein-Barr virus 375
Erythromycin 31, 223, 313, 317, 321, 432, 433
Escape beat 172, 190, 193, 194, 194t
Escape rhythm 271, 281
Excitation-contraction coupling 318
Exercise stress test, phase of 488
Exercise test 491
positive 485
Exercise tolerance test 484, 485, 489, 492f, 493, 493f
diagnostic indications of 485
indications of 485b
limitations 491
positive 489b
prognostic indications for 485
safety 485
Extracardiac disorders 113
Extrasystoles 478
Extrinsic causes 281
F
Fabry disease 365
Faintness 195
False positive exercise tolerance test, causes of 491b
False-negative test 491
False-positive test 491
Familial screening 309
Fascicle bifurcates, posterior 242
Fascicular block
left anterior 77, 252, 268
left posterior 255, 268
Fascicular tachycardia
left anterior 227f
left posterior 226f
Fascicular ventricular tachycardia 225, 226f, 227f
Fasciculoventricular fiber 338
Fatal conditions, diagnosis of 466
Fatal ventricular arrhythmia, development of 315
Fatigue 188
Fever 35, 108, 384
Fibrinolytic therapy 98, 161
Fibrotic conduction system 247
Flecainide 309, 432
Flip test 11
Fluconazole 313, 317, 321
Fluoroquinolones 223, 432, 433
Fluoxetine 181
Fluphenazine 313, 317, 321
Flutter waves
positive 205f
regular 202
Focal activation 197
Food and drug administration 313
Framingham electrocardiographic score 75
Framingham formula 28
Fridericias formula 28
Friedreich's ataxia 320, 415, 416, 421
Fungal infection 389
Fusion beats, presence of 231
G
Gait ataxia 421
Gastrointestinal tract losses 394
Gatifloxacin 31
Gemifloxacin 432
Genetic disorder, rare 313
Giant P-waves 453
Glycogen storage disease 365
Goldberger's triad 363f
Gonococcus 375, 384, 389
Great arteries 456
complete 456
transposition of 435, 453
Griffith algorithm 236, 237
H
Haemophilus 375
Hemorrhage
intraparenchymal 421
subarachnoid 24, 138, 140, 156, 313, 414f, 420, 421
Haloperidol 31, 223, 313, 317, 321
Halothane 317
Hay phenomenon 286, 304
Head injury, severe 420
Heart 2, 11, 375, 449
abnormal rotations of 51f
anomalies, congenital 450
beats 319
clockwise rotation of 43, 49
conductive system of 3f, 242f
counterclockwise rotation of 43, 49
defects, congenital 313
depolarization wave 39
electrical axis 41f
inflammation of 375
muscle 389
rotation of 39, 43
Heart block 301
complete 191f, 202f, 223, 294, 297f, 298f, 300f, 303, 304, 390, 393, 414f, 430f, 453, 480, 482
congenital complete 303f
drug-induced first-degree 282
electrocardiogram criteria of first-degree 285
first degree 128f, 285, 301, 303, 388f
high grade 150
in neonate, complete 481f
infra-His complete 298f
postprocedure first-degree 285
second-degree 303, 390, 393
supra-His complete 297f
third-degree 286, 296, 301, 303
Heart disease
carcinoid 365
chronic 208
ischemic 247, 259, 267
congenital 94, 237, 244, 267, 326, 435
detectable 197
electrocardiogram features of congenital 435
hypertensive 197, 213
ischemic 29f, 267
structural 227
Heart failure 35, 37
uncontrolled 484
Heart rate 16, 196f, 197f, 473, 481, 484
calculation of 13, 32, 33f, 34f
from electrocardiogram 37
irregular 477
normal 64
standard formulas for calculating 34b
Heart strain
acute right 407
right 80
Heart transplantation 417f
electrocardiogram after 416, 421
types of 416
Hemiblock 268
causes of 268
concept 252
impulse conduction in left posterior 257f
left anterior 42, 243, 252, 255, 255f-257f, 268
left posterior 42, 243, 255, 258f, 259f, 268
typical left posterior 257f
Hemidiaphragmatic paralysis, left 449
Hemochromatosis 281, 304, 365
Hemorrhagic stroke 421
Hepatitis B virus 375
Heterotaxy syndrome 449
Heterotopic transplantation 416
Hexaxial reference system 40, 41f
His bundle 3, 295
tissue 338
His-Purkinje system 2, 3, 326, 402
Hodges formula 28
Holiday heart syndrome 199
Holter monitor electrocardiogram 497f
Holter monitoring 196, 496, 497f, 498, 498f, 499, 500f, 502
diagnostic value of 497b
electrocardiogram 221f
tracing 479f
indications for 496b, 500
strip 501f
left side of 278f
Holter strip 273f
Holter technology 496
Human cardiac sodium 307
Human herpes virus 375
Human immunodeficiency virus 375, 387
infection 386, 417
Hyperacute T wave 24f, 117
Hypercalcemia 31, 181, 317, 320, 398, 401, 402, 420
severe 401f, 403
Hyperkalemia 24, 24f, 31, 36, 37, 138, 139, 153, 217, 267, 281, 286, 304, 317, 320, 392, 393, 402, 466
degree of 393
diagnosis of 468, 471
mild 393f
levels of 393
moderate 392f, 393, 394
degree 394f
phases of 392f, 393t
severe 393
stage of 26f, 393
Hypermagnesemia 401, 403
Hypertension 78, 259, 267, 268
absence of 370
uncontrolled 484, 491
Hyperthermia 31, 317
Hyperthyroidism 35
Hypertrophic cardiomyopathy 25, 50, 197, 238, 326, 345, 346f-348f, 355, 357f, 369, 491, 493, 501f
diagnosis of 351, 355f, 370b
patterns of 369b
Hypertrophic obstructive cardiomyopathy 345, 350f, 460
severe 484
Hypertrophied right ventricular 80
Hypertrophy 82
biventricular 82, 93, 94
Hyperventilation 21
Hypocalcemia 29, 401, 403
causes of 401
degree of 401
symptoms of 401
Hypokalemia 21, 24, 29, 99, 174, 181, 199, 223, 285, 394, 396, 397, 397f, 402, 491, 493
causes of 394
degree of 397
electrocardiogram features of 402b
mild 394, 398f
degree of 399f
moderate 399f
phases of 397t, 398f
severe 397, 400f
Hypomagnesemia 29, 174, 181, 199, 223, 285, 401403
Hypoparathyroidism 401
Hypotension 37, 401, 430
with shock 35
Hypothermia 21, 29, 37, 281, 320, 409, 410f, 415, 420, 420b
stages of 409
Hypothyroidism 37, 281, 382, 411, 420
Hypoxia 35, 196, 450
I
Ibuprofen 392
Ibutilide 30, 432
Idiopathic fibrosis 304
Idiopathic ventricular fibrillation 317
Idioventricular rhythm 161
accelerated 150, 168, 217, 227, 228f
Imipramine 31, 313, 317, 321, 430
Immune response, reduced 313
Individual waves, duration of 13
Infarcted myocardium 181
Infarction 244, 320
anteroseptal 134
current 23
diagnosis of acute 134
inferior wall 145
localization of site of 125
posterior 131, 155
Infarct-related artery, exact site of 140
Infectious diseases 282, 386b
Infiltrative diseases 281
Inflammatory disorders 382
Influenza 375
Infranodal block, presence of 286
Instantaneous vectors 39
Intact ventricular septum 340
Intermittent junctional escape rhythm 178f
Internodal pathway, anterior 2
Internodal tract
middle 2
posterior 2
Interpolated beat 182
Interstitial lung disease 417
Interventricular septum
origin 181
thickness 346f
Intestines 401
Intra-atrial
pathways 2
reentrant tachycardia 456
Intracerebral tumors 413
Intracranial pressure
electrocardiogram features of increased 412, 421
raised 29
Intraventricular conduction
defects 491
delay 349, 352f
disturbance, nonspecific 265
Intrinsicoid deflection 80
delayed 70
Ischemia 89, 89t
absence of 425
reversible 304
J
James fibers 327
Jervell and Lange-Nielsen syndrome 313, 321
Joint replacements 406
Josephson's sign 233, 236f
J-point 19
depression 489
elevation 153
Junctional bradycardia 395f
Junctional complex 177f
premature 172, 176, 192, 192b
Junctional escape
beats 191f
rhythm 179f
Junctional rhythm 176f
accelerated 150, 179f
electrocardiogram of 177f
Junctional tachycardia 180f, 433
K
Kartagener's syndrome 449
Katz-Wachtel phenomenon 83f, 84f, 94, 444, 444f
Katz-Wachtel sign 83, 83f, 93, 94, 444
Kawasaki syndrome 475
Ketoconazole 313, 317, 321
Kidney 401
disease, chronic 401, 429f
L
Lange-Nielsen syndrome 223
Laplace's law 78
Laxative abuse 394
Left atrial enlargement, diagnosis of 87f
Left axis deviation 39, 48, 70
causes of 48
pathological 45f
Left bundle branch 3, 4, 242, 252
Left bundle branch block 42, 55, 68, 89, 99, 103f, 123, 134, 138, 139, 156, 188, 243, 247, 249, 250, 251f, 254f, 260, 267, 292f, 320, 338, 466, 469471
causes of 267
complete 249, 249f, 253f
diagnostic criteria
of complete 267
of incomplete 267
incomplete 252f
morphology 239
pattern 220f
presence of 77, 122
Left circumflex
artery 146f, 149
coronary artery 145
Left heart syndrome, hypoplastic 435
Left main stenosis, electrocardiogram evidence of 114
Left ventricular
aneurysm 140f, 155f
ejection fraction 469, 471
endocardium 2
hypertrophic cardiomyopathy 30f
mass 79
noncompaction 367
origin 181
strain pattern 76
systolic function 425
Left ventricular hypertrophy 6, 42, 68, 70, 72f, 7678, 85, 87, 88b, 89, 90, 93, 94, 98, 99, 138, 139, 153, 156, 247, 320, 345, 370, 450, 491
absence of 123
cardiomyopathy 30f
detect 75
diagnosis of 68, 77
diastolic overload pattern 79f
pressure 93t
causes of 90
strain 72f, 73f, 88, 89t
pattern 76f
systolic overload pattern 78f, 452f
volume 68, 92
overload, causes of 90
with ischemia 76
with strain 76
Left-axis deviation 349
Lenegre-Lev syndrome 285
Leptospirosis 386
Lev's and Lenegre's disease 259, 267, 268
Lev's disease 285
Levofloxacin 432
Life-threatening arrhythmia 313, 500
untreated 484
Limb lead 7
augmented 5, 8, 8t, 10
inferior 437
placement of 7t
positions
alternate 8f
bipolar 5f
Limb, upsloping 28f
Lithium 223
Liu's diagnostic criteria 149b
Loop diuretics 394
Lower limb fractures 406, 418
Lown grading system 189, 190t
Lown-Ganong-Levine syndrome 326, 338, 339f, 342
Lung
cancer 199
disease, chronic 81, 92, 94
disorders, acute 407
resistivity of 74
Lyme disease 282, 304, 386
M
Macrolide antibiotics 432, 433
Macruz index 85
Mahaim fibers 327
preexcitation 338
Mahaim tachycardia, characteristics of 339
Mahaim-type preexcitation 326, 338, 342
McGinn-White sign 407
Medical therapy, guideline-directed 469, 471
Medications, use of 425
Mefloquine 317
Meningococcus 375
Mesocardia 449
Metabolic equivalents 485
Methamphetamines 113
Metronidazole 317
Microvascular dysfunction 115
Mitral regurgitation 92, 417
Mitral stenosis 92, 197, 213, 417
Mitral valve 325, 453
annulus calcification 285
insufficiency 491
prolapse 21, 25, 181, 238, 453, 456, 491, 493
repair 286
Mitral valvular lesions 493
Morphology, saddle-shaped 120
Morris index 85, 93
Mortality, long-term 59
Motion artefact, reduce 6
Moxifloxacin 317, 432
Mumps 375
Myalgias 384
Myocardial cell 2
membrane 431
Myocardial degeneration 44
Myocardial diseases, infiltrative 304
Myocardial fibrosis 416
Myocardial infarction 24, 112, 114, 149, 151, 157, 181, 327, 376, 382
acute 61, 61t, 113, 114, 117, 134, 141, 156, 181, 331, 484
acute anterior 119f, 124f, 126, 134f, 138f, 301f, 368
wall 120f
acute anteroseptal 126f
acute inferior 20f, 107f, 125f, 127, 127f-130f, 145, 147f, 148f, 284f, 286, 288f
anterior 122f, 126f, 127f, 154f, 259f, 314f
anterolateral 149
anteroseptal 149
diagnosis of 113b
acute 247
extensive anterior 149
high lateral 149
inferior 42, 132f, 149, 265f, 289f, 301, 331, 487
inferolateral 149
lateral wall 42
management of acute 117
posterior 8, 9f, 50, 132f, 149, 155b
Myocardial infiltration, diffuse 365
Myocardial ischemia 22, 24, 29, 98, 99, 244, 484
acute 313, 320
detecting 484
diagnosis of 109f
Myocardial necrosis, extensive 150
Myocardial perfusion 166
Myocardial reperfusion 161
Myocardial tissues 271
Myocarditis 24, 37, 113, 153, 181, 238, 244, 267, 286, 301, 304, 383, 384, 385, 385f, 389, 390
acute 320, 484
diagnosis of 384
electrocardiogram of 386f
Myocardium 375, 383, 389, 473
Myxedema 375, 382
N
Nelfinavir 317
Neoplastic pericarditis 375
Nephropathy, salt-losing 394
Nephrotic syndrome 382
Neuromuscular disorders 421
electrocardiogram changes in 415
Nodal blocking drugs 301
Nodal rhythm 176f
Node dysfunction 453
Nodo-Hisian junction 286
Nodoventricular fiber 338
Noncardiac causes 181
Noncoronary causes 113, 115
Non-ST elevation myocardial infarction 99, 113
Nortriptyline 430
Numerous human 117
O
Obesity 382
Obstructive coronary atherosclerosis, diagnosis of 488
Obstructive pulmonary disease, chronic 42, 197, 404, 405, 418
Occlusion, left anterior descending 142
Ofloxacin 432
Olanzapine 31
Orthodromic supraventricular tachycardia 342
Orthodromic tachycardia 340
Orthotopic heart transplantation 416, 417f
Osborn wave 409f, 410f, 420b
causes of 420
classic 420
Osmotic diuretics 394
Ostium primum type 454
Ostium secundum 435
P
P pulmonale 404, 409
P wave 14, 35
abnormal 93, 415
characteristics of normal 16
inverted 55, 65
normal 84
Pacemaker 460, 467f
activity 2
biventricular 470
cells 2, 193
codes 462
complications 466
electrocardiogram
identification of 470b
interpretation of 459, 466
functions of 459
magnet effects on 468
malfunctions 459, 466
on electrocardiogram, effects of 466
permanent 305
presence of 466, 468, 471
rhythm 42
interpretation of 469
spikes 459
temporary 302f
terminology 465
to sense and to pace, failure of 468f
types 462
of common 470
Pacing spikes 470
Palpitations, cause of 496
Parasympathomimetic action 425
Parasystole 183
Parkinson's disease 415, 416f, 417f, 421
Paroxysmal atrial
fibrillation, silent 502
flutter 271
Paroxysmal hypoglycemia 313
Paroxysmal supraventricular tachycardia 206, 420
Paroxysmal tachycardia 338
Parvovirus B19 375
Patent ductus arteriosus 82, 435, 450, 455
P-congenitale 84
Pectus excavatum 491, 493
Pediatric electrocardiogram 473, 474f, 478f, 480, 480b, 482
indications for 480b
interpretation 473
Pediatric population 208
Penicillins 385
Pentamidine 31
Percutaneous coronary intervention 72, 117
primary 117, 131, 161, 164, 227, 228f, 300f, 302f, 394
Pericardial constriction 493
Pericardial effusion 382, 389, 390
cause of 382
electrocardiogram changes in 382
Pericardial fluid, aspiration of 384f
Pericardial friction rub 387
Pericardial syndromes 387
Pericarditis 37, 138, 139, 156, 197, 320, 375, 378, 383, 484
acute 139, 153, 375, 377, 378, 378f, 379f, 380, 380t, 382, 382t, 389, 389t, 390
diagnosis of acute 375
electrocardiogram
criteria of acute 388
diagnosis of 375
of acute 376
signs of acute 375f
old 24
setting of 17
subacute 24
Pericardium 375, 387
Peri-infarction
arrhythmias, classification of 150
block 265, 265f
Permanent pacing, indications for 459
Persistent juvenile
pattern 64, 64f
T-wave pattern 481
Pertussis 386
Perugia score 75
Pharmacologic agents, use of 271
Phenothiazines 223
Pheochromocytoma 35
Pimozide 30, 317
P-mitrale 84
Pneumococcus 375
Pneumomediastinum 449
Pneumonectomy, right 50
Pneumonia 199
Pneumopericardium 382
Pneumothorax 382, 407
Polymorphic ventricular tachycardia, catecholaminergic 307, 317, 319f, 322
Populations, special 496
Postcardiac arrest 29
Postcardiac surgery 197, 238
Postcardiac surgical state 108
Postirradiation therapy 365
Postmyocardial infarct angina 98
Postmyocardial infarction
pericarditis 382
syndrome 375, 387
Postpericardiotomy pericarditis 387
Post-tachycardia syndrome 414
P-pulmonale 84
PQRST complex 3
PR interval 16, 473
causes of prolonged 17
normal 36
short 65, 338
variation 55
PR segment 17, 36
Precordial electrode
normal 7
placement of 7
Precordial leads 8, 39
right 23, 82, 422
Preexcitation 98
alternans 335
Preexcitation syndromes 325, 338, 339, 342t
patterns of 340
types of 326
Pregnancy 35
Premature junctional complex, electrocardiogram characteristics of 192
Premature ventricular complex 113, 168, 172, 176, 186, 188, 190t, 192, 192b, 193, 193t, 204f, 426
electrocardiogram characteristics of 192
interpolated 188f, 193
typical 180f, 188f
Premature ventricular contractions 181
bigeminy 181
couplet 181
multifocal 181
multiformed 181
quadrigeminy 181
salvos 182
trigeminy 181
triplet 181
unifocal 181
Prinzmetal's angina 111, 111f, 114, 138, 139, 156
during chest pain 111f
sign of 114
Probucol 317
Procainamide 223, 309, 317, 321, 432
Prominent T-waves 119
Pronounced sinus arrhythmia 477
Propafenone 309, 432
Provocable ischemia, positive for 487f
Pseudo Q waves 331, 342
Pseudoephedrine 181
Pseudo-infarction pattern 351f
Pseudo-P pulmonale 85
Psychotropic agents 320
Pulmonary artery 453
Pulmonary atresia 340
Pulmonary disease, chronic 35
Pulmonary embolism 35, 42, 92, 113, 153, 244, 406, 407, 407f, 408, 418
acute 406
Pulmonary embolus 267
Pulmonary hypertension 82, 92, 417, 422, 493
development of 406
primary 81, 92, 94, 417, 418f, 419f, 422
Pulmonary stenosis 92, 94, 450, 452f, 455
Pulmonary thromboemboli, acute 320
Pulmonary valve stenosis 435
Purkinje fibers 24, 393
Purkinje system 415
P-wave 3, 473
morphologies, distinct 64
Q
Q wave 14, 36
absence of 122
abnormal 368
deep pathological 152f
pathological 133f, 151f, 346
presence of 233
septal 65
QRS amplitude, increased 68
QRS axis, interpretation of 45
QRS complex 3, 14, 18, 18f, 19, 21, 23, 33, 40, 43f, 44f, 51f, 79, 83, 134, 153f, 177f, 178, 182, 190f, 192, 233f, 276f, 286, 294, 304, 305, 315, 367f, 405, 431, 449f, 460, 468, 469, 475
appearance of 239
duration 311
equiphasic 40
fragmentation of 153b, 154f
morphology 249f
normal 36, 173
positive 136f
start of 313f
width of 239
QRS concordance 239
QRS configuration, axis determination from 41
QRS duration 55, 231, 252f, 267
QRS morphology 250f, 339f
axis determination from 45
multiple 223f
QRS prolongation 411
QRS slurring 380
QRS vector 39, 79
QRS voltage
factors influencing 74
increased 76
low 383
QRS/T angle, widened 70
QT interval 27, 36, 313f, 314, 315, 475
calculating 32f
corrected 28, 431
measurement 31f
normal 31f, 36
short 317
QT prolongation
absence of 315
drugs causing 30
QT syndrome
acquired long 313
arrhythmias in long 315
congenital long 29
diagnosis of long 315b
long 307, 312, 313, 315, 320, 321, 321t
short 307, 317, 318f, 321, 322
varieties of inherited long 313
QTc criteria 321t
QTc interval 314
causes of long 321, 321b
QTc prolongation 317t
drugs with 315
Quinidine 30, 223, 317, 321, 432, 433
Q-wave 131, 475
abnormality 58
appearance of pathological 117, 121
develop 122
duration 6
infarction 123
persistent 153
significant 475
R
Rabbit ear sign 233, 234f, 239
Refractory period, effective 209f
Regional contractile dysfunction 152
Renal failure 401
end-stage 113
Renal losses 394
Renal tubular acidosis 394
Reperfusion arrhythmias 168, 168b
Reperfusion therapy 166
failure of 161
use of 117
Repolarization 2
changes 402
patterns, types of 308
Respiratory depression 401
Respiratory distress syndrome, adult 113
Restlessness 415
Restrictive cardiomyopathy 345, 365, 365f, 366f, 370
Reverse tick sign 425, 426f-428f
Rheumatic carditis 35, 388f, 390
electrocardiogram changes in 387
Rheumatic fever 282, 286, 301, 304, 387, 390
Rheumatic heart disease 197, 267
Rheumatic valvular heart disease 238
Rheumatoid arthritis 285, 375
Rhythm abnormalities 453
Rhythm sinus 432f
Rhythm, irregular 197f
Right atrial enlargement, signs of 455
Right axis deviation 39, 48, 93, 417, 420, 481
causes of 42, 48
Right bundle branch 3, 4
Right bundle branch block 18, 42, 90, 97, 99, 102f, 138, 138f, 140, 188, 201, 219f, 243, 243f, 244, 245, 260, 267, 310, 311, 320, 360f, 406, 435, 454, 466, 491
causes of 267
complete 142, 203f, 244, 245, 245f, 246f
diagnostic criteria
of complete 267
of incomplete 267
incomplete 245, 246f, 248f, 312f, 436f, 442f
morphology 239
partial 474f
new 407
partial 437f, 439f
pattern 226f, 352f, 405f
partial 55
presence of 122
Right coronary artery, proximal 166f
Right ventricular
branch 145
cardiomyopathy, particularly arrhythmogenic 320
damage 129
dilatation, acute 407
diseases, primary 320
endocardium 2
ischemia 320
load 42
myocardial infarction 156
origin 181
outflow tract 226, 228f, 466
strain 407, 444
Right ventricular hypertrophy 18, 25, 42, 50, 66f, 79, 80f, 81f, 92, 94, 99, 267, 404, 417, 419f, 450, 452, 452f, 453f, 473
causes of 92
diagnosis of 92
strain 81f
systolic overload pattern 82f
Right ventricular infarction 129, 149
acute inferior and 147f
Risperidone 31, 313, 317, 321
Romano-Ward
patients 313
syndrome 223, 313, 321
Romhilt-Estes
criteria 87, 88b
point score system 87
score 75
Roxithromycin 317
Rubella 375, 386
virus 384
R-wave 14, 18
progression, poor 151
S
S wave 14
Sarcoidosis 199, 281, 304, 365, 417
Sawtooth 202
Schamroth's sign 406f
Schwartz criteria 315b
Scleroderma 285, 417
Secundum atrial septal defect 436f
Sepsis 35, 113
Septal fascicle 268
Septal fascicular block, left 255
Septal hemiblock, left 255, 268
Septal right atrium, low 271
Sertraline 31
Serum
K 402
potassium 393, 402
concentration 392
high 393
mild elevations of 392
Sex, influence of 480
Sgarbossa score 136
Sgarbossa's criteria 471
Sgarbossa's scoring system 136, 136f, 156b
Shock 37
Short PR interval, causes of 17
Sick sinus syndrome 271, 272f, 273f, 276f-278f, 280, 281, 497
Simultaneous hypokalemia 402
Sine-wave appearance 402
Single photon emission computed tomography 493
Single-chamber pacing 462
Sinoatrial block 281
first-degree 279, 281
second-degree 279, 281
third-degree 280
type II 280
Sinoatrial exit block 279, 281
third-degree 281
type II 280f
Sinoatrial node 24, 64, 173, 189f, 190, 271, 326, 460, 466
electrical impulses from 282
Sinus 435
arrest 271, 274f, 281
arrhythmia 55, 56f, 64, 478
degree of 478f
diagnosis of 482
marked 481
beat 177f
N-normal 185f
bradycardia 34, 34f, 55, 60f, 150, 271, 272f, 276f, 281, 410f, 411f, 413f, 420, 426, 428f, 431f, 499f
cause 37
severe 432f
node 196
dysfunction 271, 280, 453
reentrant tachycardia 195, 196, 213
pause 271
rhythm 184f, 185f, 208f, 233, 469, 471
basic 182
normal 190, 191f, 214
variations from 476
tachycardia 35, 37, 55, 105f, 195, 196f, 213, 258f, 370, 384f, 386, 386f, 387, 387f, 388f, 389, 406, 407, 408f, 415, 420, 421, 476f
Situs ambiguus 449
Situs inversus 446
Situs solitus 446
Sjögren syndrome 375
Sleep apnea syndrome, obstructive 417
Small vessel disease 345
Sodium channel blockers 311
Sokolow-Lyon
criteria 74, 87
voltage 74
Sotalol 30, 223, 317, 321, 432, 433
Sparfloxacin 31
Spinal cord injury 406, 418
Spironolactone 392
Spodick's sign 376, 377, 379f, 389
ST depression
causes of 99
primary 113
secondary 113
primary 100
and secondary 100
reciprocal 103, 114
secondary 102
Stable angina 98
electrocardiogram criteria of 113
Standard bruce protoco 485t
Standard calibration 9
Standard exercise testing, contraindications for 484b
ST-elevation
cause of saddle-shaped 121
concomitant inferior and anterior 157
initial 120
normal variant 138, 139
with concavity upward, causes of 121
with convexity upward, cause of 121
ST-elevation myocardial infarction 8, 18, 98, 117, 134, 138, 149, 153, 155, 161, 168, 267, 371, 380, 389, 389t
acute 377, 378, 380, 380t
anterior 142
diagnosis of 117, 123, 155b, 156b, 466, 471
high lateral 131
posterior 131b
stages of 24
evolution of 118f
treatment of 161
Storage disorders 365
Strain 68
Strenuous exercise 113
Stress testing 485
Stroke 113
ST-segment 3, 14, 19, 21, 476
abnormal 68
change, calculation of 170
deviation resolution, degree of 169
normal 36
normalization of 117, 122
ST-segment depression 98100, 131b, 346, 357f, 485
causes of 21
common causes of 20
degree of 101f
diffuse 108, 109f
downsloping 106f
patterns of 99
reciprocal 103
resolution of 169
secondary 102f
significance of 488
types of 103
widespread 100f
ST-segment elevation 98, 111, 117, 119, 131, 135, 140, 164, 349, 371, 486
causes of 20, 36, 156, 138
common causes of 19
differential diagnosis of 138, 156
morphology of 120
resolution 166
ST-segment elevation myocardial infarction
acute anterior 354f
anterior 368f
true posterior 104
ST-segment resolution 164, 164b, 170, 227
single-lead 164
sum 164, 170
ST-T abnormalities 21, 76
secondary 70
Sudden cardiac death 223, 307, 345, 355, 453, 496
Sudden death 338
Sulfonamides 385
Supraventricular tachycardia 99, 195, 237, 318, 333f, 387, 411, 412f
with aberrancy 229, 233, 235fc, 239
with aberrant conduction 229, 239
with accessory pathway 229
Sympathetic nervous system 411, 413
Sympathomimetics 174
Syncopal spells 318
Syncope
and seizures 480
management of 259
Systemic disorders 417
Systemic hypertension 450
Systemic infection, acute 484
Systemic lupus erythematosus 285, 375, 480
Systemic sclerosis 375
Systemic vasculitides 375
Systole and diastole, electrocardiogram of 3f
Systolic blood pressure 484
Systolic pressure, levels of 78
T
T wave 14, 22, 26
abnormalities, secondary 79
changes, pacing-induced 470
inversion
causes of 24
pathological 37
ischemic 24, 25f
normal 36
patterns of different 23
pseudonormalization of 104, 491
Tachyarrhythmias 113, 433
supraventricular 150
Tachycardia 37, 195, 217, 223, 226, 230, 234, 272, 325, 338, 340, 430
bradycardia syndrome 272, 277f, 278f, 281
broad complex 217, 218f-220f, 227, 229, 231f, 235f, 237, 237f, 238b, 239, 239b
causes of
broad complex 217, 237
supraventricular 217
ventricular 217, 238
complex regular 334f
diagnosis, complex 237
morphology 234
narrow complex 195, 208, 218f
notching, broad complex 233f
several 272
types of ventricular 238b
wide complex 212f
Takotsubo cardiomyopathy 113, 345, 368, 368f, 371
features of 371
mimics 368
Tamponade 389
Tangent method 315
Terfenadine 223, 313, 317, 321
Tetanus 386
Tetralogy of Fallot 92, 94, 435, 444, 445f, 455
Thiamine deficiency 320
Thiazides 394
Thioridazine 30, 223, 317
Threshold method 315
Thrombolysis 162f
Thrombolytic therapy 161
Thrombophilic states 115
Thrombus, formation of 98
Thyrotoxic patients 411
Thyrotoxicosis 78, 92, 199, 213, 409, 411f, 412f, 420
Timothy syndrome 313, 321
Tobacco 174
Tombstone ST elevation 134
Torsades de pointes 238, 312, 315, 316f, 411, 420, 431
causes of 223
Trauma 375
Treadmill stress test 484
Tricuspid atresia 435, 453, 456
Tricuspid regurgitation 79
Tricuspid stenosis 94
Tricyclic antidepressants 181, 217, 223, 425, 430, 431f, 433
Trifascicular block 243, 259, 260, 263f, 264f, 269, 393
Trimethoprim 223
Truncus arteriosus 435
Tuberculosis 382
T-wave 131, 476
abnormalities 21
changes 104
inversion 66, 98, 100, 114, 117, 122, 346
anterior 407
appearance of early 166
nonspecific 66
morphology 315
Typhoid 386
myocarditis 386
U
U wave 32
causes of prominent 32
during exercise, inversion of 491
normal 37
Unifocal premature ventricular complexes 182f
Unifocal ventricular ectopic beats 183
Uremia 375
V
Vagally-mediated atrioventricular block 293
Valvular heart disease 181, 269, 417, 422
multiple 197, 417
Varicella 375
Vasculitis 417
Vector foot, augmented 14, 196
Vector left, augmented 5
Vector right, augmented 5
Venlafaxine 31
Venous thromboembolism, presentation of 406
Ventricle
age-related changes in 473
right 2
Ventricular activation time 70
increase 70
Ventricular aneurysm 138, 139, 156
Ventricular arrhythmia 113, 170, 318, 411
documented 312
malignant 331
Ventricular bigeminy 184f
Ventricular complex
consecutive premature 185f
diagnosis of premature 178
morphology of premature 181b
multifocal premature 183f
multiformed premature 183f
patterns of premature 193b
Ventricular contraction, causes of premature 181
Ventricular demand pacemaker 460, 462f
Ventricular depolarization 282
Ventricular diastole 4
Ventricular ectopic 433
beats 193
focus discharges 189f
rhythms 42, 150
Ventricular escape rhythm 191f
Ventricular extrasystole 176, 406, 420
Ventricular fibrillation 150, 224, 240, 307, 322, 328
electrocardiogram 225f
criteria of 225
start of 182
Ventricular flutter 223
electrocardiogram criteria of 223
Ventricular hypertrophy, diagnosis of 479
Ventricular paced
beats 113
rhythm 99
Ventricular pacing 460, 461f, 469, 470
Ventricular parasystole 189f, 193
Ventricular perforation 466
Ventricular preexcitation 209
Ventricular premature beat 176, 415
Ventricular rate and rhythm, analysis of 195
Ventricular reperfusion arrhythmia 169
Ventricular repolarization 413
period of 117
Ventricular rhythms 238
Ventricular septal defect 82, 435, 444, 450, 455
Ventricular systole 4
Ventricular tachyarrhythmia 312, 317, 420, 431
Ventricular tachycardia 150, 161, 217, 218f, 228f, 229, 232f, 233, 233f, 235fc, 237, 237f, 238, 238b, 239, 239b, 294, 309, 322, 387, 397, 406, 411, 430, 449, 496
bidirectional 227, 228f
electrocardiogram criteria of 217
mechanism of 238
mimicking 386f
monomorphic 220, 233f, 238
morphological criteria for 238
nonsustained 238, 497f
patterns of 238
pauses of 233f
polymorphic 223f, 420
sustained 238
with atrioventricular dissociation 230f
Ventricular trigeminy 184f
Verapamil 431, 433
Vereckei's algorithm 236f
Viral pericarditis 375
Vitamin D deficiency 401
Voltage and timing intervals, standardization of 9, 11
Voltage criteria 68, 345, 479
Vomiting 394
W
Wandering pacemaker 64, 65f, 66
diagnosis of 66
heart rate 66
Wavelet formation, multiple 197
Wellens’ syndrome 104, 108f, 114, 145f, 157
Wenckebach block 279
Wenckebach phenomenon 285, 286, 290f, 303, 304, 479f, 482
Wenckebach sequence 478
Wolff-Parkinson-White syndrome 44, 50, 217, 229, 325, 326, 327, 328, 328f, 331, 335, 338, 339, 342, 448f, 455, 491, 493
presence of 331, 342
type B 330f
World Health Organization 345
Wrist 13
Z
Ziprasidone 30, 317
×
Chapter Notes

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Textbook of Basic and Advanced Electrocardiography
‘Simplicity Is Complexity Resolved’
— Constantin Brancusi (1876–1957)
Reviewed by
Dr Mokaddas Hossain Sadi
Dr Fahmida Zaman
Dr Rashiduzzaman
Dr Farzana Razzaque Shwarna
Dr Sharmistha Datta Gupta
Dr Md Abul Khayer
Dr Shiblee Sadik Pathan
Dr Ahmed Aldnane Alam
Dr Monasyr Saquiff Amanullah
Dr Shudipan Chakraborty
Textbook of Basic and Advanced Electrocardiography
Baren Chakraborty MBBS (DMC) MCPS (Med), FCPS (Med) FACA (USA), FCCP (USA), FRCP (Ireland) FRCP (Edinburgh), FRCP (Glasgow), FACC (USA) Professor, School of Health Science, State University of Bangladesh and Chief, Medical Education and Research and Senior Consultant Cardiologist Labaid Cardiac Hospital, Dhaka, Bangladesh
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© 2020, Jaypee Brothers Medical Publishers
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Textbook of Basic and Advanced Electrocardiography
First Edition: 2020
9789352702886
Printed at
My Gifted Clinical Teacher
Major General (Prof) Anis Waiz FRCP
Who taught me ECG
Preface
Last two decades saw phenomenal progress and development in the field of Cardiology. Procedures once thought impossible have been made possible, practices once were unsafe are safe now and conditions once considered beyond care are within the grip of the cardiologists. Even during the last decade, Primary Percutaneous Coronary Intervention (PPCI) for ST-segment Elevation Myocardial Infarction (STEMI) and Cardiac Resynchronization Therapy (CRT) devices implantation for heart failure were not very popular around the globe, particularly in the developing countries. Nowadays, PPCI for STEMI and CRT for heart failure are realities and considered as routine procedures all over the world. All clinicians, therefore, need to know the electrocardiographic (ECG) signs of successful reperfusion after STEMI, ECG signs of failed fibrinolytic therapy with a view to rescue angioplasty, difference between the benign and malignant reperfusion arrhythmias, ECG criteria of assessing the suitability of device implantation, ECG evidences of proper device placement, etc. During, last few years, a plethora of articles have been published in different peer-reviewed journals on the diagnostic and prognostic ECG signs of these new techniques/therapies. Most of these newer ECG findings/signs have remained confined to the pages of those well-admired journals; and unfortunately, there is little reflection of these new ECG signs in the standard ECG textbooks. Keeping in view this reality, ‘Textbook of Basic and Advanced Electrocardiography’ has been written to keep pace with newer developments in the field of electrocardiogram. As such, this book will be a means of updating one's knowledge on every aspects of electrocardiographic diagnosis both old and new.
All the chapters of this book have been divided into two separate parts: ‘Text’ and ‘summary’. ‘Text’ part is for better understanding of the particular subject and for broadening the concept in detail. And the ‘summary’ part is for easy understanding and quick recapitulation, aiding an examinee to revise and re-read the whole book even before night prior to examination.
Throughout the whole book, my utmost endeavor was to keep the simple things simple and to make complicated things concise, easily understandable and of course simple too. This book will prove worthy to the uninitiated undergraduate students, who will find here the fundamentals of electrocardiography based on time honored electrophysiological concepts and facts, and it will be also equally deserving to the cardiologists and internists, who will find it rewarding to review the concepts already acquired and as an update of the latest electrocardiographic disclosures.
To understand the enigmatic smile of ‘Monalisa’, it is not necessary that one should be an art genius like Leonardo da Vinci and to be a good gardener, it is also not necessary to be a glorious botanist like Carl Linnaeus. In the same way, to become a good interpreter of ECG, it is not necessary that one should be an electrical engineer or intuitive electrophysiologist. Understanding the genesis of the different waves of ECG may be intricate but their clinical interpretation are easy. Keeping this fact in view, I designed this book in such a way that this textbook will be an immense educational resource to both the beginners as well as to the enlightened readers. Throughout the text, I have tried to describe the tricky and knotty subjects in a very simplified way.
This book has been written in a lucid language in my own style and is intended for MBBS students, PG trainees (FCPS, MD, DM, MRCP, DNB students) and of course for the cardiologists and clinicians for updating their existing knowledge. ECG interpretation is an art, and I firmly believe that this textbook will certainly turn the unawareness into awareness, ignorance into knowledge and knowledge into wisdom.
Baren Chakraborty
Acknowledgments
As the author of the book I must testify my gratitude to my late esteemed teachers and astute clinicians Major General (Dr) Anis Waiz, Colonel (Dr) Quazi Shafiuddin Ahmed and Dr A Johan (Singapore). All through my career, I was groomed up as a physician and cardiologist under their able guidance. I also wish to make special mention of my late senior colleague Dr Matiur Rahman, MP for his constant academic inspiration.
I wish to express heartfelt appreciation to my senior and junior colleagues, Maj Gen (Dr) AKM Shafiullah Khan, Maj Gen (Dr) Ziauddin Ahmed, Maj Gen (Dr) M Abdul Moyeed Siddiqui, Maj Gen (Dr) MG Rabbani, Maj Gen (Dr) Rabiul Hossain, Brig Gen (Dr) ABM Syeed Hosain, Brig Gen (Dr) SM Mamunur Rhaman, Brig Gen (Dr) Mamun Mostafi and Col (Dr) Shaila Perveen of Combined Military Hospital, Dhaka and Dr Fazlul Kadir, Dr Lutful Kabir, Dr Md Liaquat Ali, Lt Col (Dr) Md Mofazzel Hossain, Dr Monzur Rahman Galib, Dr Muzibul Haque Mollah, Dr Taimor Nawaz and Dr Ziaul Haque of Bangladesh Medical College, Dr Arthur Tan, Dr Amy Ng, Dr Charles Chan, Dr Chee Tek Siong, Dr Ding Zee Pin, Dr Koh Tian Hai, Dr K Gunasegaran, Dr Lau Kean Wah, Dr Lim Soo Teik, Dr Lee Chung Yin, Dr Mak Koon Hou, Dr Melvin Tan, Dr Philip Koh, Dr Ruth Kam, Dr Susan Quek, Dr Terrance Chua and Dr Teo Wee Siong of Singapore General Hospital, Dr AG Ravi Kishore, Dr Bijay Kumar Mahala, Dr George Cherian, Dr J Kanan, Dr Keshore, Dr Pradeep Kumar Shetty, Dr PV Suresh, Dr Sanjay Mehrotra, Dr Shashi Dhar, Dr Sunitha Abraham, Dr Sunita Maheshwari and Dr R Bagirath of Narayana Hrudayalaya Institute of Cardiac Science, Bengaluru, India for their unforgettable help in shaping up my academic career in various phases.
I am ardently grateful to my teachers and colleagues Dr Abduz Zaher, Dr AK Miah, Dr APM Sohrabuzzaman, Dr Arun Kumar Sharma, Dr Atikuzzaman Sohel, Dr AHM Abul Monsur, Dr ASM Nazmul Islam, Dr Azizur Rahman, Dr Fahmida Zaman, Dr Habibur Rahman, Dr Lutfor Rahman, Dr Md Lokman Hossain, Dr Mahbubor Rahman, Dr Mahbubul Islam, Dr Md Elias Ali, Dr Md Abul Khayer, Dr Mokaddas Hossain Sadi, Dr Nur Mohammad, Dr Reyan Anis, Dr Rabiul Islam, Dr Samiran Kumar Saha, Dr Shaheena Nazneen, Dr Shiblee Sadik Pathan and Dr Ziaul Kabir of Labaid Cardiac Hospital, who, in many ways, have helped and advised me in preparing the manuscript. I particularly express my indebtedness to my present hospital colleagues for furnishing this textbook with rare ECGs.
I wish to thank Dr Abdullah Al Shafi Majumder, Dr Abdul Wadud Chowdhury, Dr Atahar Ali, Dr Fazilatunnesa Malik, Dr Fatema Begum, Dr Kaisar Nasrullah Khan, Dr KMHS Sirajul Haque, Brig Gen (Dr) MA Malik, Dr M Amanullah, Dr M Abdul Kader Akanda, Dr M Afzalur Rahman, Dr MG Azam, Dr Mir Jamal Uddin, Dr M Jalaluddin, Dr M Khaled Mohsin, Dr M Maksumul Haq, Dr Md Mohosin Hossain, Dr Mohosin Ahmed, Maj Gen (Dr) M Shahjahan, Dr NAM Momenuzzaman, Dr Nazrul Islam, Brig Gen (Dr) Nurunnahar Fatema, Dr Razia Sultana Mahmud, Dr Rashiduzzaman, Lt Col (Dr) Rezaul Karim, Dr Sajal Banerjee, Dr Shams Munwar, Dr Shahabuddin Talukder, Dr SM Mustafa Zaman, Dr Sufia Rahman, Dr Syed Ali Ahsan, Dr Syed Azizul Haque and Col (Dr) Zehad Khan of Bangladesh, Dr Atifur Rahman (Australia), Dr Zhang Bin, Dr Zhimin Du, Dr Rong Bai and Dr Wenyi Guo (China), Dr Angela Hoye, Dr Nicholas P Gall (England), Dr Anil Saxena, Dr Ashok Seth, Dr N N Khanna, Dr Praveen Chandra, Dr Rabin Chakraborty, Dr Rakesh Gupta, Dr Satish K Parashar, Dr Shuvo Dutta, Dr Sunip Banerjee, Dr Suvro Banerjee, Dr TS Kler and Dr Upendra Kaul of India, Dr Dicky A. Hanafy, Dr Gunawan, Dr Muhammad Munawar and Dr Yoga Yuniadi (Indonesia), Dr Takashi Akasaka (Japan), Dr Azmee Mohd Ghazi, Dr Kenneth Chin, Dr Razali Bin Omar, Dr Rosli Bin Mohd Ali and Dr Shaiful Azmi Bin Yahaya (Malaysia), Dr Arun Maskey and Dr Yadav Bhatta (Nepal), Dr Alex T Junia, Dr Eugene B Reyes, Dr Jorge Sison (Philippines), Dr Jayaram Lingamanaicker, Dr Lim Yean Teng and Dr Paul TL Chiam (Singapore), Dr Do-Sun Lim, Dr Hyung Joon Joo and Dr Kyung Woo Park (South Korea), Dr Gotabhaya Ranasinghe and Dr WS Santharaj (Sri Lanka), Dr Paul Hsien Li Kao (Taiwan), Dr Rapin Kukreja and Dr Shakti Ranjan Paul (Thailand), Dr Chowdhury Hafiz Ahsan, Dr Chowdhury M Hasan and Dr Rafique Ahmed (USA) and Dr Phong D Phan (Vietnam), with whom I enjoyed a long clinical association.
I am fervently grateful to Brig Gen (Dr) Manzoor A Mollah for taking all the trouble in reviewing the manuscript and editing it. I also express my appreciation to all my intimate friends and well wishers, Dr AM Shamim, Mr Amirul Islam, Mr Alamgir Rahman, Mr Al Emran Chowdhury, Dr Debashish Ganguly, Mr Faridur Reza Sagor, Mr Mazharul Islam, Dr Mehbub Majid Himel, Mr M Mosaddek Hossain, Munni Saha, Mr Suvas Singho Roy, Dr Rita Saha, Mr Tapash Majumder for their constant inspiration in writing a professional book. I am also obligated to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director) and Mr MS Mani (Group President) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their incentive and effort in the publication of the book. It is needless to say that, it is they, who transformed my dream into reality.
I shall be failing if I do not thank my young scientific designers Mr S Alam, Mr Samiul Haque and Mr Zahidul Islam Sohag for their praiseworthy accomplishments in support of the book.
At last, I earnestly confesses that this book might not have been written, or would have been very different, without the decisive influence of my wife Dr Shikha Ganguly Chandana (Professor of Gynaecology and Obstetrics, Medical College) and Hospital Dhaka, Bangladesh, son, Dr Shudipan Chakraborty (Resident Doctor, Medical College Hospital, Dhaka) and daughter Anindita Chakraborty (5th year, medical student, Armed Forces Medical College, Dhaka). These three lovable and precious family members ceaselessly and consistently pushed me to write at least one academic textbook. Unyielding effort of this trio ultimately turned a novelist to an academic scientific author!