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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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
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!