Learn ECG in a Day: A Systematic Approach Prem Alva, Sajjan Madappady, EVS Maben
INDEX
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table.
A
Adrenaline 67
Anemia 59
Aneurism, ventricular 66, 83
Angina pectoris 84
Anxiety 59
Aorta, coarctation of 40
Aortic stenosis 24, 40, 77
Apex beat
left ventricular type of 79
normal 78
right ventricular type of 74, 76, 79
Arrhythmias 5, 49, 62, 71fc
interpretation of 71
systematic interpretation of 71
Artery
left circumflex 33, 38f
pulmonary 77
Asthma, bronchial 24
Atria 50, 74, 79, 80
disturbance of 49
Atrial cells 4
Atrial contraction, type of 65
Atrial depolarization 4f
Atrial escape beat 55, 56f
Atrial fibrillation 20, 49, 59, 62, 62f, 65, 70, 81
Atrial flutter 49, 59, 64, 64f, 65, 81
Atrial premature
beat 54t
contraction 49
Atrial septal defect 24, 74
secundum 74
Atrial size 7478
Atrioventricular block
first degree 25f
third degree 26, 26f, 50
Atrioventricular canal defect, partial 74
Atrioventricular nodal re-entry tachycardia 61, 61f, 62, 62f
Atrioventricular node 3, 4, 56
canal defect, common complete 76
disturbance of 49
Axis 20, 72
B
Baseline vibration 63
Bilirubin, deposition of 59
Blood pressure
high 63
measurement 79
Bradyarrhythmias 71
Bradycardia 84, 85
Bundle branch block 4, 42, 50
Bundle of His 3, 4, 56, 62
C
Capture beat 65
Cardiac apex, right ventricular type of 74
Cardiomyopathy, hypertrophic 21, 40, 85
Carotid sinus massage 62
Cells, myocardial 4
Cerebrovascular accident 85
Chamber enlargement 73, 80
Chest
leads 9f, 17, 17f, 83
placement of 12, 12f
wall
thick 83
thin 83
Conduction system 59
Congenital anomaly detection 72
COPD 82
Cor pulmonale 21, 41, 45
Coronary artery 33
anomalous left 77
Crochetage pattern 74
Culprit coronary vessel, detection of 38
Cyanosis 78
absence of 80
central 78
deep 78
presence of 80
Cyanotic spells 78
D
Deafness, congenital 85
Delta waves 69f
Dextrocardia 81, 82
Digitalis 67
Digoxin
effect 84
toxicity 84
Dilated right atrium 76, 78
Down's syndrome 76
Drowning 67
Drug over dosage 67
Dual atrioventricular nodal pathway, concept of 60
Dyspnea, exertional 74
E
ECG
basics of 6
features 75, 76, 78
findings 65
history of 1
interpretation, pediatric 72
leads 8
paper 13f
patterns, labeled normal 17f
standardization 82
strip, parts of 15f, 15t
systematic interpretation of 18
wave morphology 14f
Ectopic beats 50
high nodal 81, 82
Ejection click 76, 77, 79
Ejection systolic murmur 74, 7679
Electrical activity, normal spread of 4
Electrical cavity, spread of 4f
Electrocardiogram, systematic interpretation guidelines for 18
Electrocardiography 6
complete 1f
Electrode 7, 32
Emphysema 21, 24, 82, 83
Endocardial surface 4f
Epigastric pulsation 41
Exercise 59
Extreme left axis deviation 76
Extremities, bluish discoloration of 7779
F
F wave, fibrillating 63
Fallot's tetralogy 21, 41
Fatigue, exertional 7678
Fever 59
Fibrillation 65t
Flutter 65t
Fusion beat 66
G
Great vessels, transposition of 78
H
Heart 4, 34f
block 5
complete 26
first degree 72, 82
mobitz type 26, 26f, 50, 82
second degree 26, 49, 72
third degree 72, 81
conduction system of 3, 3f
disease
acyanotic congenital 74
congenital 72, 73
cyanotic congenital 77
obstructive acyanotic 76
rheumatic 63, 64
failure 26, 78
early infancy symptoms of 77
symptoms of 76, 79
marked clockwise rotation of 82
rate 54, 62, 80
normal 73t
sound
absent 67
fixed split second 74
loud second 75
normal 75
single second 78
wide split second 74, 76, 79
Hurried breathing 75, 79
since neonatal period 78
Hypercalcemia 84
Hyperkalemia 81, 83, 84
Hypertension 63, 64
pulmonary 41
significant pulmonary 75
systemic 40
Hyperthermia 84
Hyperthyroidism 84
Hypertrophy 39, 72
left atrial 81
right atrial 81
right ventricular 21, 41, 45, 7276, 78, 79, 82
ventricular 7479, 83, 84
Hypocalcemia 85
Hypokalemia 66, 67, 84
Hypomagnesemia 66, 67
Hypothermia 59, 82, 83, 85
Hypothyroidism 59, 82, 83, 84
I
Impulse
conduction 44f, 46f
disorders of 49
formation, disorders of 49
Incomplete compensatory pause 50, 51, 51f
Infarction 29, 29f, 30
Injury 28, 28f
Intra-atrial conduction 24, 24f, 25f
Ischemia 27, 28f
myocardial 84
non-infarction transmural 83
Isoprenaline 67
J
Jaundice, obstructive 59
Jervell and Lange-Nielsen syndrome 85
Junctional escape beat 55, 57f
K
Kent bundle 69f
L
Leads 8f, 9fc, 11f
placement of 11
Left anterior descending artery 33
infarction 35f37f
Left anterior hemiblock 21, 47, 47f, 50
Left atrial
abnormality 24t
enlargement 22, 25f
Left axis deviation 21, 21f, 47, 74, 80
Left bundle branch 3
block 21, 45, 46f, 48, 50, 82, 83
ECG of 45f
Left posterior hemiblock 21, 47, 47f, 50
Left ventricle quadrant 34f
Left ventricular
apex 75
function 66
hypertrophy 21, 39, 72, 75, 77, 78, 82
ECG of 39f
mild 75
strain pattern 40, 40f
third heart sound 77
Limb leads 9f
placement of 12, 12f
Lips, bluish discoloration of 77, 78
Long QT interval 85
Lower respiratory infections, recurrent 74, 75, 79
Lown–Ganong–Levin syndrome 82
M
Massive pleural effusion, left sided 82
Mitral regurgitation 24
Mitral stenosis 24, 63, 64
Multiple re-entrant wavelets 63f
Murmur, pansystolic 75, 77
Myocardial infarction 82, 84
acute 27, 27fc, 32f, 45, 48, 63, 64, 66, 67, 8385
anterior 59
inferior wall 59
true posterior 84
anterior 82
anterolateral wall 31
anteroseptal 82
inferior wall 31, 31f
subendocardial 84
true posterior 82
Myocarditis 66, 85
Myocardium, ventricular 4f
N
Nodal blocks 49
Nodal premature beat 54t
Non-ST elevation myocardial infarction 33, 33f
Noonan syndrome 76
Normal ECG 13
morphology 13
pattern 15, 16f
O
Obesity 82, 83
P
P mitrale 22, 23f
P pulmonale 23, 23f
P wave 65, 68, 81
absent 63, 81
atrial depolarization 14
different morphology of 22f
inverted 24, 54, 81
morphology 21, 22f, 72
variable 81
multiple 81
small 81
tall 81
wide 81
Pacemakers
order of 50fc
rates of 4
wandering 81
Paroxysmal supraventricular tachycardia 49, 60
Pericardial effusion 82, 83, 84
Pericarditis
acute 83, 84
chronic 83
Pneumothorax, left sided 82
Posterior descending artery 33
involvement 37f
P-R interval 25, 72
prolonged 82
short 82
variable 82
Premature beat 50, 50f, 57t
atrial origin of 54f
nodal origin of 54f
Prinzmetal's angina 83
Pulmonary embolism 24, 45, 82
Pulmonic valve stenosis 24
Pulse
absent 67
bounding 79
collapsing 79
pressure
narrow 77
wide 79
volume, normal 79
Purkinje cells 4
Purkinje fibers 3, 56
Q
Q wave 82
QRS
axis 7478
complex 14, 65, 67, 83
wide 42
high voltage 83
low voltage 83
variable 83
wave
different patterns of 15f, 16f
morphology 27
wide 83
Q-T interval 84
short 84
Quadrant infarction
anteroseptal 35
anterosuperior 36
posterolateral 37, 38
R
R wave 82
progression, normal 17, 17f
small 82
tall 82
Rabbit ear pattern 42, 42f
Raised intracranial pressure 59
Rate 19, 65, 67, 68
Re-entry circuit 69
Respiration 67
Respiratory infections, recurrent 75, 78
Retrograde conduction 81
Rheumatic fever, history of 63
Rhythm 20, 52, 65, 67, 68, 72, 7479
abnormalities of 57
atrial 59
high nodal 55, 55f, 81
idioventricular 67, 68f, 81, 83
irregular 20
junctional 49, 54
low nodal 55, 55f
mid nodal 55, 55f, 81
nodal 54, 81, 82
sinus 60
ventricular 65
Right atrial
abnormality 24, 24t
enlargement 23, 24f, 74, 7981
Right axis deviation 21, 21f, 42, 47, 74, 76, 78, 79
Right bundle branch block 21, 42, 44f, 50, 82, 83
ECG of 43f
Right left axis, deviation of 21
Right ventricular
apex 76
hypertrophy 21, 41, 45, 7276, 78, 79, 82
ECG of 41f
strain pattern 41, 42f
Romano–Ward syndrome 85
R-R interval 19f, 20f
irregular 20f
S
Septal depolarization 4f
Shock 59
Sick sinus syndrome 59
Sinoatrial blocks 49
Sinoatrial nodal parts 54f
Sinoatrial node 3, 4, 56
block 55
Sinus 62t
arrest 55, 56f
arrhythmia 20, 49, 57
ECG of 58f
bradycardia 49, 57, 58
ECG of 58f
mechanism, disturbances of 49
pause 55, 56f
rhythm 60
conduction in 60f
normal 7479
tachycardia 49, 57, 59
ECG of 59f
Soft ejection systolic murmur 75, 78
Sokolow–Lyon criteria 39, 41
ST depression 84
ST elevation 31, 3537, 38fc, 77, 83
ST segment 14, 28f, 83
Stenosis
congenital pulmonary 76
pulmonary 41, 76
severity of 76
Stokes–Adams attacks 26
Strain pattern 40
Sudden death 70, 85
Supraventricular premature beat 51, 53
ECG of 52f
Supraventricular tachycardia 62t
Syncope 70, 77, 85
T
T inversion 84
T wave 84
inverted asymmetric 42
small 84
tall 84
ventricular repolarization 14
Tachyarrhythmias 71
Tachycardia 75, 77, 79, 84
atrial 61, 61f, 65, 65t, 81
junctional 49
sinus 49, 57, 59
supraventricular 59, 62t, 69, 81
ventricular 49, 65, 66f, 68t, 81, 83
Tachypnea 76
Tetralogy of Fallot 24, 77, 78
Thyrotoxicosis 59, 63, 64
Torsades de pointes 66, 67f, 83
Total anomalous pulmonary venous connection 78
Tricuspid atresia 79
Truncus arteriosus 79
U
U wave 84
prominent 84
V
Vagal stimulation 84
Vagal tone 58
Valvular lesions 63, 64
Ventricles, disturbance of 49
Ventricular bigeminy 53
Ventricular ectopic 49, 81, 83, 84
Ventricular escape beat 55, 57f
Ventricular fibrillation 20, 49, 67, 67f, 68f, 83
Ventricular myocardium 4f
anteroseptal region of 4f
Ventricular premature beat 5153
ECG of 53f
Ventricular septal defect
large 75
moderate 75
Verapamil 59
W
Wenckebach block 49
Wenckebach phenomenon 26, 82
Williams syndrome 77
Wolff–Parkinson–White syndrome 21, 68, 82, 83
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Chapter Notes

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History of ECGCHAPTER 1

Einthoven was born in Indonesia in the year 1860. His father who was a doctor, died when Einthoven was still a child. His mother along with her children moved to Netherlands in 1870. He received a medical degree from the University of Utrecht in 1885. After that he went on to become a professor at University of Leiden in 1886.
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Before Einthoven's time, it was known that electrical currents were produced by the beating of the heart, but this phenomenon could not be measured accurately without placing electrodes directly over the heart. Einthoven completed a series of prototypes of string galvanometers in 1901. The device used a very thin filament of conductive wire passing between very strong electromagnets (Fig. 1). The electromagnetic field would cause the string to move when current was passed through the filament.
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FIG. 1: Photograph of a complete electrocardiography showing the way in which the electrodes are attached to the patient. In this case the hands and one of the feet being immersed in jars of salt solution.
2This string would cast a shadow on a moving role of photographic paper when a light was shone (Fig. 1).
The original machine required cooling water for the powerful electromagnets. It required 5 people to operate it and weighed around 600 lb. This device increased the sensitivity of the standard galvanometer so that the electrical activity of the heart could be measured despite the insulation of flesh and bones.
Much of the terminology used in describing an EKG originated with Einthoven. His assignment of the letters P, Q, R, S and T to the various deflections is still used. The term Einthoven's triangle is named after him.
Einthoven went on to describe the electrocardiographic features of a number of cardiovascular disorders after his development of string galvanometer. Later Einthoven studied the acoustics, particularly heart sounds which he researched with Dr P Battaerd.
He died in Leiden, Netherlands and is buried in the graveyard of the Reformed Church at Haarlemmerstraatweg in Oegstgeest.