12-Lead ECG: The Art of Interpretation (2nd Edition)
Tomas B. Garcia
Format: PDF / Kindle (mobi) / ePub
Welcome to the most comprehensive resource on 12-Lead ECG interpretation!
This all-encompassing, four-color text, updated to the new Second Edition, is designed to make you a fully advanced interpreter of ECGs. Whether you are paramedic, nurse, nurse practitioner, physician assistant, medical student, or physician wanting to learn or brush up on your knowledge of electrocardiography, this book will meet your needs.
12-Lead ECG: The Art of Interpretation, Second Edition takes the complex subject of electrocardiography and presents it in a simple, innovative, 3-level approach. Level 1 provides basic information for those with minimal experience interpreting ECGs. Level 2 provides intermediate information for those with a basic understanding of the principles of electrocardiography. Level 3 provides advanced information for those with some mastery of the subject. The entire text is written in a friendly, easy-to-read tone. Additionally, the text contains real-life, full-size ECG strips that are integrated throughout the text and analyzed in conjunction with the concepts they illustrate.
and walk them along the ECG looking for any buried P waves. There are none in this ECG. CLINICAL PEARL When you see a very prolonged PR interval, consider the possibility of another P wave at the halfway point between the two visible Ps. ECG 15-9 ECG 15-10 Yes, this is another anteroseptal AMI with lateral extension. We hope you’re getting familiar with this pattern. We’re giving you different looks at ECGs with the same underlying pathology. It is very difficult to see just one example of a
the chest wall that gently pushes your hand upward. The ventricular heave occurs when the ventricular contraction causes the aneurysm to balloon out, resulting in that gentle tap on the chest wall. If you feel that heave, you can try to obtain other verification of the presence of an aneurysm, including an echocardiogram or catheterization if needed. Do not discharge this patient with instructions to obtain these tests as an outpatient. It is better to be safe than sorry! A cardiology consult is
typically seen in ischemic individuals. Now, let’s turn our attention to the rhythm disturbance. Are there any P waves? Yes, there are three clearly visible P waves, with the first and third having similar morphologies. The baseline is wavering at the beginning of the second one, so it is impossible to state with certainty that it has the same morphology as the other two. These P waves do not appear to be linked to each other temporally at all. They do not map out when you use calipers, and
could be caused by artifact from tremors, shivering, movement of the leads, electrical interference, or a malfunction of the ECG machine itself. Could the A-fib account for the artifact? Well, yes, it could account for a baseline wavering—but this artifact pattern appears more spiky than we would expect from A-fib. Of course, another possibility mentioned earlier could account for this presentation and would fit with the other findings on this ECG—shivering. Recall that (starting on page 226) we
posterior leads in posterior-wall progression of prolonged PR interval in Q wave QRS complex large wide right-sided leads in STEMI Wolff-Parkinson-White syndrome and myocardial tissue myocyte atrial stimulation, phases of myofibril myosin molecules N Na+-K+ ATPase narrow complexes in QRS tachycardia no atrial activity node atrioventricular sinoatrial sinus nomenclature, wave non-compensatory pause non–Q wave myocardial infarction nonspecific ST-T wave (NSSTTW)