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E-Z ECG Rhythm Interpretation
A Typical Permanent Pacemaker and its Lead Wires - Figure 16-1
Table of Contents
Free Topics
A Closer Look at the Conduction System
About
Acknowledgments
Artifact or Ventricular Tachycardia?
Breakfast is Served
Consultants
Down-to-Earth Modes
Flowchart - AV Block Decision Tree (Flowchart)
Ischemia: Holding Back the Blood
Preface
Some Artifacts Aren't Rare or Valuable
The Other Half of the Picture
The Value of Valves
Treating Atrial Fibrillation in Depth
Where to Next?
Section 1. Learning the Basics
1. A Hearty Tour
A Hearty Tour
An Elegant Design
B - 1-1. Getting a Kick Out of Your Atria
B - 1-2. Stretch Before you Exercise
B - 1-3. Picking Up Rocks
Coming Up Next
F - 1-1. Protection for your Heart
F - 1-2. Learning to Distinguish Left from Right
F - 1-3. Learning to Distinguish Top from Bottom and to Identify the H…
F - 1-4. How the Heart Gets What it Needs
How it Works - An Elegant Design
How it's Put Together - An Elegant Design
Now you Know
T - 1-1. Where Does the Blood Go Now?
T - 1-2. What are the Valves Doing Now?
T - 1-3. What's the Left Side Doing?
T - 1-4. Location of Heart Valves
Test Yourself
The Heart Needs Its Wheaties ™ Too
The Heart Needs Its Wheaties ™ Too - Breakfast is Served
The Heart Needs Its Wheaties ™ Too - Handling the Workload
The Heart Needs Its Wheaties ™ Too - Where to Next?
The Value of Valves
The Value of Valves - Contents Under Pressure
The Value of Valves - Go with the Flow
The Value of Valves - The Other Half of the Picture
2. (Dis)Charge It!
(Dis)Charge It!
A Closer Look at the Conduction System - Keep it Going
A Look Back at the Action - Keep it Going
B - 2-1. Call the Electrician?
B - 2-2. Electrical Heart Writing
Cellular Batteries - Start the Pump
Coming Up Next
Coordinated Signals - Keep it Going
F - 2-1. The Cell Membrane has Channels that Allow the Passage of Sodi…
F - 2-2. Uneven Distribution of Ions Across the Cell Membrane Produces…
F - 2-3. The Standard Action Potential Curve for the Sinus Node and Ve…
F - 2-4. The Conduction System is Vital to the Contraction of the Hear…
F - 2-5. The Action Potential Curve for Different Types of Cardiac Cel…
F - 2-6. The Intra-Atrial, Internodal, and His Purkinje (Bundle Branch…
Keep it Going
Now you Know
Start the Pump
Test Yourself
Who Runs the Show? - Start the Pump
3. The ECG Canvas
A Large-Box Estimate - Estimating Heart Rate
B - 3-1. Special Markings
B - 3-2. Running Laps
B - 3-3. A Little Wiggle Room
B - 3-4. On the March
B - 3-5. An Alternative Method
B - 3-6. Ideas from a Stupid Computer
Coming Up Next
Doing the Background Work
Estimating Heart Rate
F - 3-1. Various ECG Strip Backgrounds
F - 3-10. The Small-Box Method Gives the Most Accurate Estimate of Hear…
F - 3-11. Estimating the Heart Rate Range for Irregular Rhythms
F - 3-2. Boxes and their Standard Values
F - 3-3. Practice Measuring Intervals on a Standard ECG Strip
F - 3-4. Proper Caliper Placement
F - 3-5. Calipers Showing an Irregular Rhythm
F - 3-6. Measurement Using the Six-Second Method
F - 3-7. The R-to-R Interval
F - 3-8. The Large-Box Method
F - 3-9. Calculating the Heart Rate Using the Large-Box Method
Grid or Blank Slate? - Doing the Background Work
Keeping Count - Speed Reading
Keeping it Simple - Doing the Background Work
Now you Know
Picking Up the Beat - Speed Reading
Quick Estimate: the Six-Second Method - Estimating Heart Rate
Small-Box Precision - Estimating Heart Rate
Speed Reading
Talking About Complex Things - Speed Reading
Test Yourself
The ECG Canvas
The Tracing Takes Shape
The Tracing Takes Shape - Draw it or Burn it?
The Tracing Takes Shape - Marking Time
Thinking Outside the Box
4. Location, Location, Location
A Lot of Leads to Follow - Lead and the Signal will Follow
B - 4-1. How Hard can You Pull?
B - 4-2. A Little Help from Your Friends?
B - 4-3. Planes of the Heart
B - 4-4. Work Within the System
Bipolar Leads - Lead and the Signal will Follow
Coming Up Next
Electrode Placement and Leads
F - 4-1. The Proper Locations of the 10 Electrodes Used for a 12-Lead …
F - 4-2. The Limb Leads View the Signal as it Travels through the Vert…
F - 4-3. In a System that Uses Three Electrodes, Leads I, II, and III …
F - 4-4. The Unipolar Leads
F - 4-5. For Modified Chest Leads
I Spy with My Little Lead
In Search of an Arrow
Lead and the Signal will Follow
Leads aVR, aVL, and aVF - Electrode Placement and Leads
Leads I, II, and III - Electrode Placement and Leads
Leads V(1) Through V(6) - Electrode Placement and Leads
Learning Patchwork - In Search of an Arrow
Lines of Force
Location, Location, Location
Modified Chest Leads - Electrode Placement and Leads
Now you Know
Obeying the Law of Averages - In Search of an Arrow
T - 4-1. ECG Electrode Designations and Wire Colors
T - 4-2. Placement of ECG Bipolar Limb Leads
T - 4-3. Placement of ECG Chest Leads
Test Yourself
Unipolar Leads - Lead and the Signal will Follow
Where, Oh Where, do the Patches Go? - In Search of an Arrow
Section 2. Getting More Technical
5. The Shape of Things to Come
A Couple you Haven't Met - Waves, Complexes, Segments, and Intervals
A Couple You've Met - Waves, Complexes, Segments, and Intervals
B - 5-1. Process of Elimination
B - 5-2. Letters Large and Small
Coming Up Next
F - 5-1. The ECG Tracing Prototype
F - 5-2. The QRS Complex can Come in Many Shapes
F - 5-3. Identify the QRS Complexes on These Strips
F - 5-4. Identify the T-Waves on These Strips
F - 5-5. Identify the P-Waves on These Strips
F - 5-6. Identifying the PR, ST, and TP Segments
F - 5-7. Identifying the PR and QT Intervals
F - 5-8. Identify the PR Segment, PR Interval, and ST Segment in These…
Now you Know
Telling Dogs from Wolves
Telling Dogs from Wolves - Pattern Recognition
Telling Dogs from Wolves - Start at the Bottom
Test Yourself
The Perfect Wave
The Perfect Wave - A Gentle Curve
The Perfect Wave - A Gentler Curve
The Perfect Wave - In the Beginning was the P-Wave
The Perfect Wave - Surfing the Alphabet
The Perfect Wave - Tall, Straight Lines
The Shape of Things to Come
Waves, Complexes, Segments, and Intervals
6. Cars and Carts: From P-Wave to QRS Complex
B - 6-1. Scrambling the Alphabet
B - 6-2. Which Brand of Tissues?
B - 6-3. How Many Green Lights?
Cars and Carts: From P-Wave to QRS Complex
Check and Check Again - Measuring the PR Interval
Coming Up Next
F - 6-1. A, an Upright P-Wave
F - 6-2. P-Wave Occurring after the QRS Complex
F - 6-3. The P-Waves in this ECG Strip Occur at the Same Time as the Q…
F - 6-4. A, Lead V(1). If you Look Carefully, you Can Identify the P-W…
F - 6-5. Here there are Four P-Waves (Labeled 1-4) for Every QRS …
F - 6-6. Here there are Two P-Waves (Labeled 1 and 2) before Every QRS…
F - 6-7. Proper Caliper Placement for Measuring the PR Interval
F - 6-8. A, the PR Interval is not Measurable
First Comes the P-Wave
First Comes the P-Wave - The P-Wave and QRS Connect
First Comes the P-Wave - Where are the P-Waves?
How to Tie a Shoelace
Measuring the PR Interval
Normal P-Waves - Variations on a P-Wave
Now you Know
Renegade P-Waves - Variations on a P-Wave
Test Yourself
The AV Node Tollbooth
The AV Node Tollbooth - Keep Them Coming
The AV Node Tollbooth - Past the Tollbooth
The AV Node Tollbooth - Wait Your Turn
The AV Node Tollbooth - Well-Timed Signals
Variations on a P-Wave
Wave Plus Segment - Measuring the PR Interval
7. The Intraventricular Superhighway
B - 7-1. Your Friendly Utility Company
B - 7-2. Two for the Price of One
B - 7-3. Hanging by Your Knees
B - 7-4. How Long was that Race?
Coming Up Next
F - 7-1. Correlating the ECG Tracing with the Electrical Conduction th…
F - 7-10. Here the J-Point is Used to Identify the End of the QRS Compl…
F - 7-11. Proper Caliper Placement for Measurement of the QRS Complex
F - 7-2. The Bundle Branches are the Fast Path through the Ventricles
F - 7-3. QRS Complexes Come in All Shapes and Sizes
F - 7-4. The Ventricles Normally Depolarize Independently, but Nearly …
F - 7-5. If the Signal Travels Directly Toward an Electrode
F - 7-6. QRS Complexes Taken from the Same Patient at the Same Time, b…
F - 7-7. Identifying the QRS Complexes can Present a Challenge, Especi…
F - 7-8. When the QRS Complex Simply Returns to Baseline, Identifying …
F - 7-9. Identifying the End of the QRS Complex can be difficult When …
Measuring Tools and Techniques
Now you Know
Test Yourself
The Intraventricular Superhighway
Tracking the QRS Complex
Tracking the QRS Complex - A Different Ending: Identifying the J-Point
Tracking the QRS Complex - Height and Straight Lines
Tracking the QRS Complex - Not the Same Old Line: How QRS Shapes Vary
Tracking the QRS Complex - The Effect of Perspective
Traveling the Bundle Branch Routes
Traveling the Bundle Branch Routes - A Fast Ride Through the Ventricles
Traveling the Bundle Branch Routes - The Intraventricular Road Map
Traveling the Bundle Branch Routes - What's Happening on the Strip?
8. The Language of ECG
A Couple of Cranky Customers - A Little Less Basic
A Little Less Basic
Arriving Too Soon - A Little Less Basic
B - 8-1. King of the Heart
B - 8-2. Waiting for a Friend
Coming Up Next
How Fast does it Go? - Starting with the Basics
Meet the Twins - A Little Less Basic
Not Quite Usual - A Little Less Basic
Now you Know
Starting with the Basics
T - 8-1. Normal (Intrinsic) Rates for Various Tissues of the Heart
T - 8-2. Converting Heart Rates and Origins to Rhythm Names
Test Yourself
The Language of ECG
Where does the Rhythm Begin? - Starting with the Basics
9. Rhythm Rules
Allow for Exceptions - P or not P?
B - 9-1. Sleeping in on Weekends
B - 9-2. Sleeping in Anytime
B - 9-3. Sleeping in When You're Sick
Coming Up Next
F - 9-1. This Rhythm is Regular Because the QRS Complexes are Equally …
F - 9-2. The QRSs and the P-Waves are Regular in this Strip, but Note …
F - 9-3. The QRSs and the P-Waves First Grow Closer Together and Then …
F - 9-4. The QRSs in this Rhythm Look Regular at First Glance
F - 9-5. The QRSs in this Rhythm Seem Randomly Spaced
F - 9-6. The First Six QRSs are Evenly Spaced, and Then Suddenly Then …
F - 9-7. The Consecutive, Upright QRSs are All Separated by the Same D…
F - 9-8. Each of the First Four P-Waves has a Different Shape (Morphol…
Fast, Slow, or Just Right?
How Complex is Your QRS?
How Far from P to R?
How Many Questions?
How Regular is Regular?
Irregularly Irregular - How Regular is Regular?
Know What to Ask - P or not P?
Now you Know
P or not P?
Regular Except - How Regular is Regular?
Regularly Irregular - How Regular is Regular?
Rhythm Rules
Step 1: Determine Regularity - What was All that Again?
Step 2: Calculate Heart Rate - What was All that Again?
Step 3: Evaluate the P-Waves - What was All that Again?
Step 4: Evaluate the PR Interval - What was All that Again?
Step 5: Evaluate the QRS Complex - What was All that Again?
T - 9-1. Types of Regular and Irregular Rhythms
Test Yourself
What was All that Again?
Why All the Questions?
Section 3. Moving to the Rhythm
10. Sinus Rhythms
A Break in Sinus Discharge - Sinus Arrest and Sinus Exit Block
B - 10-1. It's Up to the Drummer
B - 10-2. If Sinus Rhythm Needs Treatment
B - 10-3. Shifting Up
B - 10-4. Treating Sinus Tachycardia
B - 10-5. Treating Sinus Bradycardia
B - 10-6. A Rhythm with a Fingerprint
B - 10-7. A Light Bulb of an Idea
Capable and Sufficient Leadership - Recognizing Sinus Rhythms
Characteristics of a Sinus Beat - Recognizing Sinus Rhythms
Coming Up Next
F - 10-1. Sinus Rhythm
F - 10-10. Sinus Bradycardia with Sinus Arrhythmia
F - 10-11. Sinus Arrhythmia
F - 10-12. Sinus Exit Block
F - 10-13. Sinus Arrest
F - 10-14. Notice the Difference in the Timing of the First P-Wave after…
F - 10-2. Sinus Rhythm in Leads II and III
F - 10-3. Sinus Rhythm in Leads aVR and V(1)
F - 10-4. Sinus Tachycardia
F - 10-5. Sinus Tachycardia
F - 10-6. Sinus Tachycardia
F - 10-7. Sinus Bradycardia
F - 10-8. Sinus Bradycardia in Lead V1
F - 10-9. Sinus Bradycardia in a Triathelete
Marching in and Out of Step - Sinus Arrest and Sinus Exit Block
Now you Know
One Who Sets the Pace
Recognizing Sinus Rhythms
Sinus Arrest and Sinus Exit Block
Sinus Arrhythmia
Sinus Bradycardia
Sinus Discharge can be a Good Thing
Sinus Rhythms
Sinus Tachycardia
T - 10-1. Criteria for Sinus Rhythm
T - 10-2. Criteria for Sinus Tachycardia
T - 10-3. Some Causes of Sinus Tachycardia
T - 10-4. Criteria for Sinus Bradycardia
T - 10-5. Criteria for Sinus Arrhythmia
T - 10-6. Criteria for Sinus Arrest and Sinus Exit Block
Test Yourself
Treat the Cause, not the Symptoms - Sinus Tachycardia
When Less Sinus Discharge is Healthy - Sinus Bradycardia
When Sinus Discharge is Too Much - Sinus Tachycardia
When Sinus Discharge Isn't Enough - Sinus Bradycardia
11. Atrial Rhythms
A Different P-Wave - A PAC with a Block
A PAC with a Block
A PAC Without the Politics
Anatomy of a PAC - A PAC Without the Politics
Another Response from the Ventricles - Atrial Fibrillation
At High Speed - Atrial Tachycardia
At Higher Speed - Atrial Flutter
Atrial Fibrillation
Atrial Flutter
Atrial Rhythms
Atrial Rule: When Leadership Disagrees
Atrial Tachycardia
B - 11-1. The Politics of the Heart
B - 11-10. Blocked PAC or Atrial Flutter?
B - 11-11. Atrial Missiles
B - 11-12. A Wavy Baseline
B - 11-13. A Two-Step Process?
B - 11-2. Get at the Cause
B - 11-3. Check Several Leads
B - 11-4. What's Going on with the Patient?
B - 11-5. Work it Out Later
B - 11-6. Calm it Down, Find the Cause
B - 11-7. A Chain of P-Waves
B - 11-8. A Saw-Tooth Pattern
B - 11-9. Hiding in the T-Wave
Coming Up Next
Ectopic Atrial Pacemaker
F - 11-1. Sinus Rhythm with Two PACs (the Third and Sixth Beats)
F - 11-10. Atrial Flutter with a Variable AV Block
F - 11-11. Blocked PACs
F - 11-12. Distorted T-Waves Caused by Blocked PACs
F - 11-13. Typical Examples of Atrial Fibrillation
F - 11-14. These Two Strips Demonstrate the Randomness of the AV Node Co…
F - 11-15. Ventricular Response Rates in Atrial Fibrillation
F - 11-2. Sinus Rhythm with Multifocal PACs (Third, Sixth, and Ninth Be…
F - 11-3. PACs in Different Recurrent Patterns
F - 11-4. Sinus Rhythm Converting to Ectopic Atrial Pacemaker
F - 11-5. P-Wave Morphologies in Atrial Rhythms Depend on the Location …
F - 11-6. Wandering Atrial Pacemaker
F - 11-7. In Mat, the P-Waves May be difficult to Identify Because of t…
F - 11-8. One Cause of Atrial Flutter
F - 11-9. Atrial Flutter with a 4:1 AV Block: Every QRS Complex has Fou…
Final Notes - Atrial Fibrillation
Multifocal Atrial Tachycardia
Now you Know
Playing Detective - A PAC with a Block
Playing the Shell Game - Wandering Atrial Pacemaker
Read Between the P-Waves - Wandering Atrial Pacemaker
Rebels with a Cause - A PAC Without the Politics
T - 11-1. Criteria for Premature Atrial Rhythm
T - 11-2. Criteria for Ectopic Atrial Pacemaker
T - 11-3. Criteria for Atrial Tachycardia
T - 11-4. Criteria for Wandering Atrial Pacemaker
T - 11-5. Criteria for Multifocal Atrial Tachycardia
T - 11-6. Criteria for Atrial Flutter
T - 11-7. Criteria for Atrial Fibrillation
Test Yourself
The Fastest of All - Atrial Fibrillation
Those Irritable Atria
Treating Atrial Fibrillation in Depth - Atrial Fibrillation
Wandering Atrial Pacemaker
What are the Ventricles Up to? - Atrial Flutter
Where's the QRS Complex? - Atrial Fibrillation
12. Junctional Rhythms
A Familiar Rhythm - Junctional Tachycardia
A Question of Origin
Accelerated Junctional Rhythm
B - 12-1. Narrow is Normal
B - 12-2. What Made it Flip?
B - 12-3. Simultaneous Events
B - 12-4. To Treat or not to Treat?
B - 12-5. Junctional Rhythm or Atrial Fibrillation?
B - 12-6. Increase the Heart Rate
B - 12-7. Increase Cardiac Output
B - 12-8. Check Potassium Level
Better Late Than Never? - A Question of Origin
Coming Up Next
F - 12-1. The Normal Path of Atrial Depolarization in Sinus Rhythm in R…
F - 12-10. Accelerated Junctional Rhythm with P-Waves
F - 12-11. Accelerated Junctional Rhythm Without P-Waves
F - 12-12. Junctional Bradycardia
F - 12-13. Supraventricular Tachycardia can Come in All Shapes and Sizes
F - 12-2. The Normal Path of Atrial Depolarization in Junctional Rhythm…
F - 12-3. Junctional Rhythm Originating Near the Top of the AV Node
F - 12-4. Junctional Rhythm Originating Near the Middle of the AV Node
F - 12-5. Junctional Rhythm Originating Near the Middle of the AV Node
F - 12-6. Sinus Rhythm with the Fifth Beat a Premature Junctional Contr…
F - 12-7. Sinus Rhythm with Multifocal Junctional Beats
F - 12-8. Sinus Rhythm with Trigeminal Premature Ventricular Contractio…
F - 12-9. A, Atrial Fibrillation
It's not Nice to Ignore the Atria - A Question of Origin
Junctional Bradycardia
Junctional Rhythm
Junctional Rhythms
Junctional Rhythms in a Nutshell
Junctional Tachycardia
Keeping Up the Good Work - Accelerated Junctional Rhythm
Not a Long-Term Option? - Accelerated Junctional Rhythm
Now you Know
Premature Junctional Contraction
Shortchanging the PR Interval - A Question of Origin
Supraventricular Tachycardia: An Easy Way Out
T - 12-1. Criteria for Premature Junctional Contraction
T - 12-2. Criteria for Junctional Rhythm
T - 12-3. Criteria for Accelerated Junctional Rhythm
T - 12-4. Criteria for Junctional Bradycardia
T - 12-5. Criteria for Junctional Tachycardia
Test Yourself
The Case of the Disappearing P-Wave - A Question of Origin
The Supraventricular Jigsaw
The Supraventricular Jigsaw - All Pieces in Place
The Supraventricular Jigsaw - How They're Alike
The Supraventricular Jigsaw - How They're Different
The Supraventricular Jigsaw - P-Waves in Reverse
Treat First, Identify Later - Junctional Tachycardia
What Causes it? - Premature Junctional Contraction
What does the P-Wave Tell Us? - Premature Junctional Contraction
What does the Rhythm Look Like? - Premature Junctional Contraction
Who's Running the Government?
13. Ventricular Rhythms
Accelerated Idioventricular Rhythm
Asystole
B - 13-1. PSST, Pass it on
B - 13-10. Defibrillate Immediately
B - 13-11. Torsade de Pointes
B - 13-12. Defibrillate Immediately
B - 13-13. Defibrillate Immediately
B - 13-14. Many Misbehaving Children
B - 13-15. Search Out the Cause
B - 13-16. A Case of Mistaken Identity
B - 13-2. Ask Questions First
B - 13-3. Cutting Through Terminology
B - 13-4. Mistreating the Heart
B - 13-5. When It's Less Severe
B - 13-6. When It's Symptomatic
B - 13-7. Revive the Higher Pacemakers
B - 13-8. A Misbehaving Child
B - 13-9. Reset the Pacemakers
Check Out the T-Wave - Premature Ventricular Contraction
Check the Wiring - Asystole
Coarse or Fine? - Ventricular Fibrillation
Coming Up Next
F - 13-1. QRS Complex Width Depends on Whether the Left and Right Ventr…
F - 13-10. Ventricular Flutter
F - 13-11. Ventricular Fibrillation
F - 13-12. Fine Ventricular Fibrillation
F - 13-13. Asystole
F - 13-14. Complete Asystole
F - 13-2. QRS Complex Size Depends on the Starting Location of Ventricu…
F - 13-3. Sinus Rhythm with Trigeminal PVCs
F - 13-4. A, Bigeminal Multifocal PVCs
F - 13-5. Idioventricular Rhythm
F - 13-6. Accelerated Idioventricular Rhythm
F - 13-7. Ventricular Bradycardia
F - 13-8. Ventricular Tachycardia
F - 13-9. Multifocal Ventricular Tachycardia
From Highways to Back Roads
From Highways to Back Roads - The Back Road
From Highways to Back Roads - The Usual Route
Going Nowhere at All: Pulseless Ventricular Tachycardia - Ventricular Tachycardia
Idioventricular Rhythm
In Revolt
Multifocal Ventricular Tachycardia
Now you Know
Premature Ventricular Contraction
P-Waves in Your PVCs - Premature Ventricular Contraction
T - 13-1. Criteria for Premature Ventricular Contraction
T - 13-10. Mnemonic for Causes of Asystole
T - 13-2. Criteria for Idioventricular Rhythm
T - 13-3. Criteria for Accelerated Idioventricular Rhythm
T - 13-4. Criteria for Ventricular Bradycardia
T - 13-5. Criteria for Ventricular Tachycardia
T - 13-6. Criteria for Multifocal Ventricular Tachycardia
T - 13-7. Criteria for Ventricular Flutter
T - 13-8. Criteria for Ventricular Fibrillation
T - 13-9. Criteria for Asystole
Test Yourself
The High End of Fast: Fast Ventricular Tachycardia - Ventricular Tachycardia
The Low End of Fast: Slow Ventricular Tachycardia - Ventricular Tachycardia
Treating Low Cardiac Output
Treating Low Cardiac Output - Picking Up the Pace
Treating Low Cardiac Output - Picking Up the Pace Cautiously
Treating Premature Ventricular Contraction - Premature Ventricular Contraction
Ventricular Bradycardia
Ventricular Fibrillation
Ventricular Flutter
Ventricular Rhythms
Ventricular Tachycardia
When Everything Stops - Asystole
Why is This Patient Breathing? - Ventricular Fibrillation
Why Use the Back Roads?
Wide and Bizarre - Premature Ventricular Contraction
Yelling, Kicking, and Screaming - Ventricular Tachycardia
Section 4. Contemplating Conduction
14. The Mental Block of AV Blocks
A Matter of Degree
B - 14-1. Boxing to the First Degree
B - 14-2. Boxing to the Second Degree
B - 14-3. Weight Lifting to the Second Degree
B - 14-4. Boxing to the Second Degree Type II
B - 14-5. Boxing to the Last Degree
B - 14-6. Rare and Dangerous
B - 14-7. Avoid Antiarrhythmics
Coming Up Next
Dissolving the Mental Block
F - 14-1. The Conduction System
F - 14-2. Sinus Rhythm with 1° AVB
F - 14-3. In 2° AVB Type I, the P-Waves March out and the R to R I…
F - 14-4. In 2° AVB Type II
F - 14-5. In 3° AVB, the P-Waves and the R to R Interval are Regul…
F - 14-6. Sometimes the Regular P-Waves are Hidden and difficult to See
F - 14-7. High-Grade 2° AVB
First-Degree Block
Focus on the PR Interval - Dissolving the Mental Block
Now you Know
Second-Degree Block Type I (Wenckebach)
Second-Degree Block Type II (Classic Second-Degree)
Simple Yet Vital - Dissolving the Mental Block
T - 14-1. Types of Atrioventricular Block
Test Yourself
The Interpretation Tree
The Interpretation Tree - At Its Roots: the Underlying Questions
The Interpretation Tree - From the Top Down
The Mental Block of AV Blocks
The Tollbooth Revisited - Dissolving the Mental Block
Third-Degree Block
Third-Degree Block - Hide and Go Seek the P-Waves
Third-Degree Block - When Nothing Gets Through
Tollbooth Trouble
Tollbooth Trouble - Short But Critical
Tollbooth Trouble - What Caused the Tie-Up?
Treating AV Blocks
Treating AV Blocks - An Overall View
Treating AV Blocks - First-Degree Block
Treating AV Blocks - Second-Degree Block Type I
Treating AV Blocks - Second-Degree Block Type II
Treating AV Blocks - Third-Degree Block
15. Detours on the Intraventricular Highways
A Widening of the Ways - Landmarks on the Long Way Home
B - 15-1. PSST, Another Message….
B - 15-2. Racing Hearts
B - 15-3. First Look for V-Tach
B - 15-4. Create an Illusion
B - 15-5. Stable or Unstable?
B - 15-6. Out of the Stable
Back to the Rock Pile - Do the Valsalva
Coming Up Next
Contents Under Pressure - Do the Valsalva
Detours on the Intraventricular Highways
Do the Valsalva
F - 15-1. Bundle Branch Blocks Produce QRS Complexes that Last Longer T…
F - 15-2. Ventricular Conduction and the Resulting QRS Complexes
F - 15-3. In BBB Rhythms, the Direction of the T-Wave, Representing Rep…
F - 15-4. Supraventricular Tachycardia with a Bundle Branch Block
F - 15-5. The RR Configuration of the QRS is Known as Rabbit Ears
F - 15-6. A, Rabbit Ears, with the First Peak of the QRS Higher Than th…
F - 15-7. Supraventricular Tachycardia with a Bundle Branch Block
Fast, Faster, Fastest - Landmarks on the Long Way Home
Frustration on the Highway
Frustration on the Highway - A Road Crew
Frustration on the Highway - Broken Branches
If It's Yellow, Waddles, and Quacks, It's Probably V-Tach
Landmarks on the Long Way Home
Now you Know
Power to the P-Wave - Landmarks on the Long Way Home
QRS Complexes in Accord
T - 15-1. Ventricular Tachycardia or Supraventricular Tachycardia with Bundle Branch Block?
Tachycardias of the Fourth Kind
Tachycardias of the Fourth Kind - Does the QRS Stay in Shape?
Tachycardias of the Fourth Kind - Origin Unknown
Tachycardias of the Fourth Kind - Pulling a Rabbit Out of the ECG
Test Yourself
Section 5. Taking Advanced Lessons
16. Pacemakers: Keeping the Heart from Early Retirement
A Group of Letters - Decoding the Code
An Electronic Superhero
Another Crack at Percentages - I can Name that Pacemaker in Four Beats
B - 16-1. Why Listen?
B - 16-10. Is the Frequency Changing?
B - 16-2. Inhibited, But not for Long
B - 16-3. Go Clean Your Room!
B - 16-4. Another Cleaning Trigger
B - 16-5. Who Spiked the Strip?
B - 16-6. Don't Rush to Judgment
B - 16-7. Watering the Lawn
B - 16-8. How Often does it Fail?
B - 16-9. Restore the Heart Rate
Challenge Your Descriptive Powers - I can Name that Pacemaker in Four Beats
Coming Up Next
Decoding the Code
Down-to-Earth Modes - Lead by Example
Dual-Chamber Pacemakers - Lead by Example
F - 16-1. A Typical Permanent Pacemaker and its Lead Wires
F - 16-10. No Matter How the Atrial Signal is Generated, if it Reaches t…
F - 16-11. Atrial Flutter with Triggered Ventricular Pacing
F - 16-12. Failure to Fire
F - 16-13. Failure to Capture
F - 16-14. Undersensing
F - 16-15. Oversensing
F - 16-16. All the Pacemaker Malfunctions are Shown Side by Side for Eas…
F - 16-17. Sinus Rhythm with PACs
F - 16-18. 100% Atrial Pacing
F - 16-19. 100% Atrial Pacing with Bundle Branch Block
F - 16-2. Two ECG Strips Showing Paced Rhythms
F - 16-20. 100% AV Pacing
F - 16-21. In the First 6 Seconds of this Strip, Four of the Seven Beats…
F - 16-22. Atrial Fibrillation with 60% Ventricular Pacing
F - 16-3. The Pacemaker Wire Travels from the Pacemaker (Here in the Le…
F - 16-4. An ECG Strip Generated by a Pacemaker in VOO Mode
F - 16-5. An ECG Strip Generated by a Pacemaker in VVI Mode
F - 16-6. An ECG Strip Generated by a Pacemaker in AAI Mode
F - 16-7. An ECG Strip Generated by a Pacemaker in DDD Mode
F - 16-8. These Four Strips Were Recorded at Different Times from the S…
F - 16-9. This Rhythm Changes from Single- to Dual-Chamber Pacing
Failure to Capture - Recognizing Trouble
Failure to Fire - Recognizing Trouble
I can Name that Pacemaker in Four Beats
Keep the Battery Juiced - I can Name that Pacemaker in Four Beats
Lead by Example
Now you Know
Oversensing - Recognizing Trouble
Pacemakers: Keeping the Heart from Early Retirement
Recognizing Trouble
Test Yourself
The Basic Four - Recognizing Trouble
Think Like a Pacemaker
Think Like a Pacemaker - An Internal Clock
Think Like a Pacemaker - Keeping Up the Pace
Think Like a Pacemaker - More Math Again
Think Like a Pacemaker - The Sensitive Side of Pacemakers
Types of Pacemakers
Types of Pacemakers - Two Basic Flavors
Undersensing - Recognizing Trouble
Unreal Modes - Lead by Example
What the Letters Mean - Decoding the Code
Would Somebody Help Me Here?
17. Some Artifacts Aren't Rare or Valuable
… And How it Interferes - Under the Influence
60-Cycle Interference. . . - Under the Influence
B - 17-1. Weed Out the Static
B - 17-2. Rule Out Dysrhythmia
B - 17-3. Activity, No Pulse
B - 17-4. Sleeping Through the Alarm
B - 17-5. A Special Arrangement of Electrons
B - 17-6. Run a Patch Check
B - 17-7. The Invisible Spike
B - 17-8. Turn Off the Setting
Baseline Sway - Check Your Patient
Cardiac Compression - Under the Influence
Check Your Patient
Coming Up Next
F - 17-1. Sinus Rhythm with Somatic Artifact, Sometimes Called 'Toothbr'
F - 17-10. Pacemaker Artifact
F - 17-11. Pacemaker Artifact
F - 17-2. Atrial Fibrillation with Somatic Artifact, Mimicking V-Tach
F - 17-3. The 'Cure' for Somatic Artifact is to Relocate the Affected P…
F - 17-4. The Top Tracing Shows Respiratory Artifact Caused by the Ches…
F - 17-5. Respiratory Baseline Sway
F - 17-6. A Sinus Rhythm Tracing with 60-Cycle Interference
F - 17-7. Three Common Rhythms with 60-Cycle Interference
F - 17-8. Chest Compression Artifact, Occurring at a Rate Slightly Slow…
F - 17-9. Loose Lead Artifact
Know What You're Dealing with
Large-Muscle Artifact - Check Your Patient
Now you Know
Pulseless Electrical Activity - Check Your Patient
Snow in Your House
Some Artifacts Aren't Rare or Valuable
Test Yourself
The Ghost in the Machine
The Ghost in the Machine - … Gone Bad
The Ghost in the Machine - Good Artifact…
The Ghost in the Machine - Loose Leads Sink Strips
Under the Influence
18. Timing Really is Everything
A Rule of Thumb - Measuring the QT Interval
An Ill-Timed Spike - Pacemakers and the QT Interval
B - 18-1. Congenital Long QT Syndrome
B - 18-2. Ready or not, Here it Comes
B - 18-3. Waiting at a Red Light
B - 18-4. All Together Now
B - 18-5. Stacking the Odds
Cardioversion: a Synchronized Shock - Shocking News on the QT
Coming Up Next
Defibrillation or Cardioversion? - Shocking News on the QT
Defibrillation: No Time to Lose - Shocking News on the QT
F - 18-1. The QT Interval is Measured from the Beginning of the QRS Com…
F - 18-10. Equipment Typically Used in Cardioversion, Both Unsynchronize…
F - 18-11. Defibrillation Artifact
F - 18-12. Two Different Types of Markers for Identifying the QRS in Syn…
F - 18-2. Despite Identical Heart Rates, the QT Intervals Vary
F - 18-3. The 6th QRS Complex is Premature and Falls on the T-Wave
F - 18-4. The Absolute Refractory Period Encompasses the QRS Complex an…
F - 18-5. A, the Ventricles are Partially Repolarized (Pink Areas) Unti…
F - 18-6. Depolarization from AV Node and Pacemaker Stimuli
F - 18-7. Pacemaker Rhythm with Fusion Beats
F - 18-8. Pseudo-Fusion Beats
F - 18-9. The 5th Beat in this Strip, Which Shows a Dual-Chamber Pacema…
Fusion Beats - Pacemakers and the QT Interval
Measuring the QT Interval
Now you Know
Pacemakers and the QT Interval
Pseudo-Fusion Beats - Pacemakers and the QT Interval
Pseudo-Pseudo-Fusion Beats - Pacemakers and the QT Interval
Shocking News on the QT
Test Yourself
This is Your QT on Drugs - Measuring the QT Interval
Timing Really is Everything
Too Long a Rest
Too Long a Rest - R on T Phenomenon
Too Long a Rest - The Relativity of Readiness
What's a QT Interval?
19. Are there Really Three I's in MI?
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A Typical Permanent Pacemaker and its Lead Wires - Figure 16-1
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