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Electrocardiography for the
Family Physician
The Essentials
H. Thomas Milhorn, MD, PhD
The
electrocardiogram can serve as an independent identifier of myocardial
disease or reflect anatomic, metabolic, hemodynamic, or
electrophysiological alterations in the heart. It can provide information
that is often essential for the proper diagnosis and therapy of a variety
of disorders and is without equal as a method for diagnosing cardiac
arrhythmias. It is the procedure of choice for patients who present with
chest pain, dizziness, syncope, or symptoms that may indicate risk of
myocardial infarction or sudden death.
Family physicians are often the first, and sometimes the
only, point of contact for many patients within the health care system.
The standard 12-lead electrocardiogram is one of the most common tests
obtained and interpreted by the family physician, with most of the
physicians reading their own recordings and basing clinical decisions on
their findings. It has been shown that family physicians can achieve
proficiency in the interpretation of over 95 percent of all
electrocardiogram findings seen in the primary care setting.
Although computerized interpretation is widely available,
it is considered unreliable in up to 20 percent of the cases, making
competency and interpretation by family physicians an essential skill.
This book provides the necessary skills for family physicians to use in
interpreting electrocardiograms, both in their offices and in the
emergency rooms of their hospitals. It also should prove of value to other
primary care physicians, as well as medical students and residents of
nearly all medical specialties.
As the subtitle states, this book is about the essential
elements involved in electrocardiographic interpretation. It is not all
inclusive; however, it does cover the abnormalities most likely to be seen
by family physicians in their everyday practice of medicine.
This book is an outgrowth of a course I taught in the
Department of Family Medicine at the University of Mississippi School of
Medicine and five articles titled Electrocardiography for the Family
Physician I subsequently published in Family Practice Recertification.
In short, this book is the one I wish I had access to
during the many years I actively practiced family medicine and when I was
a resident in family medicine.
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Contents
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Chapter 1. General Principles of Electrophysiology
Electrocardiograph Interpretation
Electrocardiograph Paper
Conduction System of the Heart
Parts of the Electrocardiogram
Deflections
Intervals
Segments
ST-T Complex
J Point
Chapter 2. Leads and normal
electrocardiogram
Leads
The Limb Leads
The Chest Leads
Lead Combinations
The Normal EKG
Mean Electrical Activity
Criteria
Chapter 3. Heart Rate and Axis
Heart Rate
Axis
Right Axis Deviation
Left Axis Deviation
Northwest Axis
Determining the Axis of the Mean
Vector
Chapter 4. Atrial Enlargement and
Ventricular Hypertrophy
Atrial Enlargement
Right Atrial Enlargement
Left Atrial Enlargement
Biatrial Enlargement
Ventricular Hypertrophy
Right Ventricular Hypertrophy
Left Ventricular Hypertrophy
Ventricular Overload (Strain)
Biventricular Hypertrophy
Chapter 5. Intraventricular
Conduction Disturbances
Right Bundle Branch Block
Left Bundle Branch Block
Incomplete Bundle Branch Block
Hemiblocks
Bifascicular Block
Nonspecific Intraventricular Conduction Defects
Chapter 6. Myocardial Ischemia, Myocardial Infarction, and
Pseudoinfarction Syndromes
Myocardial Ischemia
Classic Angina
Other Causes of ST Segment Depression
Prinzmetal’s Angina
Other Causes of ST Segment Elevation
Myocardial Infarction
Transmural Myocardial Infarction
Subendocardial Infarction
Pseudoinfarction Syndromes |
Chapter 7. Rhythm Disturbances
Normal Sinus Rhythm
Sinus Arrhythmias
Sinus Tachycardia
Sinus Bradycardia
Sinoatrial Block
Sick Sinus Syndrome
Non-sinus Atrial Arrhythmias
Premature Atrial Contraction
Paroxysmal Atrial Tachycardia
Multifocal Atrial Tachycardia
Atrial Flutter
Atrial Fibrillation
Junctional Rhythms
Premature Junctional Contraction
Junctional Tachycardia
Junctional Escape Rhythm
Junctional Escape Rhythm
Ventricular Rhythm Disturbances
Premature Ventricular Contractions
Ventricular Tachycardia
Ventricular Fibrillation
Idioventricular Rhythm
Supraventricular Beat with Aberrancy
Atrioventricular Heart Block
First-degree Heart Block
Second-degree Heart Block
Third-degree Heart Block
Bigeminy
Chapter 8.
Preexcitation Syndromes, Early Repolarization, Pulmonary Embolus, and
Pericarditis
Preexcitation Syndromes
Wolff-Parkinson-White Syndrome
Lown-Ganong-Levine syndrome
Early Repolarization
Pulmonary Embolus
Pericarditis
Stages of Pericarditis
Acute Pericarditis versus Myocardial Infarction
versus Early Repolarization
Chapter 9. Athletic Heart Syndrome, Ventricular Pacemaker, Drug
Effects, Electrolyte Effects, EKG
Worksheet, and Practice EKG
Athletic Heart Syndrome
Ventricular Pacemaker
Drug Effects
Digitalis
Quinidine
Electrolyte Effects
Potassium
Calcium
EKG Worksheet
Practice EKG
Appendix: A Quick
Review of Electrocardiography
Index |
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