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Electrocardiography for the Family Physician:
The Essentials 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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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 |