Table Of Content12-LEAD EKG CONFIDENCE
Second Edition
About the Authors
Jacqueline M. Green, MS, RN, APN-C, CNS, CCRN
Jacqueline Green received her BS in Nursing from Kean University. She
attended Rutgers University where she received an MS in Nursing. She is
presently a Clinical Nurse Specialist–Cardiac Services at Robert Wood John-
son University Hospital in New Brunswick NJ.
Anthony J. Chiaramida, MD, FACC
Dr. Chiaramida received his BS in Chemistry from Fordham University.
He attended the University of Southern California School of Medicine, where
he graduated with honors as a member of AOA. He completed his internship
and residency at Cornell Cooperating Hospitals (North Shore–Memorial Sloan
Kettering). He completed his training in Cardiology at Emory University and
is a Fellow of the American College of Physicians and the American College
of Cardiology. Since completing his studies in Cardiology at Emory Univer-
sity, he has taught the monthly fourth-year medical student EKG elective to
Robert Wood Johnson Medical School students. He makes teaching rounds
daily in the CCU and ICU with students, nurses, respiratory therapists, dieti-
cians, interns, and residents.
12-LEAD EKG CONFIDENCE
A Step-by-Step Guide
Second Edition
Jacqueline M. Green,
MS, RN, APN-C, CNS, CCRN
Anthony J. Chiaramida,
MD, FACC
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Ebook ISBN: 978-0-8261-0473-1
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Library of Congress Cataloging-in-Publication Data
Green, Jacqueline M.
12-lead EKG confidence : a step-by-step guide / Jacqueline M. Green, Anthony J.
Chiaramida. — 2nd ed.
p. ; cm.
Includes index.
ISBN 978-0-8261-0472-4
1. Electrocardiography. I. Chiaramida, Anthony J. II. Title. III. Title: Tweleve-lead
EKG confidence.
[DNLM: 1. Electrocardiography—methods—Programmed Instruction. WG 18.2 G796z
2009]
RC683.5.E5.G685 2009
616.1'207547—dc22 2009028242
Printed in the United States of America by Bang Printing.
The authors and the publisher of this Work have made every effort to use sources believed
to be reliable to provide information that is accurate and compatible with the standards
generally accepted at the time of publication. Because medical science is continually
advancing, our knowledge base continues to expand. Therefore, as new information be-
comes available, changes in procedures become necessary. We recommend that the reader
always consult current research and specific institutional policies before performing any
clinical procedure. The authors and publisher shall not be liable for any special, consequen-
tial, or exemplary damages resulting, in whole or in part, from the readers’ use of, or re-
liance on, the information contained in this book. The publisher has no responsibility for
the persistence or accuracy of URLs for external or third-party Internet Web sites referred
to in this publication and does not guarantee that any content on such Web sites is, or will
remain, accurate or appropriate
To my children, Caroline and Conor, with Love always . . .
And to you Phil,
who encouraged me, read every paper I ever wrote, and
who sacrificed the most . . . Thank You
—J.G.
To my mom, who taught me how. And to my dad, who taught me why . . .
and to my children, Jennifer, Joseph, and Matthew,
who teach me anything else that really matters.
—A.C.
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CONTENTS
Preface xi
Acknowledgments xiii
Need and Use xv
12 Critical Concepts xvii
Section I: Overview of Heart Function and the EKG
CHAPTER 1 Anatomy Review of the Human Heart 3
CHAPTER 2 Physiology Review of the Heart’s Conduction System 17
CHAPTER 3 Basics of the 12-Lead EKG 23
Section II: Methodology: Measurements and Their Clinical Significance
CHAPTER 4 Heart Rate 33
Worksheets 44
CHAPTER 5 The PR, QRS, and QT Intervals 49
Worksheets 68
CHAPTER 6 Axis—The Science of Direction 73
Worksheets 114
SECTION II Worksheets 118
Section III: Common Clinical Arrhythmias
CHAPTER 7 Atrial Arrhythmias 125
Worksheets 130
CHAPTER 8 Ventricular Arrhythmias 133
Worksheets 138
CHAPTER 9 Junctional Rhythm, Heart Block, and Pacemakers 143
Worksheets 152
SECTION III Worksheets 154
vii
viii Contents
Section IV: EKG Changes Related to Conduction Abnormalities
CHAPTER 10 Hemiblock 165
Worksheets 174
CHAPTER 11 Right Bundle Branch Block 179
Worksheets 190
CHAPTER 12 Left Bundle Branch Block 195
Worksheets 208
SECTION IV Worksheets 212
Section V: The Ischemic Disorders: EKG Changes Related to Ischemia
and Myocardial Infarction (MI)
CHAPTER 13 The Partially-Occluded Artery: Angina and Non-ST Elevation MI 219
Worksheets 239
CHAPTER 14 The Totally Occluded Artery: ST Elevation MI 243
Worksheets 260
CHAPTER 15 Prolonged Arterial Occlusion: Q Waves and Equivalents 265
Worksheets 281
SECTION V Worksheets 285
Section VI: The Non-Ischemic Disorders: EKG Changes Related
to Hypertrophy
CHAPTER 16 Atrial Abnormalities 293
Worksheets 301
CHAPTER 17 Left Ventricular Hypertrophy 305
Worksheets 319
CHAPTER 18 Right Ventricular Hypertrophy 323
Worksheets 334
SECTION VI Worksheets 338
Contents ix
Section VII: The Non-Ischemic Disorders: EKG Changes Related to Drugs,
Electrolyte Abnormalities, and Other Diseases
CHAPTER 19 Drug and Electrolyte Effects 345
Worksheets 360
CHAPTER 20 Clinical Conditions That Affect the EKG 365
Worksheets 387
SECTION VII Worksheets 391
Section VIII: Self-Assessment
SECTION VIII Worksheets 399
Answers to EKG Worksheets 409
Index 417
