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ECGt MADE EASY, SIXTH EDITION ISBN: 978-0-32340130-2
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Notices
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m:rterial herein.
Name.: Aehlert, Barbara, author.
Title: ECGa made easy I Barbara Aehlert, MSEd, BSPA, RN.
Description: Sixth edition. I Phoenix, Arizona : Southwest EMS Education,
Inc., [2018liindudes blhllographical refuences and lnda. I
Identifiers: LCCN 2017015081 (print) I LCCN 2017026543 (ebook) I ISBN
9780323479059 () I ISBN 9780323401302 (pbk. : a1k. paper)
Subjecu: LCSH: Electrocardiography--Handboob. manuals. etc.
Cl.ulifi.c:ation: LCC RC683.5.F.5 (ebook) I LCC RC683.5.E5 A39 2018 (print) I
DDC 616.1/207547--dc23
LC record available at httpt:!/ka1loc.gov/2017015081
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Executive Contel!t Stmteglst: Sandra Clark
Content Developmettt SpeclalUU: Laura SeltlrtiMelissa. Kinsey
Publishing Semcu Manager. Deepthi Unni
SenWr Project MaMpr. Umarani Na1arajan
~ Dirmton: Brian Saliabury
Worktng together
to grow l!b -r.arLC'~ Li1
de•n:l oping: cnuntrm(:~
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Many ye.ars ago, as a green but enthusiastic nurse preparing to shift from medical-surgical nursing
to critical care, I signed up for a course in basic ECG recognition. It was an intimidating experi
ence. My i.nst:ructor was extremely knowledgeable and kind. and I studied diligently throughout
the course, yet I struggled to crack the code of heart rhythm interpretation. To make matters
worse, I couldn't find any resources in which these complex concepts were presented in a practi
cal, useful way. Although I passed the course. I decided to repeat it a few months later because I
simply coulchlt recall and apply the infonnation I needed to help my patients.
After successfully completing the second course, I promised myself that I would someday
present these concepts in a simpler way. 'Ihat promise became my life's work. Ever since then,
I have been looking for better ways in which to present the skill ofb asic ECG recognition to those
who will apply that knowledge every working day:
• Paramedics
• Nursing and medical students
• ECG monitor technicians
• Nurses and other allied health personnel world.ng in emergency departments, critical care
units, postanesthesia care units, operating rooms, and telemetry units
'!his book can be used alone or as part of a formal course of instruction in basic dysrhyth
mia recognition. 1he book'• content focuses on the essentials of ECG interpretation. Each ECG
rhythm is described and accompanied by a sample rhythm strip. 1hen the discussion turns to
possible signs and symptoms related to each rhythm and. where appropriate, current recom
mended treatment. At the end of each chapter, additional rhythm strips and their description.s are
provided for practice. (All rhythm strips shown in this text were recorded in lead n unless other
wise noted.) 1he Stop 8c Review exerci!es at the end of each chapter are self-usessment activities
that allow you to check your learning.
In addition, resources to aid the in.stru.ctor in teaching this content can be found on Evolve at
http://evolve.elsevier.com/Aehlert/ecgl. 1hese resources include:
• Image Collection
• PPTSlide.
• PPT Practice Slides
• TEACH2.4
• Test Bank
I have made every attempt to supply content consistent with current literature, including cur
rent resuscitation guidelines. However, medicine is a dynamic field. Recommendations change as
medical research evolves, technology improves, and new medications, procedures, and devices
are developed. As a result, be •ure to learn and follow local protocols as defined by your medi
cal advisors. Neither I nor the publisher can assume responsibility or liability for loss or damage
resulting from the use of information contained within.
I genuinely hope this book is helpful to you, and I wish you success in your studies and clinical
practice.
Best regards,
Barbara Aehlert
iii
I would like to thank the manuscript reviewers foc their commenb and suggestiom. Areu of this
text were rewritten, reorganized, and clarified because ofy our effom.
I would also like to thank the following health care professionals, who provided many of the
rhythm strips used in this book: Andrew Baird, CEP; James Bratcher; Joanna Burgan, CEP; Holly
Button, CEP; Gretchen Chalmers, CEP; 'Ihomas Cole, CEP; Brent Haines, CEP; Paul Honeywell,
CEP; Timothy Klatt. RN; Bill Loughran. RN; Andrea Lowrey, RN; Joe Martinez, CEP; St.ephanos
Orphanidis, CEP; Jason Payne, CEP; Steve Ruehs, CEP; Patty Seneski, RN; David Stockton, CEP;
Jason Stodghill, CEP; Dionne Socie, CEP; Kristina Tellez, CEP; and Fran Wojculewicz, RN.
A special thanks to Melissa Kinsey for her humor, guidance, advice, and impeccable attention
to detail throughout this project.
iv
To
Deepak C. Patel, MD
whose knowledge, humor, and genuine compassion for his
patients are unparalleled.
Krlaten Bon:IWt, llN, MSN, PNP, Nll-P, CPN BiB Miller
Care Coordinator Paramedic Crew Chief
Cincinnati Childrms Hospital Medical Center St. Louis Fire Department-HEMS
Cincinnati, Ohio St. Louis, Missouri
Joshua BorkoU:.y, BS, pp.c Mark.Nootena, MD, PACC
EMS Education Manager Cardiologist. Private Practice
University of Cincinnati College of Medicine Munster, Indiana
Cincinnati, Ohio
Ruth C. Tamulonis, MS, RN
Angela McConachie, DNP, MSN-PNP, RN Nursing Professor
Assistant Professor Yuba College
Goldfarb School ofNursing at Barnes-Jewish College Marysville, California
St Louis, Missouri
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Barbara Aehlert, MSBd, BSPA, RN, has been a registered nurse for more than 40 years. with
clinical experience in medicallsurgical nursing. critical care nursing, prehotpital education, and
nursing education. Barbara i.s an active CPR and Advanced Cardiovascular Life Support (ACLS)
instructor with a special interest in teaching basic dysrhythmia recognition and ACLS to nurses
and paramedics.
vii
1 ANATOMY AND PHYSIOLOGY, 1 3 SINUS MECHANISMS, 78
Location. SJu, and Shape oft he Heart. 2 Introdudlon. 76
Surfaca oft he Heart. 2 Sinua Rhythm, 77
Coverinp of the Heart, 2 How Do I Recognize It? 77
Structure oft he Heart, 5 Sinua Bradycardia. 78
Layers oft he Heart WalL 5 How Do I Recognize It? 78
Heart Chambers, 6 What Causes m 78
Heart Valves, 8 What Do I Do About It? 79
The Heart's Blood Supply, 11 Sinua Tadlyardia, 80
The Heart's Nerve Supply, 16 How Do I Recognize It? 80
The Heart aa a Pump, 19 What Causes It? 80
Cardiac Cycle, 19 What Do I Do About It? 81
Blood PreS3Ul't, 20 Sinua Arrbytbmia, 81
R£ferenca, '1.7 How Do I Recognize It? 81
What Causes It! 81
What Do I Do About It? 82
2 BASIC ELECTROPHYSIOLOGY, 28 Sinoatrial Block. 82
How Do I Recognize It? 82
Cardiac Cella, 30 What Causes It? 82
Types of Cardiac Cells, 30 What Do I Do About It? 83
Propertia of Cardiac Cells, 30 Sinua Arrest, 83
Cardiac Action Potmtial, 30 How Do I Recognize It? 83
Polarization, 31 What Causes It? 83
Depolarization, 31 What Do I Do About It? 84
Repolarization, 32 Referencea,IOI
Phases of the Cardiac Action Potential, 32
Refractory Periods, 34
Conduction Syatem, 35 4 ATRIAL RHYTHMS, 102
Sinoatrial Node, 35
Atrioventricular Node and Bundle, 37 Introduction, 103
Right and Left Bundle Branches, 38 Atrial Dyar.bythmiaa: Mech.aDi~ms, 103
Purkinje Fibers, 38 Abnormal Automaticity, 103
Cauaea of Dyarhythmiaa, 39 Tnggered Activity, 103
Disorders of Impulse Formation, 39 Reentry, 104
Disorders of Impulse Conduction, 39 Premature Atrial Compleea, 104
The Ela:trocardiogr, 41 How Do I Recognize It? 104
Electrodes, 41 Noncompensatory versus Compensatory Pause, 105
Leads,42 Aberrantly Conducted Premature Atrial
Ambulatory Cardiac Monitoring, 46 Complexes, 106
Blectrocanliopaphy Paper, 47 Nonconducted Premature Atrial Complexes, 106
Waveforms, 48 What Do I Do About Them? 107
Segments, 53 Wuuleriq Atrial Pacemaker, 107
Intervals, 55 How Do I Recognize It? 107
Artifact. 56 What Causes It? 107
Symmatic Rhythm J:nterpretation. 57 What Do I Do About It? 107
Asseas Regularity, 57 Mal.tifoc:al Atrial Tachycanlia, 108
Asseas Rate, 58 How Do I Recognize It? 108
Identify and Examine Waveforms, 60 What Causes It? 108
Asseaslntervals and Examine Segments, 60 What Do I Do About It? 108
Interpret the Rhythm, 60
Re&renca, 74
viii
