Table Of Content-120° -90° -60° V1 I, V6 AMI I II III aVR aVLaVF V1 V2 V3 V4 V5 V6
a-1V5R0° IND LAD a-3V0°L RBBB rSR′ qRS Septal
(>.12 sec) Anterior (Loc.)
IV I
LBBB rS/QS R
180° 0° I (>.12 sec) Lateral
I, III Axis
III II Ext. Anterior
+150° DAR LAMRON +30° (L<.A10F seBc) q1r3 >–30° Inferior
+1II2I0° +90° +6I0I° LPFB q3r1 >+120° Posterior
aVF (<.10 sec)
Contents
1 ANATOMY AND PHYSIOLOGY OF 14 PACEMAKER AND IMPLANTABLE
THE HEART 1 DEFIBRILLATOR RHYTHMS 226
2 THE ELECTROCARDIOGRAM: BASIC 15 OTHER ASSORTED ECG FINDINGS 236
COMPONENTS AND LEAD MONITORING 17
16 ACUTE CORONARY SYNDROME—
3 COMPONENTS OF THE PATHOPHYSIOLOGY 257
ELECTROCARDIOGRAM 27
17 DIAGNOSTIC ECG CHANGES IN SPECIFIC
4 EIGHT STEPS TO ECG INTERPRETATION MYOCARDIAL INFARCTIONS 283
AND ANALYSIS 53
18 SIGNS, SYMPTOMS, AND DIAGNOSIS OF
5 SINUS NODE DYSRHYTHMIAS 79 ACUTE CORONARY SYNDROMES 307
6 ATRIAL DYSRHYTHMIAS 90 19 MANAGEMENT OF ACUTE CORONARY
SYNDROMES 321
7 JUNCTIONAL DYSRHYTHMIAS 106
Appendix A: Methods of Determining the
8 VENTRICULAR DYSRHYTHMIAS 117 QRS Axis 337
9 ATRIOVENTRICULAR BLOCKS 135 Appendix B: Chapter Review Answer Keys 350
10 CLINICAL SIGNIFICANCE AND Appendix C: Dysrhythmia Interpretation:
TREATMENT OF DYSRHYTHMIAS 148 Self-Assessment 359
11 THE 12-LEAD ELECTROCARDIOGRAM 180 Appendix D: Self-Assessment Answer Keys 427
12 ELECTRICAL AXES AND VECTORS 191 Glossary 445
13 BUNDLE BRANCH AND FASCICULAR Index 447
BLOCKS 207
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Keith Wesley, MD
Medical Director
HealthEast Medical Transportation
St. Paul, Minnesota
Medical Director
United EMS
Wisconsin Rapids, Wisconsin
Medical Director
Chippewa Fire District
Chippewa Falls, Wisconsin
3251 Riverport Lane
St. Louis, Missouri 63043
HUSZAR’S BASIC DYSRHYTHMIAS: INTERPRETATION ISBN: 978-0-323-03974-1
AND MANAGEMENT, FOURTH EDITION
Copyright © 2011, 2007, 2002, 1998 by Mosby, Inc., an affi liate of Elsevier Inc.
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Th is book and the individual contributions contained in it are protected under copyright by the Publisher
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Notices
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our understanding, changes in research methods, professional practices, or medical treatment may become
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To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
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ISBN: 978-0-323-03974-1
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Dedication
Th is book is dedicated to my wife Karen and three sons JT,
Austin, and Camden.
Without your love, confi dence, and patience, I could not have
pursued my dream.
I love you.
It is with great gratitude and humility that I continue Dr.
Huszar’s legacy of this wonderful text.
Keith Wesley, MD
v
About the Author
Keith Wesley is a board-certifi ed emergency medicine physician In 2008, Dr. Wesley moved his practice to Minnesota when
living in Wisconsin. Originally from Tyler, Texas, he graduated he accepted the position as the Minnesota State EMS Medical
from Brigham Young University in 1982 and Baylor College of Director. He currently works for HealthEast Care Systems in
Medicine in Houston, Texas in 1986. He completed an Emerg- St. Paul, where he is the EMS Medical Director for HealthEast
ency Medicine Residency at Methodist Hospital in Indianapo- Medical Transportation.
lis, Indiana, where he gained his fi rst exposure to EMS fl ying Dr. Wesley is a former chair of the National Council of State
air medical missions. EMS Medical Directors and is active in the National Association
Dr. Wesley has been involved in EMS since 1989, working of EMS Physicians. Dr. Wesley has co-authored four textbooks
with many services in Wisconsin. In 1992, he was selected by and numerous articles and papers and is a frequent speaker at
the Governor as a founding member of the Wisconsin State state and national conferences. He is currently on the editorial
Physician Advisory Committee and served for 12 years, the board for JEMS magazine.
last 4 years as Chair. In 2006, Dr. Wesley was selected as the An active member of the American College of Emergency
Wisconsin State EMS Medical Director and continues to Physicians and the National Association of EMS Physicians,
provide medical oversight to several services throughout Dr. Wesley has been actively involved in the creation of educa-
Wisconsin. tional programs for medical and nursing students, EMTs, and
From 1992 to 2004, Dr. Wesley was a Clinical Assistant physicians.
Profe ssor, University of Wisconsin Family Practice Residency, When not engaged in EMS duties, Dr. Wesley enjoys sailing
Eau Claire, Wisconsin responsible for the training and education on Lake Superior with his wife Karen and spending time with
of family practice residents rotating through the emergency his three sons.
department. During the same period, Dr. Wesley was an ACLS
instructor overseeing the courses throughout south central
Wisconsin.
vi
Acknowledgments
First, I would like to thank the dedicated men and women of
my EMS services who provided me encouragement, criticism,
and reams of rhythms strips and 12 leads. Th ey include
HealthEast Medical Transportation, Chippewa Fire District,
Higgins Ambulance, and the EMT-Basic services of Ashland
and Bayfi eld Counties.
Next, I must acknowledge the successful foundation upon
which this book is based. Dr. Huszar expertly craft ed this text in
three previous editions. To be given the opportunity to carry on
where this great man left off is an honor.
Finally, no author can accomplish anything without an
editor. I have been most fortunate to have not one but two
excellent editors with Laura Bayless and Andrea Campbell.
Th ank you both for the encouragement to make this project a
success. Also, I’d like to thank Linda Honeycutt for giving me
this opportunity and her tireless support.
Keith Wesley, MD
vii
