Podrid’s Real-World ECGs : A Master’s Approach to the Art and Practice of Clinical ECG Interpretation - Volume 3 - Conduction Abnormalities

491 Pages·2013·81.941 MB·English

by  Philip Podrid, MD, Rajeev Malhotra, MD, MS, Rahul Kakkar, MD, Peter A. Noseworthy, MD

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Podrtd's Real-World ECGs
A Master's Approach to the Art and Practice of Clinical ECG Interpretation
Volume3
Podrid's Real-World ECGs
A Master's Approach to the Art and Practice of Clinical ECG Interpretation
Volume3
Philip Podrld, MD Rahul Kakkar, MD
Professor ofM edicine Cardiology Fellow
Professor ofP harmacology and Experimental Therapeutics Massachusetts General Hospital
Boston University School of Medicine Harvard Medical School
Lecturer in Medicine Boston, Massachusetts
Harvard Medical School
Boston, Massachusetts Peter A. Noseworthy, MD
Attending Physician Cardiology Fellow
West Roxbury VA Hospital Massachusetts General Hospital
West Roxbury, Massachusetts Harvard Medical School
Boston, Massachusetts
Rajeev Malhotra, MD, MS
Instructor in Medicine
Cardiology Division
IJ
Massachusetts General Hospital
cardiotext.
Harvard Medical School
Boston, Massachusetts PUBLISHING
Minneapolis, Minnesota
C 2013 Philip Podxid, Rajeev Malhotra, Rahul Kakkar, and Pete:r A. Nooeworthy Due to ongoing research, discoveries, modific:ationa to medicines, equipment and
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This book is intended for educational purposea and to further general scientific attd Cover design by Caitlin Crouchet Altobell attd Elizabeth Edwards;
medical knowledge, research, and understanding of the conditions and aosociated inte:rior deoign by Eliaabeth Edwards
treatments discussed herein. This book is not intended to serve as and should not be
relied upon as recommending or promoting any specifk diagnosis or method of treatment Library of Congren Control Number: 201394.96"5
for a particular condition or a particular patient. It io the reader's reoponsibility to
ISBN: .978-1-.9353.95-01-0
determine the proper steps for diagnosis and the proper oourse of treatment for any
condition or patient, including suitable and appropriate teats, medications or medical Printed in the United States of America
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These workbooks are dedicated first to my wife Vivian and son joshua, whose
patience, tolerance, support, and love over the years have been limitless, exceptional,
and inspirational. They are also dedicated to the many cardiology fellows, house staff,
and medical students whom I have had the pleasure and honor of teaching over the
past three decades and who have also taught me so very much.
Philip Padrid
To my wife Cindy and daughter Sapna, for all their love, support, and encouragement.
Rsjeev Malhotra
To my darling daughters, Mia and Eila, whom I love to infinity.
Rahul Kakkar
For Katie and Jack
Peter A. Noseworthy
v

Contents
Foreword
by Roman W. DeSanctis, MD ................................................. ix
Foreword
by Hein J. Wellens, MD ......................................................... II
Preface ................................................................................... xlll
Introduction
Conduction Abnormalities ....................................................... 1
Real-World ECGs: The Cases
Core ECGs: 1-56 ................................................................... 15
Practice ECGs: 57-101 ........................................................ 275
Index ..................................................................................... 479
vii

Foreword
The invention of the electrocardiogram (ECG) by Dr. Willem Einthoven, purposes, and it is a portion of his incredible collection that has been
first reported in 1901, ranks as one of the all-time great discoveries in used to spawn these books.
medicine. Einthoven's landmark achievement was duly recognized in There are scores of textbooks on electrocardiography, but what
1924, when he was awarded the Nobel Prize in Medicine. sets these volumes apart is that every ECG is tied directly to an actual
By the early 1940s, all of the components of the 12-lead ECG that clinical case. Each ECG is initially presented in a visually attrac
we use today were in place. When I finished my cardiology training tive and readable format accompanied by a clinical vignette. On the
50 years ago, the ECG was one of very few cardiodiagnostic tools next page, the salient features of the ECGs are highlighted, dissected,
available to us. As a result, we received an intensity of training in elec and discussed in meticulous detail, followed by a summary of the
trocardiography that is generally not encountered in many of today's patient's clinical problem and treatment, particularly as they relate to
cardiology fellowship programs, where the emphasis has shifted toward the ECG findings.
the newer high-tech diagnostic modalities. Yet the ECG remains a The first volume in this unique series covers electrocardiography
major pillar in the evaluation of disorders of the heart. In a patient with basics. It is followed by five more volumes covering the entire spectrum
a cardiac arrhythmia, what diagnostic information does the treating of electrocardiography: myocardial abnormalities, conduction abnor
physician want the most? Of course-the ECG. Although the medical malities, arrhythmias, narrow and wide complex tachycardias, and a
world progresses rapidly and changes constantly, the body of knowl sixth volume amalgamating a potpourri of paced rhythms, congenital
edge surrounding the ECG is virtually timeless. What was true 50 years abnormalities, and electrolyte disturbances. As I perused one of the
ago is largely true today, and will remain so 50 years from now. workbooks, I truly enjoyed the experience. It is fun to try to guess the
This wonderful series of ECG workbooks, appropriately entitled clinical problem from the ECG. In fact, on my teaching rounds, that
"Real-World ECGs," by Dr. Philip Podrid and three outstanding is often exactly what I do. I will ask the trainee to present first just
young cardiologists from Massachusetts General Hospital-Dr. Rajeev the ECG and with other trainees try to deduce from it what might be
Malhotra, Dr. Rahul Kakkar, and Dr. Peter Noseworthy-offen a going on clinically. For example, in an adult with marked left ventricu
splendid opportunity for self-education in electrocardiography (and lar hypertrophy and strain, one of three conditions is almost always
a bit of fun at the same time). An esteemed academic cardiologist, present: severe aortic valve disease, hypertrophic cardiomyopathy, or
Dr. Podrid has had a career-long interest in electrocardiography. Over hypertensive heart disease. continue•
many years he has collected and saved thousands of EC Gs for teaching
ix
Podrld's Real-World ECGs Conduction Abnormalities: Foreword
These books should prove to be valuable for the teaching and work that went into their preparation. Drs. Podrid, Malhotra, Kakkar,
learning of electrocardiography at all levels-from nursing and medi and Noseworthy should be justifiably proud of the final results of their
cal students to residents to cardiology fellows to practicing internists Herculean efforts. I am confident that other readers will find these
and cardiologists. They should be especially helpful for those seeking books and their electronic supplement as informative and enjoyable
board certification or recertification in cardiovascular diseases, where as I did.
knowledge of electrocardiography still is given a very high priority.
There is one further important dividend for those who utilize this Roman W. D~SanctU, MD
Physician and Director of Clinical Cardiology, Emeritus
series. In addition to the six workbooks, hundreds of other ECGs han
Massachusetts General Hospital
dled in a similar format are available online. From clinical diagnoses
to interactive questions to patient management, realworldECGs.com James and Evelyn J~nks and Paul Dudl~y White Professor of M~dicine
Harvard Medical School
offers ECG-centric clinical cases for the viewer to further master the
art of ECG interpretation.
Anyone who reads these books and views the auxiliary electronic
material cannot help but be impressed by the prodigious amount of
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