Quick and accurate 12-lead ECG interpretation

488 Pages·2005·33.92 MB·English

by  Davis

Quick and Accurate
12-Lead ECG
Interpretation
DALE DAVIS,
RCT
Illustrated by Patrick Turner,
Leslie Foster-Roesler and
Deborah Lynam
Quick and Accurate(cid:3)
12-Lead ECG(cid:3)
Interpretation
Fourth Edition
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Fourth Edition
Copyright © 2005 by Lippincott Williams & Wilkins.
Copyright © 2001 by Lippincott Williams & Wilkins. Copyright © 1992, 1985 by J. B. Lippincott
Company. All rights reserved. This book is protected by copyright. No part of it may be
reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic,
mechanical, photocopy, recording, or otherwise—without prior written permission of the publisher,
except for brief quotations embodied in critical articles and reviews and testing and evaluation
materials provided by publisher to instructors whose schools have adopted its accompanying
textbook. Printed in the United States of America. For information write Lippincott Williams &
Wilkins, 530 Walnut Street, Philadelphia, PA 19106.
Materials appearing in this book prepared by individuals as part of their official duties as U.S.
Government employees are not covered by the above-mentioned copyright.
9  8  7  6  5  4  3  2  1
Library of Congress Cataloging-in-Publication Data
Davis, Dale.
Quick and accurate 12-lead ECG interpretation / Dale Davis—4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-58255-379-3 (pbk. : alk. paper)
1. Electrocardiography—Interpretation.  2. Heart—Diseases—Diagnosis.  I. Title. [DNLM:  
1. Electrocardiography—methods—Handbooks.  2. Electrocardiography— methods—
Programmed Instruction.  3. Heart—Diseases—diagnosis—Handbooks.  4. Heart Diseases—
diagnosis—Programmed Instruction. WG 18.2 D261q  2004]
RC683.5.E5D33  2004
616.1(cid:0)207547—dc22
2004013921
Care has been taken to confirm the accuracy of the information presented and to describe
generally accepted practices. However, the authors, editors, and publisher are not responsible for
errors or omissions or for any consequences from application of the information in this book and
make no warranty, express or implied, with respect to the content of the publication.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and
dosage set forth in this text are in accordance with current recommendations and practice at the
time of publication. However, in view of ongoing research, changes in government regulations,
and the constant flow of information relating to drug therapy and drug reactions, the reader is
urged to check the package insert for each drug for any change in indications and dosage and
for added warnings and precautions. This is particularly important when the recommended agent
is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug
Administration (FDA) clearance for limited use in restricted research settings. It is the responsibil-
ity of the health care provider to ascertain the FDA status of each drug or device planned for use
in his or her clinical practice.
LWW.com
REVIEWERS
Elisabeth G. Bradley, RN, APN, CCRN
Clinical Nurse Specialist, Critical Care/Medical Cardiology
Christiana Care Health System
Christiana Hospital
Newark, Delaware
Ginger S. Braun, RN, MSN, CCRN
Cardiovascular Clinical Nurse Specialist
Hoag Hospital
Newport Beach, California
Janice M. Judy, RN, MSN
Instructor
University of Nebraska Medical Center, College of Nursing, West Nebraska
Division Scottsbluff, Nebraska
Marge Lantz
Assistant Director ICU/NICU/NSD
Hinsdale Hospital
Hinsdale, Illinois
Gayla P. Smith, RN, MS, CCRN
Cardiovascular Clinical Nurse Specialist
Hoag Hospital
Newport Beach, California
Nan Smith-Blair
Assistant Professor of Nursing
University of Arkansas
Fayetteville, Arkansas
v
PREFACE
Quick and Accurate 12-Lead ECG Interpretationis designed as an easy yet
comprehensive approach to basic ECG and arrhythmia interpretation. Its
easy-to-understand program can be used not only for quick and
comprehensive learning but also as a reference and a study guide.
Chapters 1 through 9 cover the fundamental knowledge necessary to
evaluate normal 12-lead ECGs. Chapters 10 though 13 cover the
specialized criteria necessary to interpret abnormal 12-lead ECGs.
Chapters 14 and 15 allow students to practice and sharpen their newly
acquired ECG interpretation skills. Chapter 16 is an introduction to basic
arrhythmia interpretation. New to this edition are the inclusion of 20 new
strips in Chapter 16 to help clarify arrhythmia interpretation even further and
the addition of Chapter 17. This new chapter allows the students to practice
their arrhythmia interpretation skills on 25 arrhythmia strips and check their
answers at the end of the chapter.
This book teaches students via a simply organized step-by-step process. It
includes easy-to-understand diagrams that enhance the text and assure
comprehension of the electrophysiology of normal and abnormal ECGs and
arrhythmias rather than just memorization of criteria. I have intentionally
chosen simplicity over exactness in some areas of the book in order to
make learning uncomplicated.
A summary of each ECG abnormality discussed in Chapters 10 to 13 is pre-
sented in a two-page display toward the end of these chapters and is
divided into three parts:
1. A diagram of the heart demonstrates the ECG abnormality, with the
ECG leads necessary for examination placed around the heart in their
correct positions.
2. Criteria necessary for recognition of the abnormality are listed directly
below the heart diagram.
3. A 12-lead ECG that is representative of the ECG abnormality is
displayed on the opposite page, with the previously designated leads
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observed around the heart diagram and in the criteria section tinted in
blue for final correlation.
Practice ECGs with answers comprising interpretations that relate only to
the topic discussed in the chapter are included at the end of each ECG
abnormality chapter. These ECGs are designed to reinforce the one
concept just learned, without students having to concern themselves with
other abnormalities.
Chapter 14 is devoted to differential diagnosis and presents an easy and
organized step-by-step guide to ECG interpretation. The criteria for the
ECG abnormalities are examined individually and compared with one
another to demonstrate possible identification problems and to give sugges-
tions and hints for easier solutions. The most common interpretation pitfalls
are discussed and demonstrated.
Chapter 15 comprises ECGs and answers consisting of interpretations of
assorted abnormalities. These are to be interpreted by students after
completing the book since they will now be able to make differential
diagnoses using all the knowledge gained.
Chapter 16 is an introduction to basic arrhythmias rather than an exhaustive
study of the subject. Each arrhythmia is presented with a list of criteria for
recognition, a diagram of the electrical conduction system with the
respective abnormality depicted, and numerous representations of the
arrhythmia. New to this edition are additional arrhythmia strips that
are identified and labeled to aid the student in becoming familiar with the
abnormality.
For the fourth edition, Chapter 17 has been added. This chapter adds
twenty-five practice arrhythmia strips with answers at the end of the chap-
ter. This addition will allow students to test their newly gained arrhythmia
interpretative skills.
Quick and Accurate 12-Lead ECG Interpretationis directed toward students
in the allied health, nursing, or medical fields who desire the ability to
interpret both routine and abnormal ECGs and to be able to assess and
accurately interpret arrhythmias. Reading the text and interpreting the
ECGs at the end of Chapter 15 will enable readers both to interpret ECGs
skillfully and rapidly and to understand the electrophysiology of normal and
abnormal ECG patterns. Reading Chapter 16 will allow students to interpret
arrhythmia strips and also understand the electrophysiology behind each
arrhythmia. Chapter 17 will enable students to hone their skills and check
the accuracy of their interpretation.
PREFACE
viii
The intention and scope of this fourth edition are unchanged from previous
editions; simplicity and an organized interpretive method remain the central
themes. I am most appreciative of the positive response to this book, and I
hope that the changes and the addition of additional arrhythmia strips will
make learning easier and more effective.
Dale Davis
PREFACE
ix
ACKNOWLEDGMENTS
It’s hard to believe that I’m on my fourth edition of Quick and Accurate
12-Lead ECG Interpretation,almost 10 years after the book first was
published. I am grateful to my publisher, Lippincott Williams & Wilkins, for
allowing me great freedom both in the layout of this book and in the
reproduction of the ECG strips. My thanks to Lisa A. Biello, my first editor,
for her enthusiasm and encouragement she gave me in producing my first
book. Many thanks to my illustrator, Patrick Turner, for his creativity and for
his patience with my often-confusing instructions. And thanks to my current
editor, Patricia Casey, for her help with this fourth edition.
I received assistance with my interpretive skills from the medical staff at
Morristown Memorial Hospital, Morristown, New Jersey. I want to
specifically thank Doctors Stelio Mangiola, Joel Cannila, Larry Lubow,
Charles Shioleno, and Arthur Geller. Each of these physicians took the time
to help me acquire the interpretive skills I have today.
I could not have produced this book without help from the staff of the
Cardiac Department at Morristown Hospital and the Cardio-Pulmonary
Department at Wilcox Memorial Hospital in Kauai, Hawaii, where I now live.
They took the time to collect many ECGs and arrhythmia strips for me to
choose from to include in my books.
xi
CONTENTS
1 WHAT IS AN ELECTROCARDIOGRAM? 1
Standard Leads 3
Augmented Leads 5
Precordial Leads 6
2 CARDIAC CELLS 9
Depolarization and Repolarization 10
Electrophysiologic Properties of a Cardiac Cell 11
3 ANATOMY OF THE HEART AND THE ELECTRICAL
CONDUCTION SYSTEM 13
Anatomy 14
Electrical Conduction System 17
4 PQRSTU WAVES, COMPLEXES, INTERVALS, AND
SEGMENTS 23
Waves and Complexes 24
Intervals and Segments 26
Kinds of QRS Complexes 28
5 ECG GRAPH PAPER AND MEASUREMENTS 31
Time and Voltage 32
Measurements 35
6 DETERMINATION OF HEART RATE AND NORMAL HEART
RHYTHMS 37
Determination of Heart Rate 38
Practice ECGs 43
Answers for Practice ECGs 53
7 NORMAL 12-LEAD ECG CONFIGURATIONS 55
Vectors 56
Standard, Augmented, and Precordial
Lead Configurations 58
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