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Section 1. Introduction to ECG Interpretation

  1. Introduction to Clinical ECG interpretation

An introduction to ECG interpretation, cardiac physiology and concepts of electrocardiology

  1. Basic Cardiac Electrophysiology

The nuts and bolts of cardiac electrophysiology.

  1. The ECG leads

Learn about lead theory, ECG lead systems, chest (precordial) leads, limb leads, presentation of leads and alternative lead systems.

  1. The Cabrera format of the 12-lead ECG and inverted lead aVR (–aVR)

Learn why the standard presentation of the 12-lead ECG is inferior to the Cabrera format with an inverted lead aVR.

  1. ECG Interpretation Part 1: The Normal ECG, Normal Variants and Abnormalities

This is perhaps the most important chapter throughout this book. You will learn how to recognize the normal ECG and identify pathological ECG changes.

  1. ECG Interpretation Part 2: A Systematic Approach to ECG Interpretation

Learn how to interpret the ECG efficienty using a systematic approach.

Section 2. Cardiac Arrhythmias (Arrhythmology)

Part 1: Basic Arrhythmology

  1. Mechanisms of Cardiac Arrhythmias

Learn about the three mechanisms causing cardiac arrhythmias: re-entry (reentry), increased automaticity and triggered activity.

  1. Aberrant Ventricular Conduction (aberrancy)

Aberrant ventricular conduction is not an arrhythmia per se but may frequently mimic arrhythmias.

  1. Premature Atrial Beats/Contractions

Learn how to diagnose premature atrial beats (or atrial extrasystoles, premature atrial contractions) and differentiate them from other diagnoses.

  1. Premature Ventricular Beats/Contractions

Learn how to recognize premature ventricular beats (or ventricular extrasystoles, premature ventricular contractions) and differentiate them from other diagnoses.

  1. Sinus Rhythm

Learn the ECG criteria, physiology and characteristics of sinus rhythm, which is the normal rhythm of the heart.

  1. Sinus Arrhythmia (Respiratory Sinus Arrhythmia)

Learn ECG characteristics and implications of sinus arrhythmia in various patient populations.

Part 2: Bradyarrhythmia (bradycardia)

Note that management (treatment) of bradycardia is discussed in the final chapter (Sinus Node Dysfunction & Sick Sinus Syndrome).

  1. Sinus Bradycardia

Learn about causes and management of sinus bradycardia.

  1. Chronotropic Incompetence

Chronotropic incompetence is the inability to increase the heart rate adequately, learn about it in this chapter.

  1. Sinoatrial Arrest, Sinus Inhibition, Sinoatrial Pause

Temporary malfunction in the sinoatrial node may lead to these two conditions which must be diagnosed whenever present.

  1. Sinoatrial Block (SA Block)

Learn about SA blocks and how to diagnose and manage them.

  1. Sinus Node Dysfunction (SND) & Sick Sinus Syndrome (SSS)

SND and SSS are common clinical conditions. In this chapter you will learn about these conditions and you will also learn how to manage bradycardias regardless of the underlying cause.

Part 3: Supraventricular Tachyarrhythmias (tachycardia)

  1. Sinus Tachycardia, Inapproproate Sinus Tachycardia, Sinoatrial Re-entry Tachycardia & High Resting Heart Rate

These are some of the most common and often puzzling conditions in clinical practice. Learn all about them in this chapter.

  1. Atrial Fibrillation

Learn classification, causes, diagnostic criteria and management of atrial fibrillation, which is the most common clinically significant tachyarrhythmia.

  1. Atrial Flutter

Learn classification, causes, diagnostic criteria and management of atrial flutter.

  1. Atrial Tachycardia, Atrial Rhythm and Multifocal Atrial Tachycardia

There are three types of atrial rhythms: ectopica atrial tachycardia, atrial rhythm and multifocal atrial tachycardia. Learn about them in this chapter.

  1. Atrioventricular Node Re-entry Tachycardia (AVNRT)

AVNRT is both common and difficult to recognize, which is why this chapter provides an in-depth discussion on causes, diagnosis, ECG manifestation and management.

  1. Pre-excitation, Atrioventricular Re-entry Tachycardia (AVRT) & Wolff-Parkinson-White syndrome

The prevalence of pre-excitation is 1 per 1000 individuals and the condition may cause frequent arrhythmias. Learn all about pre-excitation and WPW syndrome in this chapter.

  1. Junctional Rhythm & Junctional Tachycardia

The atrioventricular (AV) node may also participate in arrhythmias, which is discussed in this chapter.

Part 4: Ventricular Tachyarrhythmias (tachycardia)

  1. Ventricular Rhythm & Accelerated (Idioventricular) Rhythm

Occasionally rhythms may arise in the ventricular myocardium. Slower ventricular rhythms are either simply ventricular rhythm or accelerated (idioventricular) rhythm, both of which are discussed in this chapter.

  1. Ventricular Tachycardia (VT)

The most common of the potentially fatal arrhythmias. Ventricular tachycardia (VT) must be recognized on the ECG and management must be evidence based in order to save lives.

  1. Long QT Syndrome (LQTS)

LQTS manifests with an abnormally long QT interval and it may precipitate lethal arrhythmias. Learn all about LQTS in this chapter.

  1. Ventricular fibrillation (VF)

Ventricular fibrillation is discussed in this chapter.

  1. Pacemaker Mediated Tachycardia (PMT)

Cardiac devices, particularly pacemakers, may also cause arrhythmias. It is important to be able to differentiate PMT from true ventricular tachycardia and other tachyarrhythmias.

Part 5: Clinical Management of Tachyarrhythmias (tachycardia)

  1. Management and Diagnosis of Supraventricular and Ventricular Tachyarrhythmia

Diagnosing and managing various tachyarrhythmias may be difficult. This chapter provides an in-depth guide to clinical reasoning, differential diagnostics and management of tachyarrhtyhmias (tachycardias). General aspects as well as details on narrow complex tachycardia (NCT) and wide complex tachycardia (WCT) are covered.

Section 3. Acute & Chronic Myocardial Ischemia & Infarction (Coronary Syndromes)

Part 1. Principles of Ischemic Heart Disease (Coronary Artery Disease)

  1. Introduction to Coronary Artery Disease (Ischemic Heart Disase)

Coronary artery disease is the number one killer worldwide. This chapter will introduce you to basic concepts of ischemic heart disease.

  1. Acute Coronary Syndromes (ACS): Acute Myocardial Infarction (AMI) and Unstable Angina (UA)

The acute complication of coronary artery disease occurs when an athersclerotic plaque ruptures. This results in atherothrombosis which leads to an acute coronary syndrome. This chapter will introduce you to pathophysiology, classification and clinical implications of acute coronary syndromes.

  1. The ECG in Clinical Practice

Optimal handling of ECG increases survival in patients with chest pain (acute coronary syndromes). This chapter discusses the essentials of ECG in the management of chest pain patients.

  1. Principles of Myocardial Infarction Diagnostics

Learn how acute myocardial infarction is diagnosed and the difference between ST elevation myocardial infarction (STEMI), Non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA).

  1. Myocardial Reaction in Ischemia and Infarction

Understanding how the myocardium reacts during ischemia is essential to understanding ECG changes in ischemic heart disease. This chapter will discuss principles governing myocardial oxygen consumption as well as myocardial reaction during ischemia. You should also read the complimentary chapter: The Ischemic Cascade during Exercise Testing.

  1. Modification of the Natural Course in Myocardial Infarction

The natural course of acute myocardial infarction is discussed in this chapter.

  1. Myocardial Infarction and the Left Ventricle

Learn why myocardial infarction is equal to left ventricular infarction.

Part 2: The ECG in Ischemia and Infarction

  1. Myocardial Ischemia and the ST-T Segment

Acute ischemia causes ST-T changes. This is a difficult topic which is discussed in detail in this and the subsequent chapters.

  1. ST Segment Depression in Ischemia and Differential Diagnoses

Learn all about ST segment depressions. This is an in-depth guide to causes and implications of various ST segment depressions, including those caused by acute myocardial ischemia / infarction.

  1. ST Segment Elevation in Ischemia and Differential Diagnoses

Learn all about ST segment elevations. This is an in-depth guide to causes and implications of various ST segment elevations, including those caused by acute myocardial ischemia / infarction.

  1. STEMI/STE-ACS Without ST Segment Elevation on ECG

Learn about clinical syndromes that do not directly manifest with ST segment elevations but must be managed as STEMI in order to improve survival.

  1. T-wave Changes in Ischemia and Infarction

T-wave changes are frequently misunderstood, particularly in the setting of ischemia and infarction. This chapter provides a detailed discussion on the causes and implications of various T-wave changes (flat T-waves, inverted [negative] T-waves and hyperacute T-waves).

  1. Pathological Q-waves and pathological R-waves

Learn how to differentiate various Q-wave changes, including normal Q-waves, normalvariants and pathological Q-waves. Pathological R-waves are also discussed.

  1. Left Bundle Branch Block in Ischemia and Infarction

Learn why left bundle branch block poses a special challenge in patients with acute coronary syndromes.

  1. Other ECG changes in Ischemia and Infarction

Ischemia may cause additional ECG changes which are discussed in this chapter.

  1. Conduction Defects and Blocks in Ischemia and Infarction 17. Reperfusion assessment using 12-lead ECG 18. Localization of Ischemic and Infarct Area Using 12-lead ECG

In this chapter you will learn how to use the 12-lead ECG to localize the myocardial ischemia/infarction.

Part 3: Management of Acute Coronary Syndromes (ACS)

In these comprehensive chapters you will learn how to manage patients with chest pain, patients with STEMI and patients with NSTEMI.

17. Approach to patients with chest pain (chest discomfort)

18. Acute STEMI (ST Elevation Acute Myocardial Infarction)

19. NSTEMI (Non ST Elevation Acute Myocardial Infarction) and Unstable Angina (UA)

Section 4. Supraventricular & Ventricular Conduction Defects (Disturbances)

Part 1. Supraventricular Conduction Defects

  1. Overview of Atrioventricular (AV) Blocks
  2. First-degree AV block
  3. Second-degree AV block
  4. Third-degree AV block
  5. Management and Treatment of AV block

Part 2. Intraventricular Conduction Defects

  1. Overview of Intraventricular Conduction Defects
  2. Right Bundle Branch Block (RBBB)
  3. Left Bundle Branch Block (LBBB)
  4. Fascicular Blocks (Hemiblocks): left anterior fascicular block (LAFB) and left posterior fascicular block (LPFB)
  5. Non-specific Intraventricular Conduction Delay

Section 5: Hypertrophy and Dilatation

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  1. Overview of Hypertrophy and Dilatation
  2. Left Ventricular Hypertrophy
  3. Right Ventricular Hypertrophy
  4. Biventricular Hypertrophy
  5. Atrial Hypertrophy and Dilatation (P-mitrale, P-pulmonale)

Section 6: Drugs and Electrolyte Imbalance

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  1. Digoxin Effect on ECG, Rhythm and Conduction
  2. ECG changes caused by antiarrhythmic drugs, beta blockers and calcium channel blockers
  3. ECG changes caused by electrolyte imbalance (electrolyte disorders)

Section 7. Genetics and miscellaneous

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  1. J wave Syndromes: J-wave (Osborn’s wave), Hypothermia, Brugada Syndrome, Early depolarization

J waves occur in the J point, which is the terminal portion of the QRS complex. J waves vary in amplitude and shape and they may be caused by both benign and potentially life-threatening conditions. A clinical syndrome which manifests with abnormal J waves is referred to as a J wave syndrome. This chapter discusses general aspects of the J wave syndromes.

  1. Brugada syndrome

This chapter provides an in-depth discussion on the Brugada syndrome, which is a rather mysterious and potentially life-threatening genetic disorder.

  1. Early Repolarization Syndrome

Early repolarization is one of the most frequently misunderstood syndromes. It is common and associated with 3 to 5 times as great a risk of sudden cardiac death. Learn all about early repolarization in this chapter.

  1. Acute perimyocarditis (pericarditis, myocarditis)

This chapter elucidates electrocardiographic aspects of acute myocarditis (percarditis, perimyocarditis).

  1. Cardiac Tamponade and Electrical Alternans

Learn about cardiac tamponade and electrical alternans, and how the ECG may be used to diagnose tamponade.

  1. Takotsubo Cardiomyopathy (broken heart syndrome, stress induced cardiomyopathy)

Learn about takotsubo cardiomyopathy and why this condition frequently results in unnecessary activations of the catheterization laboratory.

Section 8. Exercise stress testing (exercise ECG)

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  1. Introduction to exercise stress testing (exercise ECG)
  2. Indications, contraindications and preparations for exercise (ECG) stress testing
  3. Exercise protocols (treadmill, cycle), evaluation and termination
  4. Exercise stress testing in special patient population
  5. Exercise physiology: from normal response to myocardial ischemia
  6. Evaluation of test results: ECG reaction and other parameters

Section 9. Devices: pacemaker, ICD and CRT

Coming soon.

Section 10. Pediatric & Neonatal ECG Interpretation

Coming soon.

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