Clinical Electrocardiography Second Edition FFrraanncciissmm __FFMM..iinndddd ii 22//77//22000088 1122::1100::2266 PPMM FFrraanncciissmm __FFMM..iinndddd iiii 22//77//22000088 1122::1100::2266 PPMM Clinical Electrocardiography Second Edition Edited by Francis Morris Consultant in Emergency Medicine Northern General Hospital, Sheffi eld William J Brady Professor Department of Emergency Medicine University of Virginia, Charlottesville, VA, USA John Camm Professor of Clinical Cardiology St George’s Hospital Medical School, London FFrraanncciissmm __FFMM..iinndddd iiiiii 22//77//22000088 1122::1100::3300 PPMM © 2008 by Blackwell Publishing Ltd BMJ Books is an imprint of the BMJ Publishing Group Limited, used under licence Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia The right of the Author to be identifi ed as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First published 2003 Second edition 2008 1 2008 Library of Congress Cataloging-in-Publication Data ABC of clinical electrocardiography / edited by Francis Morris, William J. Brady, John Camm. – 2nd ed. p. ; cm. Includes index. ISBN 978-1-4051-7064-2 (alk. paper) 1. Electrocardiography. I. Morris, Francis. II. Brady, William, 1960- III. Camm, A. John. [DNLM: 1. Electrocardiography. 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No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. FFrraanncciissmm __FFMM..iinndddd iivv 22//77//22000088 1122::1100::3311 PPMM Contents Contributors, vii Preface, ix 1 Introduction. I–Leads, Rate, Rhythm and Cardiac Axis, 1 Steve Meek, Francis Morris 2 Introduction. II–Basic Terminology, 5 Steve Meek, Francis Morris 3 Bradycardias and Atrioventricular Conduction Block, 9 David Da Costa, William J Brady, June Edhouse 4 Atrial Arrhythmias, 14 Steve Goodacre, Richard Irons 5 Junctional Tachycardias, 18 Demas Esberger, Sallyann Jones, Francis Morris 6 Broad Complex Tachycardia–Part I, 23 June Edhouse, Francis Morris 7 Broad Complex Tachycardia–Part II, 27 June Edhouse, Francis Morris 8 Acute Myocardial Infarction–Part I, 32 Francis Morris, William J Brady 9 Acute Myocardial Infarction–Part II, 37 June Edhouse, William J Brady, Francis Morris 10 Myocardial Ischaemia, 41 Kevin Channer, Francis Morris 11 Exercise Tolerance Testing, 46 Jonathan Hill, Adam Timmis 12 Conditions Affecting the Right Side of the Heart, 51 Richard A Harrigan, Kevin Jones 13 Conditions Affecting the Left Side of the Heart, 56 June Edhouse, R K Thakur, Jihad M Khalil 14 Conditions not Primarily Affecting the Heart, 60 Corey Slovis, Richard Jenkins 15 Paediatric Electrocardiography, 64 Steve Goodacre, Karen McLeod v FFrraanncciissmm __FFMM..iinndddd vv 22//88//22000088 55::2266::1188 PPMM FFrraanncciissmm __FFMM..iinndddd iiii 22//77//22000088 1122::1100::2266 PPMM vi Contents 16 Cardiac Arrest Rhythms, 69 Robert French, Daniel DeBehnke, Stephen Hawes 17 Pacemakers and Electrocardiography, 75 Richard Harper, Francis Morris 18 Pericarditis, Myocarditis, Drug Effects, and Congenital Heart Disease, 80 Chris A Ghammaghami, Jennifer H Lindsey Self Assessment Quiz, 85 Index, 97 FFrraanncciissmm __FFMM..iinndddd vvii 22//88//22000088 55::2266::1188 PPMM Contributors William J Brady Richard A Harrigan Professor, Associate Professor of Emergency Medicine, Department of Emergency Medicine, Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA Temple University School of Medicine, Philadelphia, PA, USA Kevin Channer Stephen Hawes Consultant Cardiologist, Royall Hallamshire Hospital, Department of Emergency Medicine, Wythenshaw Hospital, Sheffi eld, UK Manchester, UK David Da Costa Jonathan Hill Consultant Physician, Northern General Hospital, Sheffi eld, UK Specialist Registrar in Cardiology, Barts and the London NHS Trust, London, UK Daniel DeBehnke Department of Emergency Medicine, Medical College of Richard Irons Wisconsin, Milwaukee, WI, USA Consultant in Accident and Emergency Medicine, Princess of Wales Hospital, Bridgend, UK June Edhouse Consultant in Emergency Medicine, Stepping Hill Hospital, Richard Jenkins Stockport, UK Specialist Registrar in General Medicine and Endocrinology, Northern General Hospital, Sheffi eld, UK Demas Esberger Consultant in Accident and Emergency Medicine, Kevin Jones Queen’s Medical Centre, Nottingham, UK Consultant Chest Physician, Bolton Royal Hospital, Bolton, UK Robert French Sallyann Jones Department of Emergency Medicine, Specialist Registrar in Accident and Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA Queen’s Medical Centre, Nottingham, UK Chris A Ghammaghami Jihad M Khalil Assistant Professor of Emergency and Internal Medicine, Thoracic and Cardiovascular Institute, Director, Chest Pain Centre, Department of Emergency Medicine, Michigan State University, Lancing, MI, USA University of Virginia, Charlottesville, VA, USA Jennifer H Lindsey Steve Goodacre Fellow, Division of Cardiology, Department of Pediatrics, Professor of Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA Medical Care Research Unit, University of Sheffi eld, Sheffi eld, UK Karen McLeod Consultant Paediatric Cardiologist, Richard Harper Royal Hospital for Sick Children, Glasgow, UK Assistant Professor of Emergency Medicine, Temple University School of Medicine, Steve Meek Associate Research Director, Division of Emergency Medicine, Consultant in Emergency Medicine, Royal United Hospitals, Temple University Hospital, Philadelphia, PA, USA Bath, UK vii FFrraanncciissmm __FFMM..iinndddd vviiii 22//77//22000088 1122::1100::3311 PPMM viii Contributors Francis Morris R K Thakur Consultant in Emergency Medicine, Professor of Medicine, Thoracic and Northern General Hospital, Sheffi eld, UK Cardiovascular Institute, Michigan State University, Lancing, MI, USA Corey Slovis Professor of Emergency Medicine and Medicine, Adam Timmis Vanderbilt University Medical Center, Consultant Cardiologist, London Chest Hospital, Department of Emergency Medicine, Nashville, TN, USA Barts and the London NHS Trust, London, UK FFrraanncciissmm __FFMM..iinndddd vviiiiii 22//77//22000088 1122::1100::3311 PPMM