ECG Made Easy ECG Made Easy Fourth Edition Atul Luthra MBBS MD DNB Diplomate National Board of Medicine Physician and Cardiologist Delhi, India www.atulluthra.in ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Panama City • London ® Jaypee Brothers Medical Publishers (P) Ltd. Headquarter Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd., Jaypee-Highlights Medical Publishers Inc. 83 Victoria Street London City of Knowledge, Bld. 237, Clayton SW1H 0HW (UK) Panama City, Panama Phone: +44-2031708910 Phone: 507-317-0160 Fax: +02-03-0086180 Fax: +50-73-010499 Email: [email protected] Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2012, Jaypee Brothers Medical Publishers All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher. Inquiries for bulk sales may be solicited at: [email protected] This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device. ECG Made Easy® First Edition : 1998 Second Edition : 2004 Third Edition : 2007 Fourth Edition : 2012 ISBN 978-93-5025-591-9 Printed at To My Parents Ms Prem Luthra and Mr Prem Luthra Who guide and bless me from heaven PREFACE The imaging techniques of contemporary ‘high-tech’ cardiology have failed to eclipse the primacy of the 12-lead ECG in the initial evaluation of heart disease. This simple, cost-effective and readily available diagnostic modality continues to intrigue and baffle the clinician as much as it confuses the student. A colossal volume of literature on understanding ECG bears testimony to this fact. This book is yet another humble attempt to bring the subject of ECG closer to the hearts of students and clinicians in a simple and concise form. As the chapters unfold, the subject gradually evolves from basics to therapeutics. Although emphasis is on ECG diagnosis, causation of abnormalities and their clinical relevance are briefly mentioned too. This should help students preparing for their examinations without having to search through voluminous textbooks. While some arrhythmias are harmless, others are ominous and life-threatening. The clinical challenge lies in knowing the cause of an arrhythmia, its significance, differential diagnosis and practical aspects of management. Therefore, seemingly similar cardiac rhythms are discussed together under individual chapter headings. Medical students, resident doctors, nurses and technicians will find this format particularly useful. I have thoroughly enjoyed the experience of writing this book and found teaching as pleasurable as learning. Since the scope for further refinement always remains, it is a privilege to bring out the vastly improved 4th edition of ECG Made Easy. Your appreciation, comments and criticisms are bound to spur me on even further. Atul Luthra ACKNOWLEDGMENTS I am extremely grateful to: • My school teachers who helped me to acquire good command over the English language. • My professors at medical college who taught me the science and art of clinical medicine. • My heart patients whose cardiograms stimulated my grey matter to make me wiser. • Authors of books on electrocardiography to which I referred liberally, while preparing the manuscript. • My readers whose generous appreciation, candid comments and constructive criticism spur me on. • M/s Jaypee Brothers Medical Publishers (P) Ltd who repose their unflinching faith in me and provide moral encourage- ment along with expert editorial assistance.