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ECG. Made Easy. EIGHTH EDITION. John R. Hampton. DM MA DPhil FRCP FFPM Seventh edition The ECG Made Easy was first published in . ecgthe made easy eighth edition john r. hampton dm ma dphil toronto the ecg made easy 8th edition pdf - getfreetutorial - for forty. ecg made easy 8th edition pdf - getfreetutorial - for forty years the ecg made easy has been regarded as one of best introductory guides to the.

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ecgthe made easy eighth edition john r. hampton dm ma dphil philadelphia st louis sydney toronto the ecg made easy 8th edition pdf - getfreetutorial - for . made easy() was described by the british medical journalas the ecg made easy 8th edition pdf - getfreetutorial - for forty years the ecg made easy has. The ECG Made Easy: John Hampton DM MA DPhil FRCP FFPM FESC The ECG Made Easy-Book by John R Hampton PDF. Therefore, seemingly similar.

In patients with acute heart failure or low in block e. Patients with any bradycardia that is has no effect. IP affecting the circulation can be treated 6.

Narrow complex tachycardias should For more on with atropine, but if this is ineffective they be treated initially with adenosine. Wide complex tachycardias should pp. WPW syndrome. Is the abnormality occasional or sustained? Are there any P waves?

Are there as many QRS complexes as P waves? Are the ventricles contracting regularly extent like recognizing an elephant — once seen, IP or irregularly? However, in cases of difficulty 5. Is the QRS complex of normal shape? For more on it is helpful to ask the following questions, tachycardias, 6. What is the ventricular rate? Is the QRS complex of normal duration? Is the ST segment raised or depressed? Abnormalities of the T wave 98 6. Is the T wave normal?

Other abnormalities of the ST segment Remember: The P wave can only be normal, unusually tall or unusually broad.

Then ask the following questions — always too tall, and it may contain an abnormal in the same sequence: Q wave. Are there any abnormalities of the P wave?

The ST segment can only be normal, 2. What is the direction of the cardiac axis? Apart from alterations of the shape of the P wave 2. Left atrial hypertrophy usually due to mitral associated with rhythm changes, there are only stenosis causes a broad and bifid P wave two important abnormalities: Anything that causes the right atrium to become hypertrophied such as tricuspid Fig.

Since characteristics: Its duration is no greater than ms three in lead V1 becomes upright i. In a right ventricular lead V1 , the S wave this is nearly always abnormal Fig. There is greater than the R wave. In a left ventricular lead V5 or V6 , the height of the R wave is less than 25 mm. Left ventricular leads may show Q waves due to septal depolarization, but these are less than 1 mm across and less than 2 mm deep. In each case, the increased width S indicates that depolarization has spread V6 through the ventricles by an abnormal and therefore slow pathway.

Peaked P waves. Right axis deviation S waves in lead I. In pulmonary embolism the ECG may show 3. Tall R waves in lead V1. Right bundle branch block. Inverted T waves in lead V1 normal , abnormal other than sinus tachycardia.

When a spreading across to lead V2 or V3. A shift of transition point to the left, of the following: If in doubt, V4 clockwise rotation. A deep S wave will treat the patient with an anticoagulant. Left ventricular hypertrophy causes a tall R However, do not hesitate to treat the patient if wave greater than 25 mm in lead V5 or V6 the clinical picture suggests pulmonary embolism and a deep S wave in lead V1 or V2 Fig. It is difficult to diagnose minor degrees of left ventricular hypertrophy from the ECG.

However, Q waves greater than one small square in width representing 40 ms and greater than 2 mm in depth have a quite different significance.

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The ventricles are depolarized from inside 4. Therefore, an electrode If the infarction involves both the anterior placed in the cavity of a ventricle would record and lateral surfaces of the heart, a Q wave will only a Q wave, because all the depolarization be present in leads V3 and V4 and in the leads waves would be moving away from it.

Q waves greater than one small square in The right ventricle occupies the front of the width and at least 2 mm deep therefore indicate heart anatomically, and normally depolarization a myocardial infarction, and the leads in which of the right ventricle moving towards the the Q wave appears give some indication of the recording electrode V1 is overshadowed by part of the heart that has been damaged. Thus, depolarization of the left ventricle moving away infarction of the anterior wall of the left from V1.

The result is a dominant S wave in lead ventricle causes a Q wave in the leads looking V1. For more on myocardial becomes more obvious, and a dominant R wave The presence of a Q wave does not give any infarction, see develops in lead V1. The appearance of the ECG indication of the age of an infarction, because once pp. The leads between the T wave and the next P wave — but in which the elevation occurs indicate the part Fig.

Downward-sloping — as opposed to horizontally Horizontal depression of the ST segment, depressed — ST segments are usually due to associated with an upright T wave, is usually a treatment with digoxin see p. The older term for the in lead V3 in some black people. Ischaemia Left ventricular hypertrophy causes inverted T 3.

Ventricular hypertrophy waves in leads looking at the left ventricle I, II, 4. Right ventricular 5. Digoxin treatment. Subsequently, Q waves appear, and branch block is usually associated with an the T waves become inverted. The ST segment abnormal path of repolarization. Therefore, returns to the baseline, the whole process taking inverted T waves associated with QRS a variable time but usually within the range complexes which have a duration of ms or 24—48 h. T wave inversion is often permanent.

A high depression of the ST segment Fig. It is potassium level causes peaked T waves with helpful to record an ECG before giving digoxin, the disappearance of the ST segment. The QRS to save later confusion about the significance of complex may be widened. The effects of T wave changes. T wave and QT interval measured from the onset of the QRS complex to the end of the T wave are most commonly affected. T wave inversion is associated with ECG and in complexes originating in the bundle branch block, ischaemia, and IP ventricular muscle.

It is also seen in ventricular hypertrophy. For more on the Wolff—Parkinson—White syndrome. Right be due to electrolyte abnormalities, but see pp. For example, Figure 5. All the ECGs in this chapter came from health screening clinics, and we The T wave will assume that the individuals considered U waves themselves to be healthy.

Automated ECG reporting often fails to do this. Supraventricular extrasystoles are of no clinical Occasional ventricular extrasystoles are significance, although atrial extrasystoles need experienced by many people with normal hearts. In an individual patient, however, their medically when they are so frequent as to presence is not a good predictor of such risk.

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This does not cause symptoms and When depolarization is initiated from a focus is usually of no clinical significance. Tall P waves alone may indicate tricuspid The upper limit of the PR interval in a normal stenosis, but this is rare. However, the ECGs of healthy individuals, ECG Bifid P waves in the absence of signs of especially athletes, not uncommonly have PR IP associated left ventricular hypertrophy can intervals slightly longer than ms, and these For an example indicate mitral stenosis now fairly rare , but a can be ignored in the absence of any other mitral stenosis, bifid and not particularly prolonged P wave is indication of heart disease.

The ECG in Figure 5. Nevertheless, PR interval The P waves of atrial extrasystoles tend to be prolongation to this extent is probably evidence ECG abnormally shaped compared to the P waves of of disease of the conducting tissue.

IP the sinus beats of the same patient Fig. Second degree heart block of the Mobitz 1 For more on P waves cannot always be seen in all leads, Wenckebach type may be seen in athletes, but hyperkalaemia, but if there is a total absence of P waves the otherwise second and third degree block are see p.

It is common in healthy subjects, the patient has had a myocardial infarction, particularly if they are tall, as with the ECG in raising the possibility of left posterior Figure 5.

Right bundle branch block with Depolarization of the whole ventricular muscle a QRS complex duration greater than ms mass should occur within ms, so this is sometimes seen in healthy subjects, but represents the maximum width of the normal should be taken as a warning of things like an QRS complex.

Any widening indicates atrial septal defect. Partial incomplete right conduction delay or failure within the bundle bundle branch block RSR1 pattern in lead V1, branch system, pre-excitation see below , or a but with a QRS complex duration less than ventricular origin of depolarization — any of ms; Fig.

The QRS complex 5 Fig. The deviation, or T wave inversion in leads V2—V3 , Sokolow—Lyon criteria define left ventricular this can be a normal variant Fig. In fact these criteria are unreliable, and a QRS If the QRS complexes seem too small to be complex height greater than 25 mm is often consistent with the clinical findings, check the ECG seen in fit young men.

Left ventricular calibration of the ECG recorder. If this is correct, IP hypertrophy can only be diagnosed with possible explanations of small QRS complexes For more on left confidence when tall QRS complexes are are obesity, emphysema and pericardial effusion.

This is sometimes referred to developed changes of an ST segment elevation see pp. Narrow Q likely to be normal, even when associated with waves in the inferior and lateral leads Fig. These features and sometimes even quite deep ones, may also often disappear if the ECG is repeated with the be perfectly normal.

Occasionally, a normal heart may be Tall and peaked T waves Fig. Peaked T hypokalaemia. However, the best examples of waves are also associated with hyperkalaemia, prominent U waves come from normal people ECG but in fact some of the tallest and most peaked Fig. V6 septal Q waves. There are a few features of chest pain that The ECG in patients with intermittent make the diagnosis obvious.

Chest pain that chest pain radiates to the teeth or jaw is probably cardiac The ECG in patients with breathlessness in origin; pain that is worse on inspiration is either pleuritic or due to pericarditis; and pain in the back may be due to either myocardial Chest pain is a very common complaint, and ischaemia or aortic dissection. The ECG will when reviewing the ECG of a patient with help to differentiate these causes of pain but it chest pain it is essential to remember that there is not infallible — for example, if an aortic Box 6.

The first is infarction the rupture of atheromatous plaque within a associated with ST segment elevation, known as coronary artery. The diagnosis of lost. If a patient has chest pain and there is ECG Box 6. The diagnosis of anti-platelet agents and a beta-blocker. STEMI can also be accepted if there is left During the first few hours after the onset of bundle branch block which is known to be new.

Otherwise, after a repeatedly in a patient with chest pain that variable time, usually within a day or so, the ST could be due to cardiac ischaemia, but whose segments return to the baseline, the T waves in ECG is nondiagnostic. If In unstable angina there is ST segment anterior ST segment elevation persists, a left depression while the patient has pain Fig.

Once the pain has resolved the ECG returns to Figures 6. These that is damaged: This is with inferior infarction. A few days later pain and a few days later, and they show the Fig. Figure 6. In a routine ECG there will be dominant R wave that can be a normal variant. Normal ECG. Raised ST segments. Appearance of Q waves. Normalization of ST segments. Inversion of T waves. However, there is Fig. With time the T waves may revert now treatment PCI or thrombolysis that can to normal, but inversion may persist.

Patients whose chest pain is due to oesophageal 1 2. If a diagnosis of angina is in doubt, ECG changes can be induced by exercise. The has great advantages over coronary angiography: The onset of any symptoms. After confidently be made if there is horizontal ST For more on recording the ECG at rest, exercise is segment depression of at least 2 mm.

If the ST exercise testing, progressively increased in stages of 3 min. The segments are depressed but upward-sloping, see pp.

Figures 6. The two low-level stages the 6.

The ECG in patients with intermittent chest pain 6 Fig. ECG evidence of cardiac When the ECG of a breathless patient shows enlargement may point to the cause of an arrhythmia or a conduction abnormality, or breathlessness.

John hampton ecg made easy pdf

For example, ECG evidence evidence of ischaemia or of atrial or ventricular of left ventricular hypertrophy may be due to hypertrophy, then the breathlessness may be hypertension or to mitral or aortic valve disease. V1 or V2 greater than 35 mm. Pulmonary embolism often presents as a In practice, it is not a very reliable indicator combination of chest pain and breathlessness. Although the chest pain is characteristically one-sided and pleuritic, a major embolus affecting the main pulmonary arteries may cause pain resembling that of myocardial infarction.

This is because the heart is rotated, diseases do not usually cause the ECG changes with the right ventricle occupying more of the associated with severe pulmonary hypertension, precordium than usual. The only way of NORMAL ECGs being certain that a cardiac problem is the cause of either phenomenon is to record an Symptoms may not be due to heart disease — the ECG when the patient is having a typical patient may have epilepsy or some other attack, but this is seldom possible.

Nevertheless, condition. In a young associated with exercise think of anaemia or person, who is unlikely to have coronary disease, anxiety, and the palpitations build up and slow this pattern pattern suggests hypertrophic down, sinus tachycardia is likely to be the cause cardiomyopathy Fig.

In paroxysmal tachycardia, with arrhythmias, syncope and sudden death. In both cases an abnormal block, which may be due to aortic stenosis; or pathway bypasses the atrioventricular AV node, right ventricular hypertrophy, which may be causing the short PR interval. This may be pathway connects the atrium and the ventricle, confused with right ventricular hypertrophy.

In the WPW syndrome type A, the right-sided, connecting the right atrium and pathway is left-sided, connecting the left right ventricle, and this is called the WPW atrium and left ventricle, and causes a syndrome type B Fig. Here, lead V1 has dominant R wave in lead V1 Fig. Figure 7. A few seconds before the cardiac arrest, he A QTc interval longer than ms is likely developed a transient broad complex tachycardia to be abnormal.

QT interval prolongation can in which the QRS complexes were initially be congenital, but is most often due to drugs, upright but then changed, to become particularly to antiarrhythmic drugs Box 7. Box 7. It can also be associated with a variety of Fig. However, such It is important to consider the possible combinations may also be associated with higher underlying causes of heart block, and these are degrees of block, and ambulatory recording may summarized in Box 7.

The QRS complexes in paroxysmal change of axis compared to sinus rhythm; tachycardia can be narrow i. Narrow complex tachycardias may indicate: Figure bundle branch block is normally present. It is usually temporary, predominantly upwards or downwards and does not need pacing unless there is in the chest leads. When complete block complicates an to be atrial fibrillation with bundle branch anterior STEMI, a large amount of myocardium block, or atrial fibrillation in the WPW has usually been damaged, and temporary syndrome a dangerous combination.

When no spontaneous activity is sensed, the pacemaker Pacemakers produce a small electrical discharge stimulates the right ventricle; and when that either replaces the function of the sinoatrial spontaneous activity is sensed, the pacemaker is node or bypasses a blocked His bundle. The inhibited.

The ECG looks like that in Figure 7. If the pacemaker does not sense Pacemaker function can be assessed from the spontaneous atrial depolarization, it stimulates resting ECG.

If no atrial activity is sensed within a predetermined 1. The first letter describes the chamber s period, the atrial pacing lead will pace. A paced A for right atrium, V for right maximum PR interval is also predetermined, ventricle or D for dual, i. The second letter describes the chambers will be paced.

A pacemaker inhibition. The fourth letter R is used when the rate one or two pacing leads. In either pulseless electrical activity PEA. The The shockable rhythms are ventricular treatment sequence after the first two steps is: Action in either case, following 1. Adrenaline 1 mg i. CPR Atropine 3 mg i. Precordial thump. If unsuccessful, continue adrenaline 1 mg 2.

One shock at J. Resume chest compressions at Particularly in cases of PEA, consider 4. If unsuccessful, defibrillate at J.

If unsuccessful, give adrenaline 1 mg i. Defibrillate at J. If VF or pulseless VT persists, give amiodarone mg i. Look at all the leads, and describe the ECG in the same order every time: ECG descriptions and interpretations rate and rhythm — conduction — PR interval if sinus rhythm You should now be able to recognize the — cardiac axis common ECG patterns, and this final chapter — QRS complexes: But do not forget two important things: The range of normality, and especially prepared to take some action based on your which leads can show an inverted T wave in findings.

This is a theme developed in the a normal ECG. When reporting an ECG, remember: The ECG is easy. You may 2. A report has two parts — a description and find the Reminders displayed below helpful. The rhythm and conduction: The ST segment: P wave abnormalities: T waves: The cardiac axis: The QRS complex: U waves: QRS apparently not 1: QRS more than 1: ST segment slopes downwards.

This pain VF and V3 is due to sinus arrhythmia sounds muscular, and she only needs reassurance.

The This ECG shows: If so, look at pp. Fixed changes, not to a pacemeaker. This was explained in Chapter 2. Clinical management This patient clearly has severe disease of her conduction system.

The block Stokes—Adams attacks. This could be IP attacks of dizziness may be due to further investigated with a h ambulatory ECG For more on slowing of the heart rate with the same rhythm, recording, but this is not really necessary as pacemakers, or may be due to intermittent complete heart she needs an immediate permanent pacemaker. This ECG shows: This patient has developed the chest leads pulmonary oedema, so needs urgent treatment. While preparations are made for DC cardioversion, he could be given intravenous lidocaine and furosemide, but you should not Interpretation of the ECG rely on a satisfactory response to drug therapy.

The QRS complexes are broad, so this is either ventricular tachycardia or supraventricular ECG 5 tachycardia with bundle branch block. ECG atrial rhythm. He will also need the inverted T waves in those leads see the an exercise test, and a decision will need to be ECG extract from the trace, below , indicate an made about the need for coronary angiography.

IP inferior myocardial infarction. Since the ST For more on segment is virtually isoelectric i. Read pp. This patient has and V5—V6 presented too late for immediate treatment of the infarction by thrombolysis or urgent angioplasty, and he does not need pain relief or Interpretation of the ECG any treatment for complications.

The aim of The rhythm and PR interval are normal but management is therefore to prevent a further the wide QRS complexes show that there is a infarction, and he will need long-term aspirin, a conduction delay within the ventricles.

The downward-sloping ST extract from lead V6, above shows that this is segments indicate that she is taking digoxin, left bundle branch block LBBB.

In LBBB the T which explains the good control of the ECG waves are usually inverted in the lateral leads, ventricular rate with untreated atrial fibrillation IP and have no further significance.

In the presence the ventricular rate would usually be rapid ; For more on of LBBB the ECG cannot be interpreted any and the U waves suggest hypokalaemia see the the ECG in further, so it is not possible to comment on the extracts from the traces, opposite page: If you made a mistake with this one, read p.

Clinical management The story sounds like angina, but when angina is Clinical management ECG combined with dizziness always think of aortic If this patient who is taking digoxin feels sick, IP stenosis, which can also cause angina even with she is probably suffering from digoxin toxicity, For more on normal coronary arteries.

LBBB is common in and hypokalaemia may be the main cause of electrolyte aortic stenosis. A patient with aortic stenosis who this. It directs users of the electrocardiogram to straightforward and accurate identification of normal and abnormal ECG patterns. Provides a full understanding of the ECG in the diagnosis and management of abnormal cardiac rhythms. Emphasises the role of the full 12 lead ECG with realistic reproduction of recordings. The unique page size allows presentation of lead ECGs across a single page for clarity.

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Thanks in advance for your time. Skip to content. About Elsevier. Search for books, journals or webpages All Pages Books Journals. John Hampton Joanna Hampton. Paperback ISBN: Published Date: Page Count: View all volumes in this series: Made Easy.Ventricular hypertrophy waves in leads looking at the left ventricle I, II, 4. Strictly, each ECG pattern should be called Table 1.

Log In Sign Up. When the depolarization through the ventricles Fig. Paperback ISBN: Although left axis deviation can be due to excess influence of an enlarged left ventricle, in fact this axis change is usually due to a conduction defect rather than to increased bulk of the left ventricular muscle see Ch.

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