9780130272812

For courses in EKGs, Professional Nursing, Physician Assistant, Paramedic Respiratory Therapy, and Cardiac Technology.This student-friendly learning resource comprehensively provides a practical approach to the skill of twelve-lead EKG interpretation. It simplifies and thoroughly explains all the vital concepts necessary for a complete understanding of this complex subject creating a useful and understandable tool for health care providers in their provision of optimum patient care.

Foreword

ix

Preface

xiii

The Anatomy of the Heart (Structure)

1

(8)

Objectives

1

(1)

Introduction

1

(1)

Anatomy of the Heart

1

(1)

Location, Size, and Shape of the Heart

2

(1)

Layers of the Heart

3

(1)

Valves of the Heart

4

(1)

Arteries, Veins, and Capillaries

5

(2)

Review Questions

7

(2)

Cardiovascular Physiology (Function)

9

(7)

Objectives

9

(1)

Introduction

9

(1)

Blood Flow through the Heart

10

(1)

Cardiac Cycle

10

(1)

Stroke Volume

11

(1)

Cardiac Output

11

(1)

Autonomic Nervous System

12

(1)

Receptors and Neurotransmitters

12

(2)

Review Questions

14

(2)

Basic Electrophysiology

16

(8)

Objectives

16

(1)

Introduction

16

(1)

Basic Cell Groups

17

(1)

Primary Cardiac Cell Characteristics

17

(1)

Major Electrolytes That Affect Cardiac Function

18

(1)

Movement of Ions

19

(1)

Cardiac Depolarization

19

(1)

Cardiac Repolarization

20

(1)

Refractory Periods

21

(1)

Review Questions

21

(3)

The Electrical Conduction System

24

(6)

Objectives

24

(1)

Introduction

24

(1)

SA Node

25

(1)

Internodal Pathways

26

(1)

AV Node

26

(1)

AV Junction

26

(1)

Bundle of His

26

(1)

Bundle Branches

27

(1)

Purkinje Network

27

(1)

Review Questions

27

(3)

The Electrocardiogram

30

(17)

Objectives

30

(1)

Introduction

30

(1)

Electrical Basis of the EKG

31

(1)

EKG Leads

31

(6)

EKG Graph Paper

37

(1)

EKG Waveforms

37

(5)

Standard 12-Lead EKG Waveforms

42

(2)

Review Questions

44

(3)

Interpretation EKG Strips

47

(14)

Objectives

47

(1)

Introduction

47

(1)

General Rules

48

(1)

The Five-Step Approach

48

(6)

The 5 + 3 Approach

54

(1)

ST Segment Depression

55

(1)

ST Segment Elevation

56

(1)

Pathologic Q Waves

57

(1)

Review Questions

58

(3)

Acute Myocardial Infarctions

61

(10)

Objectives

61

(1)

Introduction

61

(1)

Coronary Artery Anatomy

61

(2)

The Coronary Sinus (Great Cardiac Vein)

63

(1)

Angina Pectoris

64

(1)

Acute Myocardial Infarctions

64

(1)

Chest Pain

65

(2)

Clinical Significance of Acute Myocardial Infarctions

67

(1)

Patient Assessment

67

(1)

Review Questions

68

(3)

Myocardial Ischemia, Injury, and Necrosis

71

(8)

Objectives

71

(1)

Introduction

71

(1)

Time Is Muscle (Myocardium)

72

(1)

Infarct Regions and Definitions

72

(4)

Clinical Significance of Myocardial Ischemia, Injury, and Necrosis

76

(1)

Review Questions

76

(3)

Interpretation of Inferior MIs

79

(10)

Objectives

79

(1)

Introduction

79

(1)

Anatomy and Physiology Review

80

(1)

Transmural versus Subendocardial Infarctions

81

(1)

Lead-Specific ST Elevation

81

(2)

EKG Changes Related to Inferior Infarction

83

(1)

Clinical Significance of Inferior MIs

84

(2)

Review Questions

86

(3)

Interpretation of Anterior MIs

89

(11)

Objectives

89

(1)

Introduction

89

(1)

Anatomy of the Coronary Arteries

90

(1)

``Widowmaker''

90

(1)

Lead-Specific ST Segment Elevation

91

(3)

EKG Changes Commonly Associated with Anterior MIs

94

(1)

Clinical Significance of Anterior MIs

94

(2)

Summary

96

(1)

Review Questions

97

(3)

Interpretation of Septal MIs

100

(8)

Objectives

100

(1)

Introduction

100

(1)

Anatomy of the Interventricular Septum and the Coronary Arteries

100

(1)

Lead-Specific ST Segment Elevation

101

(3)

EKG Changes Commonly Associated with Septal MIs

104

(1)

Clinical Significance of Septal MIs

104

(1)

Summary

105

(1)

Review Questions

105

(3)

Interpretation of Lateral MIs

108

(8)

Objectives

108

(1)

Introduction

108

(1)

Anatomy of the Left Ventricle and the Circumflex Branch of the Left Coronary Artery

108

(1)

Lead-Specific ST Segment Changes

109

(2)

EKG Changes Commonly Associated with Lateral MIs

111

(1)

Clinical Significance of Lateral MIs

112

(1)

Summary

113

(1)

Review Questions

114

(2)

Interpretation of Posterior MIs

116

(12)

Objectives

116

(1)

Introduction

116

(1)

Coronary Artery Anatomy Review

117

(1)

Lead-Specific ST Segment Changes

117

(1)

The Mirror Test

117

(1)

Another Trick for Identifying Posterior MIs

118

(1)

Posterior V Leads

118

(3)

EKG Changes Related to Posterior MIs

121

(1)

Clinical Significance of Posterior MIs

122

(2)

Summary

124

(1)

Summary of Recognition of Specific MIs

124

(1)

Review Questions

125

(3)

Axis Deviation and Bundle Branch Blocks

128

(15)

Objectives

128

(1)

Introduction

128

(1)

EKG Leads

128

(1)

The Hexaxial Reference System

129

(1)

Axis Deviation

130

(2)

Bundle Branch Blocks

132

(6)

Clinical Significance of Bundle Branch Blocks

138

(2)

Review Questions

140

(3)

Therapeutic Modalities

143

(15)

Objectives

143

(1)

Introduction

143

(1)

Thrombolytics

144

(4)

Emergency External Cardiac Pacing

148

(2)

Defibrillation

150

(3)

Cardioversion

153

(2)

Review Questions

155

(3)

Cardiovascular Pharmacology

158

(23)

Objectives

158

(1)

Introduction

159

(1)

Oxygen

159

(1)

Sympathomimetics

160

(5)

Sympatholytics

165

(1)

Antidysrhythmics

166

(7)

Analgesics

173

(2)

Antianginals

175

(1)

Alkalinizing Agents

176

(1)

Anticoagulants

177

(1)

Review Questions

178

(3)

More Review Questions

181

(24)

12-Lead EKG Review Strips

205

(78)

Appendix 1: Answers to Review Questions

283

(6)

Chapter 1

283

(1)

Chapter 2

283

(1)

Chapter 3

283

(1)

Chapter 4

283

(1)

Chapter 5

284

(1)

Chapter 6

284

(1)

Chapter 7

284

(1)

Chapter 8

284

(1)

Chapter 9

284

(1)

Chapter 10

284

(1)

Chapter 11

285

(1)

Chapter 12

285

(1)

Chapter 13

285

(1)

Chapter 14

285

(1)

Chapter 15

285

(1)

Chapter 16

286

(1)

Chapter 17

286

(3)

Appendix 2: Answers to Review Questions: Chapter 18 (12-Lead EKG Review Strips)

289

(36)

Index

325

What is included with this book?

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.

PREFACE Our purpose in writing this book was to create a learning resource that is reader-friendly, yet comprehensive in its approach to the interpretation of the 12-lead electrocardiogram. This text serves as a companion text toUnderstanding EKGs: A Practical Approach. This book consists of 18 chapters that are designed to provide the user with a practical approach to the skill of 12-lead EKG interpretation. The goal of this text is to focus on providing a useful and understandable tool for the health care provider in his/her provision of optimum patient care. It has been our intent that the presentation of the material be accomplished in a logical order. In order to afford the student the opportunity to work in a reasonable order through the technical information, the material is presented in such a manner as to achieve understanding of each chapter prior to proceeding to the next chapter. The content is presented in short, succinct chapters in order to facilitate comprehension of each concept in a "building block" format. At the end of each chapter, we have included a section of multiple choice questions to be used as self-assessment and review. A thorough knowledge of basic EKG interpretation is an essential prerequisite to understanding 12-lead EKG interpretation. With this thought in mind, we began this book with a series of chapters reviewing basic dysrhythmia interpretation. This book includes rhythm strip examples within each applicable chapter, as well as an entire chapter devoted to 12-lead EKG review strips. In addition, there are chapters devoted to cardiovascular pharmacology and therapeutic modalities. Since the late 1980s, the use of thrombolytics in the treatment of acute myocardial infarctions has become an ever expanding, dynamic component of the health care professions. As a direct result of this, more and more health care providers are required to interpret, understand, and apply their knowledge of 12lead EKGs in the clinical setting. We sincerely hope that this logical, yet comprehensive approach to 12lead EKG interpretation will furnish the student, as well as other health care providers, with a substantial foundation for the interpretation and understanding of electrocardiology. Ultimately, it is our wish that your future patients will benefit from the knowledge that you attain from this text.

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Understanding 12 Lead EKGs : A Practical Approach

Understanding 12 Lead EKGs : A Practical Approach

0130272817

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