The ECG in emergency decision making:
Gespeichert in:
| Hauptverfasser: | , |
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| Format: | Buch |
| Sprache: | English |
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St. Louis
Saunders Elsevier
[2006]
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| Ausgabe: | Second edition |
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| Online-Zugang: | Inhaltsverzeichnis Klappentext |
| Beschreibung: | xix, 281 Seiten Illustrationen |
| ISBN: | 9781416002598 |
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MARC
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| 245 | 1 | 0 | |a The ECG in emergency decision making |c Hein J.J. Wellens, Mary Conover |
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| 264 | 1 | |a St. Louis |b Saunders Elsevier |c [2006] | |
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Contents CHAPTER 1 The ECG in Acute ST Segment Elevation MI, 1 LIMITATIONS OF THE ST DEVIATION VECTOR APPROACH IN MI DIAGNOSIS, 16 Risk Stratification, 17 ST SEGMENT ELEVATION MI, 1 THE IMPORTANCE OF ST SEGMENT DEVIATION, 2 PRIMARY PERCUTANEOUS CORONARY INTERVENTION VERSUS THROMBOLYTIC THERAPY, 17 ST SEGMENT DEVIATION SCORE, 2 RECOGNITION OF THE HIGH-RISK PATIENT, 17 Limitations, 2 ST SEGMENT DEVIATION VECTOR, 2 Size of the Ischemic Area, 17 Determining the Site of Occlusion in the Coronary Artery, 3 Severity of Ischemia, 17 INFEROPOSTERIOR ST SEGMENT ELEVATION MI, 3 RCA Occlusion, 3 Risk Index, 17 Time Interval Between Onset of Chest Pain and Presentation, 18 CONDUCTION DISTURBANCES IN ACUTE MI, 22 CX Coronary Artery Occlusion, 4 Blood Supply to the Conduction System, 22 RV Involvement, 4 Posterior LV Wall Involvement, 5 Sinus Bradycardia, 23 SA Block and Sinus Arrest, 25 Lateral Wall Involvement, 5 Value of Lead V4R, 5 Conduction Abnormalities at the AV Nodal Level, 26 ISOLATED RV ST SEGMENT ELEVATION MI, 10 ANTERIOR ST SEGMENT ELEVATION MI, 10 Conduction Disturbances Below the AV Node, 29 Occlusion Proximal to the First Septal and First Diagonal Branch, 10 Acquired Versus Preexisting RBBB, 29 Occlusion Between the First Septal and the First Diagonal Branch, 10 DIAGNOSIS OF MI DURING ABNORMAL VENTRICULAR ACTIVATION, 32 Occlusion Between the First Diagonal and the First Septal Branch, 10 Occlusion Distal to the Diagonal Branch(es), 10 LBBB and MI, 32 ECG Diagnosis of LBBB in MI, 33 Paced Ventricular Rhythm, 38 Ventricular Preexcitation, 38 Left Main Coronary Artery
Occlusion, 11 xi
xii Contents ECG Signs of Reperfusion, 42 ST SEGMENT CHANGES, 42 T-WAVE CHANGES, 43 VENTRICULAR ARRHYTHMIAS, 43 Accelerated Idioventricular Rhythm, 43 Sustained Monomorphic VT, 43 Nonsustained VT, 43 Polymorphic VT and Ventricular Fibrillation, 43 SUPRAVENTRICULAR ARRHYTHMIAS, 47 Differential Diagnosis, 47 ACUTE PULMONARY EMBOLISM, 48 ACUTE PERICARDITIS, 48 APPROACH IN UNSTABLE CORONARY ARTERY DISEASE, 55 THE VALUE OF THE ECG IN NON-ST SEGMENT ELEVATION MI AND UNSTABLE ANGINA, 55 The Importance of the Degree of ST Segment Depression in the Admission ECG, 55 The Value of the Number of Leads Showing ST Segment Deviation, 55 The Value of Т-Wave Changes After Chest Pain Has Subsided, 56 CONCLUSION, 57 AORTIC DISSECTION, 48 CHAPTER 3 MYOCARDITIS, 48 PANCREATITIS AND CHOLECYSTITIS, 49 Bradyarrhythmias, TRANSIENT LV APICAL BALLOONING (TAKOTSUBO CARDIOMYOPATHY), 49 SA Conduction Abnormalities, 61 Typical ECG Features, 49 Conclusion, 49 Visual Findings, 49 Clinical Implications, 49 Treatment of ST Segment Elevation MI, 49 MANAGEMENT RELATIVE TO TIME INTERVAL FROM PAIN TO MEDICAL ATTENTION, 50 Situation A: A Percutaneous Cardiac Intervention Center Can Be Reached Within 30 Minutes, 50 Situation B: A Percutaneous Cardiac Intervention Center Can Be Reached Within 30 to 60 Minutes, 50 Situation C: A Percutaneous Cardiac Intervention Center Cannot Be Reached in 60 Minutes, 50 CHAPTER 2 6i MECHANISM, 62 CAUSES, 62 Intrinsic, 62 Extrinsic, 62 DIAGNOSIS, 62 ECG Recognition, 62 TYPE II SECOND-DEGREE SA BLOCK (SA MOBITZ II), 62 ECG Recognition, 63 TWO-TO-ONE SA BLOCK, 63 Differential
Diagnosis, 63 COMPLETE SA BLOCK AND SINUS ARREST, 66 SICK SINUS SYNDROME, 66 ECG Recognition, 66 Bradycardia-Tachycardia Syndrome, 68 Causes, 69 Diagnosis and Mechanisms, 69 Latent Sick Sinus Syndrome, 70 ECG Recognition of Non-ST Elevation MI and Unstable Angina, 54 AV Conduction Disturbances, 71 AN EARLY INVASIVE VERSUS A CONSERVATIVE (SELECTIVE INVASIVE) NONINVASIVE METHODS FOR DETERMINING SITE OF AV BLOCK, 72 Management, 70 CLASSIFICATION OF AV BLOCK, 72
Contents SYSTEMATIC APPROACH, 92 HIS BUNDLE ELECTROGRAM, 72 PROLONGED PR INTERVAL, 72 PHYSICAL EXAMINATION DURING SVT, 92 SECOND-DEGREE AV BLOCK, 74 TYPE I AV BLOCK (AV WENCKEBACH), 76 Pulse, Blood Pressure, and First Heart Sound, 92 ECG Recognition, 76 Neck Veins, 93 Mechanism, 77 The Frog Sign, 93 Incidence, 77 Other Signs and Symptoms, 93 Prognosis, 77 Different Types of SVT, 93 Management, 77 ATRIAL TACHYCARDIA, 93 TYPE II (MOBITZ II) AV BLOCK, 77 Mechanisms, 93 ECG Recognition, 94 ECG Recognition, 77 Mechanism, 77 ATRIAL FLUTTER, 94 Clinical Implications, 77 Causes, 78 Counterclockwise Atrial Flutter, 97 Clockwise Atrial Flutter, 97 Prognosis, 78 ECG Recognition, 97 Management, 78 ATRIAL FIBRILLATION, 98 TWO-TO-ONE AV BLOCK, 78 ECG Recognition, 100 ECG Recognition, 78 Distinguishing Between Two-to-One Block in and Below the AV Node, 80 Mechanisms, 100 AV NODAL REENTRY TACHYCARDIA, 100 Substrate, 100 Clinical Implications, 80 Management, 80 Mechanisms, 101 COMPLETE AV BLOCK (THIRD-DEGREE AV BLOCK), 82 ECG Recognition, 82 Clinical Implications, 85 ECG Recognition, 106 Clinical Implications, 106 Wolff-Parkinson-White Syndrome, 106 MECHANISM OF PREEXCITATION, 108 Management, 85 CONCEALED ACCESSORY PATHWAY, 108 PAROXYSMAL AV BLOCK, 85 CIRCUS MOVEMENT TACHYCARDIA, 108 ECG Recognition, 85 Other Possible Scenarios, 86 Five Characteristics of Paroxysmal AV Block, 87 Mechanisms, 87 Clinical Implications, 88 Management, 89 Pathways of Circus Movement Tachycardia, 108 ORTHODROMIC CIRCUS MOVEMENT TACHYCARDIA WITH A RAPIDLY CONDUCTING ACCESSORY PATHWAY, 108 Initiation and
Perpetuation, 108 ECG Recognition, 108 CHAPTER 4 Narrow QRS Tachycardia, xiii 91 ORTHODROMIC CIRCUS MOVEMENT TACHYCARDIA WITH A SLOWLY CONDUCTING ACCESSORY PATHWAY, 112 CAUSES OF NARROW QRS TACHYCARDIA, 92 Anatomic Substrate, 113 THREE MOST COMMON TYPES OF REGULAR SVT, 92 ECG Recognition, 115 Mechanism, 114
xiv Contents Systematic Approach to the Patient with a Narrow QRS Tachycardia, 115 CHAPTER 5 IS AV BLOCK PRESENT?, 115 CAUSES, 129 PHYSICAL EVALUATION FOR AV DISSOCIATION, 129 IS QRS ALTERNANS PRESENT?, 116 WHERE IS THE P WAVE RELATIVE TO THE QRS?, 117 WHAT IS THE POLARITY (AXIS) OF THE P WAVE?, 117 ABERRANT VENTRICULAR CONDUCTION, A HELPFUL CLUE, 117 Systematic Approach to Treatment of Regular SVT, 121 VAGAL STIMULATION, 122 TYPES OF VAGAL MANEUVERS, 123 CAROTID SINUS MASSAGE, 123 HOW TO PERFORM CAROTID SINUS MASSAGE, 123 Wide QRS Tachycardia, 128 The Jugular Pulse, 129 Varying Intensity of the First Heart Sound, 129 Changes in Systolic Blood Pressure, 130 ECG Findings of Value in Differentiating Causes of a Wide QRS Tachycardia, 132 AV DISSOCIATION, 132 CONFIGURATIONAL CHARACTERISTICS OF THE QRS COMPLEX, 135 RBBB-SHAPED QRS COMPLEX, 135 LBBB-SHAPED QRS COMPLEX, 137 Limitations, 138 Palpate and Auscultate the Carotid Arteries, 123 Concordant Pattern in the Precordial Leads, 138 Presence of Q Waves During Tachycardia, 138 Precautions, 123 Correct Positioning of the Patient, 123 Interval from Onset of QRS to Nadir of the S Wave in Precordial Leads, 143 Correct Technique, 123 EFFECT OF CAROTID SINUS MASSAGE ON SVT, 123 Emergency Management of Atrial Fibrillation, 124 OTHER DIAGNOSTIC CLUES, 143 Width of the QRS Complex, 143 QRS Axis in the Frontal Plane, 144 Narrow Beats During a Wide QRS Tachycardia, 146 Echo Beats, 146 ATRIAL FIBRILLATION PRESENT LESS THAN 48 HOURS, 124 Two Ventricular Ectopic Foci, 147 Narrow Beats During Wide QRS SVT, 148 RECENT ONSET ATRIAL FIBRILLATION:
HEMODYNAMICALLY UNSTABLE, 125 ATRIAL FIBRILLATION PRESENT MORE THAN 48 HOURS: HEMODYNAMICALLY STABLE, 125 Difference Between the Bundle Branch Block Shape in Tachycardia and Sinus Rhythm, 148 ATRIAL FIBRILLATION PRESENT MORE THAN 48 HOURS: HEMODYNAMICALLY UNSTABLE, 127 THREE SIGNS AND SYMPTOMS THAT CANNOT BE USED IN THE DIFFERENTIAL DIAGNOSIS OF BROAD QRS TACHYCARDIA, 149 Hemodynamic Status and Age, 149 When No Left Atrial Thrombus Is Found by Transesophageal Echocardiogram, 127 When a Left Atrial Thrombus Is Found by Transesophageal Echocardiogram, 127 QRS Width During Tachycardia Less Than During Sinus Rhythm, 149 Ventricular Rate During the Tachycardia, 151 Regularity, 151
Contents Wide QRS Tachycardias in Patients with an Accessory AV Pathway, 152 REGULAR TACHYCARDIAS, 152 Antidromic Circus Movement Tachycardia, 152 Emergency Response, 152 IRREGULAR WIDE QRS TACHYCARDIA: ATRIAL FIBRILLATION WITH CONDUCTION OVER AN ACCESSORY PATHWAY, 153 Emergency Response, 154 XV ST-T SEGMENT CHANGES DURING DIGITALIS USE, 160 TYPICAL FEATURES OF DIGITALIS ARRHYTHMIAS, 160 SLOW RHYTHMS, 160 Sinus Bradycardia and SA Block, 160 AV Nodal Block, 160 RAPID RHYTHMS, 160 Atrial Tachycardia with Block Caused by Digitalis Toxicity, 160 Ventriculophasic PP Intervals, 166 Emergency Treatment of the Wide QRS Tachycardia, 154 AV Junctional Tachycardia Caused by Digitalis Toxicity, 166 WHEN IN DOUBT, 154 Fascicular VT Caused by Digitalis Toxicity, 168 WHEN VT IS THE DIAGNOSIS, 154 ECG Features Bifascicular VT, 170 WHEN SVT IS THE DIAGNOSIS, 154 VENTRICULAR BIGEMINY, 170 SUPERIORITY OF PROCAINAMIDE OVER LIDOCAINE IN VT OUTSIDE AN EPISODE OF ACUTE CARDIAC ISCHEMIA, 155 ATRIAL FIBRILLATION WITH DIGITALIS TOXICITY, 171 SYSTEMATIC APPROACH TO WIDE QRS TACHYCARDIA, 155 When the Patient Is Hemodynamically Unstable, 155 When the Patient Is Hemodynamically Stable, 155 FOLLOW-UP CARE, 155 When Cardioversion Was the First Therapeutic Response, 155 When VT Was the Diagnosis, 157 When SVT Was the Diagnosis, 157 Possible Causes When the Rhythm Is Regular, 171 Possible Mechanism for Group Beating, 171 ATRIAL FLUTTER, 172 ECG Signs of Digitalis Toxicity in Atrial Flutter, 172 SYMPTOMS OF DIGITALIS INTOXICATION, 172 MORTALITY RATE IN UNDIAGNOSED DIGITALIS TOXICITY, 173 FACTORS AFFECTING
DOSAGE REQUIREMENTS IN PATIENTS TAKING DIGITALIS, 173 CHAPTER 6 Drug Interaction, 173 Digitalis-Induced Emergencies, ise Drugs That Do Not Appear to Affect Digoxin Concentration, 173 ACTIONS, 159 TREATMENT OF DIGITALIS ARRHYTHMIAS, 173 MECHANISM OF DIGITALIS TOXICITY, 159 CONDITIONS THAT MAY PROMOTE DIGITALIS TOXIC ARRHYTHMIAS, 160 DANGERS OF PACING AND CAROTID SINUS MASSAGE, 174 SUPPRESSANTS OF TRIGGERED ACTIVITY, 160 A SYSTEMATIC EVALUATION OF PATIENTS TAKING DIGITALIS, 174 Digitalis Antibodies, 174
xvi Contents CHAPTER 7 Drug-Induced Arrhythmic Emergencies, 177 MECHANISMS OF DRUG-INDUCED ARRHYTHMIAS, 178 AFTERDEPOLARIZATIONS, 178 Delayed Afterdepolarizations, 178 Early Afterdepolarizations, 178 QT PROLONGATION, 178 TORSADES DE POINTES, 178 ECG Findings, 178 Causes, 178 Risk Factors, 178 Cytochrome P-450 3A4 Inhibitors, 181 Risks to Women, 181 Prevention, 182 Emergency Treatment, 182 REENTRY, 182 CLASS IC DRUG-RELATED EMERGENCIES, 182 Characteristics, 184 Emergency Treatment, 184 DRUG-INDUCED BRADYCARDIA, 184 Emergency Treatment, 185 Cause, 191 Treatment of Severe Potassium Deficiency, 191 Treatment of Moderate Hypokalemia, 191 CHAPTER 9 ECG Recognition of Acute Pulmonary Embolism, 193 VALUE OF THE ECG, 194 VALUE OF THE ECHOCARDIOGRAM, 194 ECG FINDINGS DURING THE ACUTE PHASE, 194 Arrhythmias, 194 Р-Wave Abnormalities, 194 QRS Complex Abnormalities, 194 ST Segment Elevation, 195 Т-Wave Abnormalities, 195 Clockwise Rotation, 195 Abnormal Q or S Waves, 195 ECG DURING THE SUBACUTE PHASE, 195 ECG DURING THE CHRONIC PHASE, 195 PATHOPHYSIOLOGY, 195 SIGNS AND SYMPTOMS, 195 Special Consideration, 196 PHYSICAL FINDINGS, 196 CHAPTER 8 Possible Results of RV Hypertension, 197 Potassium-Related Emergencies, i87 Possible Results of RV Failure, 197 POTASSIUM, 188 HYPERKALEMIA, 188 Electrophysiologic Consequences, 188 ECG Changes in Progressive Hyperkalemia, 188 ECG Changes in Mild Hyperkalemia (Less Than 6.0 mEq/L), 188 ECG Changes in Severe Hyperkalemia (Greater Than 6.0 mEq/L), 188 Treatment of Mild Hyperkalemia, 189 Treatment of Severe Hyperkalemia, 189 HYPOKALEMIA, 190 Mechanism,
190 ECG Changes in Progressive Hypokalemia, 191 Possible Results of Increased Pulmonary Artery Pressure, 198 INCIDENCE, 198 DIFFERENTIAL DIAGNOSIS, 199 MI, 199 EMERGENCY TREATMENT, 199 PREVENTION, 200 CHAPTER 10 Hypothermia, 202 HYPOTHERMIA, 202 Typical ECG Features, 202 Clinical Implications, 202 Treatment, 203
Contents HYPOTHERMIA NOT CAUSED BY EXPOSURE TO COLD, 203 xvii ECG SIGNS, 214 QT Interval, 214 The T Wave, 214 CHAPTER 11 Emergency Decisions in Monogenic Arrhythmic Diseases, 205 Hypertrophic Cardiomyopathy, 206 ECG FINDINGS, 206 During Sinus Rhythm, 206 Arrhythmias, 206 DIFFERENTIATION BETWEEN HYPERTROPHIC CARDIOMYOPATHY AND ATHLETE’S HEART SYNDROME, 206 RISK FACTORS FOR SUDDEN DEATH, 206 EMERGENCY RESPONSE, 206 LONG-TERM MANAGEMENT, 206 Arrhythmogenic RV Dysplasia/ Cardiomyopathy, 207 QT Interval in Women, 214 TORSADES DE POINTES, 214 RISK FACTORS: AGE AND SEX, 214 Long QT Syndrome Type 1, 214 Long QT Syndrome Type 2, 214 Long QT Syndrome Type 3, 216 CLINICAL CHARACTERISTICS, 216 EMERGENCY RESPONSE TO TORSADES DE POINTES IN CONGENITAL LONG QT SYNDROME, 217 LONG-TERM MANAGEMENT, 217 Checklist, 217 Beta-Blockers, 217 Pacemakers, 217 Left Cardiac Sympathetic Denervation, 217 Implantable Cardioverter-Defibrillators, 217 IMPORTANCE OF COUNSELING, 217 Physical and Emotional Stress, 217 ECG RECOGNITION, 208 Drugs to Avoid, 217 THE ECG DURING NONSUSTAINED AND SUSTAINED VT, 208 Electrolyte Loss, 219 DIFFERENTIATING ARRHYTHMOGENIC RV DYSPLASIA/CARDIOMYOPATHY VT FROM IDIOPATHIC VT, 209 INCIDENCE, 210 DIAGNOSIS, 210 Major Diagnostic Criteria, 211 SUMMARY OF INHERITED LQTS, 219 Brugada Syndrome, 219 ECG DIAGNOSIS, 220 Pseudo-Brugada Pattern, 221 UNMASKING CONCEALED AND INTERMITTENT FORMS, 222 Minor Diagnostic Criteria, 211 The Flecainide Test, 222 Magnetic Resonance Imaging, 211 Electrophysiologic Study, 211 Beta-Adrenergic Stimulation, 223 PATHOPHYSIOLOGIC CHARACTERISTICS, 223
SYMPTOMS, 211 INCIDENCE, 223 PROGNOSIS, 211 CAUSE, 211 RISK STRATIFICATION, 223 MANAGEMENT, 211 Emergency Response, 211 Long-Term Management, 212 TREATMENT, 223 Emergency Approach, 223 Long-Term Treatment, 223 SUMMARY OF BRUGADA SYNDROME, 223 Congenital Long QT Syndrome, 212 Catecholaminergic Polymorphic VT, 223 INCIDENCE, 214 MANAGEMENT, 224
xvïii Contents Short QT Syndrome, 224 CHAPTER 12 Pacemaker and Defibrillator Emergencies, 228 Pacing Emergencies, 228 INTRODUCTION, 230 FAILURE TO CAPTURE OR SENSE, 230 Causes, 230 ECG Recognition, 231 Treatment, 231 Summary, 231 PACING FAILURE, 232 Mechanism, 232 ECG Recognition and Treatment, 232 PACEMAKER SYNDROME, 232 INFECTION OR EROSION OF THE PULSE GENERATOR, 237 Treatment, 238 ELECTROMYOGRAPHIC INHIBITION, 238 Mechanism, 238 ECG Recognition, 239 Treatment, 239 ARRHYTHMIAS DURING PACEMAKER INSERTION, 239 The Implantable Cardioverter-Defibrillator, 239 IN CASE OF EMERGENCY, 240 ELECTRICAL STORM, 240 TREATMENT, 240 PSYCHOSOCIAL CONSIDERATIONS, 240 CHAPTER 13 Mechanism, 232 ECG Recognition, 232 Prehospital Cardiac Emergencies, 242 Symptoms and Physical Findings, 232 Reasons for Delay, 242 Treatment, 232 PACEMAKER-MEDIATED TACHYCARDIA, 233 Mechanism, 233 ECG Recognition, 233 Treatment, 233 Prevention, 233 MYOCARDIAL PERFORATION AND TAMPONADE, 233 ECG Recognition and Physical Findings, 234 Treatment, 234 PATIENT AND FAMILY EDUCATION, 242 TRAINING OF THE EMERGENCY RESPONSE TEAM, 243 INHOSPITAL RESPONSE, 243 Prehospital Assessment of High-Risk Patients with Chest Pain, 243 HISTORY, 243 PHYSICAL EXAMINATION, 244 THE ECG, 244 MANAGING OCCASIONAL ATRIAL TACHYCARDIAS IN PATIENTS WITH PACEMAKERS, 235 USEFULNESS OF LEAD V4R IN ACUTE INFERIOR MI, 244 BURST-TYPE ANTITACHYCARDIA PACING, 236 Procedure, 237 Pacing Options, 237 Thrombolytic Therapy, 244 THROMBOSIS AND PULMONARY EMBOLISM, 237 Treatment, 237 SIGNIFICANCE OF BUNDLE BRANCH BLOCK IN ACUTE ANTERIOR MI, 244 INITIATION OF
PREHOSPITAL THROMBOLYTIC POLICY, 245 EVALUATION OF THE PATIENT FOR THROMBOLYTIC THERAPY IN THE FIELD, 245
Contents WHEN REPERFUSION THERAPY IS INDICATED, 245 RESPONSE AT THE BASE HOSPITAL, 245 CAUSES FOR DELAY, 245 Unconscious Patient, 249 UNCONSCIOUS PATIENT IN TACHYCARDIA, 249 CANDIDATES FOR THROMBOLYSIS, 245 UNCONSCIOUS PATIENT IN BRADYCARDIA, 249 ABSOLUTE CONTRAINDICATIONS FOR THROMBOLYSIS, 246 Emergency Cardioversion, 249 RELATIVELY MAJOR CONTRAINDICATIONS (INDIVIDUAL EVALUATION OF RISK VERSUS BENEFIT), 246 RELATIVELY MINOR CONTRAINDICATIONS, 246 Unstable Angina with ST Segment Depression or Negative T Waves, 246 RECOGNITION OF CRITICAL PROXIMAL LAD CORONARY ARTERY STENOSIS, 246 RECOGNITION OF LEFT MAIN STEM AND THREE-VESSEL DISEASE, 246 Conscious Patient with a Tachycardia, 247 NARROW QRS TACHYCARDIA, 247 Physical Signs, 247 Effect of Carotid Sinus Massage, 247 BROAD QRS TACHYCARDIA, 247 ENERGY SETTINGS FOR DEFIBRILLATION AND CARDIOVERSION OF UNCONSCIOUS PATIENTS, 249 AUTOMATIC EXTERNAL DEFIBRILLATOR, 249 PRECORDIAL THUMP, 249 APPENDIX A Determining the Axis of the ECG Components, 250 APPENDIX В Electrical Treatment of Arrhythmias and the Automated External Defibrillator in Outof-Hospital Resuscitation, 258 Physical Signs of AV Dissociation, 247 ECG in Lead Vj-Positive Broad QRS (RBBBLike) Tachycardia, 247 ECG in Lead V^Negative Broad QRS (LBBBLike) Tachycardia, 247 APPENDIX C Emergency Drugs, 263 Other Helpful ECG Clues, 248 TREATMENT, 248 VT, 248 SVT with Aberration, 248 If in Doubt, 248 APPENDIX D Mechanisms of Aberrant Ventricular Conduction, 265 Broad and Irregular Rhythm, 248 Torsades de Pointes, 248 Possible Digitalis Intoxication, 248 A Conscious Patient in
Bradycardia, 248 xîx Perforated Decision-Making Cards, back of book
The ECG in Emergency Decision Making, SECOND EDITION by Hein J. J. Wellens, MD, and Mary Conover, dsn On-the-spot advice for informed decisions in cardiac emergencies! The ECG in Emergency Decision Making, Second Edition, explains and illustrates accurate 12-lead ECG interpretation for effective treatment strategies and optimal patient outcomes. Each chapter begins with a brief highlighted summary section that clearly outlines an authoritative, systematic, step-by-step approach to emergency decisions, followed by complete rationales and the underlying mechanisms of the condition. The second edition features the most up-to-date content on acute cardiac care including information on new ways to utilize the ECG in acute myocardial infarction to risk stratify the patient and select the optimal reperfusion strategy, localize the site of origin of atrial and ventricular arrhythmias, diagnose paroxysmal atrioventricular block, handle emergency situations in patients with pacemakers and defibrillators, and much more. With The ECG in Emergency Decision Making, Second Edition, you’ll discover. c Information on using the ST deviation vector in acute myocardial infarction to localize the site of occlusion in the coronary artery and thereby the site and size of the area at risk с How to risk stratify and treat patients with acute coronary syndromes showing ST segment depression с Noninvasive measures to determine the site of atrioventricular block с A guide to prehospital screening for patients with chest pain E The ECG features of myocardial infarction in patients with acute
myocardial infarction " New information on monogenic diseases leading to cardiac arrhythmias ’ " ' . The KG in Emergency Decision Making |
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Contents CHAPTER 1 The ECG in Acute ST Segment Elevation MI, 1 LIMITATIONS OF THE ST DEVIATION VECTOR APPROACH IN MI DIAGNOSIS, 16 Risk Stratification, 17 ST SEGMENT ELEVATION MI, 1 THE IMPORTANCE OF ST SEGMENT DEVIATION, 2 PRIMARY PERCUTANEOUS CORONARY INTERVENTION VERSUS THROMBOLYTIC THERAPY, 17 ST SEGMENT DEVIATION SCORE, 2 RECOGNITION OF THE HIGH-RISK PATIENT, 17 Limitations, 2 ST SEGMENT DEVIATION VECTOR, 2 Size of the Ischemic Area, 17 Determining the Site of Occlusion in the Coronary Artery, 3 Severity of Ischemia, 17 INFEROPOSTERIOR ST SEGMENT ELEVATION MI, 3 RCA Occlusion, 3 Risk Index, 17 Time Interval Between Onset of Chest Pain and Presentation, 18 CONDUCTION DISTURBANCES IN ACUTE MI, 22 CX Coronary Artery Occlusion, 4 Blood Supply to the Conduction System, 22 RV Involvement, 4 Posterior LV Wall Involvement, 5 Sinus Bradycardia, 23 SA Block and Sinus Arrest, 25 Lateral Wall Involvement, 5 Value of Lead V4R, 5 Conduction Abnormalities at the AV Nodal Level, 26 ISOLATED RV ST SEGMENT ELEVATION MI, 10 ANTERIOR ST SEGMENT ELEVATION MI, 10 Conduction Disturbances Below the AV Node, 29 Occlusion Proximal to the First Septal and First Diagonal Branch, 10 Acquired Versus Preexisting RBBB, 29 Occlusion Between the First Septal and the First Diagonal Branch, 10 DIAGNOSIS OF MI DURING ABNORMAL VENTRICULAR ACTIVATION, 32 Occlusion Between the First Diagonal and the First Septal Branch, 10 Occlusion Distal to the Diagonal Branch(es), 10 LBBB and MI, 32 ECG Diagnosis of LBBB in MI, 33 Paced Ventricular Rhythm, 38 Ventricular Preexcitation, 38 Left Main Coronary Artery
Occlusion, 11 xi
xii Contents ECG Signs of Reperfusion, 42 ST SEGMENT CHANGES, 42 T-WAVE CHANGES, 43 VENTRICULAR ARRHYTHMIAS, 43 Accelerated Idioventricular Rhythm, 43 Sustained Monomorphic VT, 43 Nonsustained VT, 43 Polymorphic VT and Ventricular Fibrillation, 43 SUPRAVENTRICULAR ARRHYTHMIAS, 47 Differential Diagnosis, 47 ACUTE PULMONARY EMBOLISM, 48 ACUTE PERICARDITIS, 48 APPROACH IN UNSTABLE CORONARY ARTERY DISEASE, 55 THE VALUE OF THE ECG IN NON-ST SEGMENT ELEVATION MI AND UNSTABLE ANGINA, 55 The Importance of the Degree of ST Segment Depression in the Admission ECG, 55 The Value of the Number of Leads Showing ST Segment Deviation, 55 The Value of Т-Wave Changes After Chest Pain Has Subsided, 56 CONCLUSION, 57 AORTIC DISSECTION, 48 CHAPTER 3 MYOCARDITIS, 48 PANCREATITIS AND CHOLECYSTITIS, 49 Bradyarrhythmias, TRANSIENT LV APICAL BALLOONING (TAKOTSUBO CARDIOMYOPATHY), 49 SA Conduction Abnormalities, 61 Typical ECG Features, 49 Conclusion, 49 Visual Findings, 49 Clinical Implications, 49 Treatment of ST Segment Elevation MI, 49 MANAGEMENT RELATIVE TO TIME INTERVAL FROM PAIN TO MEDICAL ATTENTION, 50 Situation A: A Percutaneous Cardiac Intervention Center Can Be Reached Within 30 Minutes, 50 Situation B: A Percutaneous Cardiac Intervention Center Can Be Reached Within 30 to 60 Minutes, 50 Situation C: A Percutaneous Cardiac Intervention Center Cannot Be Reached in 60 Minutes, 50 CHAPTER 2 6i MECHANISM, 62 CAUSES, 62 Intrinsic, 62 Extrinsic, 62 DIAGNOSIS, 62 ECG Recognition, 62 TYPE II SECOND-DEGREE SA BLOCK (SA MOBITZ II), 62 ECG Recognition, 63 TWO-TO-ONE SA BLOCK, 63 Differential
Diagnosis, 63 COMPLETE SA BLOCK AND SINUS ARREST, 66 SICK SINUS SYNDROME, 66 ECG Recognition, 66 Bradycardia-Tachycardia Syndrome, 68 Causes, 69 Diagnosis and Mechanisms, 69 Latent Sick Sinus Syndrome, 70 ECG Recognition of Non-ST Elevation MI and Unstable Angina, 54 AV Conduction Disturbances, 71 AN EARLY INVASIVE VERSUS A CONSERVATIVE (SELECTIVE INVASIVE) NONINVASIVE METHODS FOR DETERMINING SITE OF AV BLOCK, 72 Management, 70 CLASSIFICATION OF AV BLOCK, 72
Contents SYSTEMATIC APPROACH, 92 HIS BUNDLE ELECTROGRAM, 72 PROLONGED PR INTERVAL, 72 PHYSICAL EXAMINATION DURING SVT, 92 SECOND-DEGREE AV BLOCK, 74 TYPE I AV BLOCK (AV WENCKEBACH), 76 Pulse, Blood Pressure, and First Heart Sound, 92 ECG Recognition, 76 Neck Veins, 93 Mechanism, 77 The Frog Sign, 93 Incidence, 77 Other Signs and Symptoms, 93 Prognosis, 77 Different Types of SVT, 93 Management, 77 ATRIAL TACHYCARDIA, 93 TYPE II (MOBITZ II) AV BLOCK, 77 Mechanisms, 93 ECG Recognition, 94 ECG Recognition, 77 Mechanism, 77 ATRIAL FLUTTER, 94 Clinical Implications, 77 Causes, 78 Counterclockwise Atrial Flutter, 97 Clockwise Atrial Flutter, 97 Prognosis, 78 ECG Recognition, 97 Management, 78 ATRIAL FIBRILLATION, 98 TWO-TO-ONE AV BLOCK, 78 ECG Recognition, 100 ECG Recognition, 78 Distinguishing Between Two-to-One Block in and Below the AV Node, 80 Mechanisms, 100 AV NODAL REENTRY TACHYCARDIA, 100 Substrate, 100 Clinical Implications, 80 Management, 80 Mechanisms, 101 COMPLETE AV BLOCK (THIRD-DEGREE AV BLOCK), 82 ECG Recognition, 82 Clinical Implications, 85 ECG Recognition, 106 Clinical Implications, 106 Wolff-Parkinson-White Syndrome, 106 MECHANISM OF PREEXCITATION, 108 Management, 85 CONCEALED ACCESSORY PATHWAY, 108 PAROXYSMAL AV BLOCK, 85 CIRCUS MOVEMENT TACHYCARDIA, 108 ECG Recognition, 85 Other Possible Scenarios, 86 Five Characteristics of Paroxysmal AV Block, 87 Mechanisms, 87 Clinical Implications, 88 Management, 89 Pathways of Circus Movement Tachycardia, 108 ORTHODROMIC CIRCUS MOVEMENT TACHYCARDIA WITH A RAPIDLY CONDUCTING ACCESSORY PATHWAY, 108 Initiation and
Perpetuation, 108 ECG Recognition, 108 CHAPTER 4 Narrow QRS Tachycardia, xiii 91 ORTHODROMIC CIRCUS MOVEMENT TACHYCARDIA WITH A SLOWLY CONDUCTING ACCESSORY PATHWAY, 112 CAUSES OF NARROW QRS TACHYCARDIA, 92 Anatomic Substrate, 113 THREE MOST COMMON TYPES OF REGULAR SVT, 92 ECG Recognition, 115 Mechanism, 114
xiv Contents Systematic Approach to the Patient with a Narrow QRS Tachycardia, 115 CHAPTER 5 IS AV BLOCK PRESENT?, 115 CAUSES, 129 PHYSICAL EVALUATION FOR AV DISSOCIATION, 129 IS QRS ALTERNANS PRESENT?, 116 WHERE IS THE P WAVE RELATIVE TO THE QRS?, 117 WHAT IS THE POLARITY (AXIS) OF THE P WAVE?, 117 ABERRANT VENTRICULAR CONDUCTION, A HELPFUL CLUE, 117 Systematic Approach to Treatment of Regular SVT, 121 VAGAL STIMULATION, 122 TYPES OF VAGAL MANEUVERS, 123 CAROTID SINUS MASSAGE, 123 HOW TO PERFORM CAROTID SINUS MASSAGE, 123 Wide QRS Tachycardia, 128 The Jugular Pulse, 129 Varying Intensity of the First Heart Sound, 129 Changes in Systolic Blood Pressure, 130 ECG Findings of Value in Differentiating Causes of a Wide QRS Tachycardia, 132 AV DISSOCIATION, 132 CONFIGURATIONAL CHARACTERISTICS OF THE QRS COMPLEX, 135 RBBB-SHAPED QRS COMPLEX, 135 LBBB-SHAPED QRS COMPLEX, 137 Limitations, 138 Palpate and Auscultate the Carotid Arteries, 123 Concordant Pattern in the Precordial Leads, 138 Presence of Q Waves During Tachycardia, 138 Precautions, 123 Correct Positioning of the Patient, 123 Interval from Onset of QRS to Nadir of the S Wave in Precordial Leads, 143 Correct Technique, 123 EFFECT OF CAROTID SINUS MASSAGE ON SVT, 123 Emergency Management of Atrial Fibrillation, 124 OTHER DIAGNOSTIC CLUES, 143 Width of the QRS Complex, 143 QRS Axis in the Frontal Plane, 144 Narrow Beats During a Wide QRS Tachycardia, 146 Echo Beats, 146 ATRIAL FIBRILLATION PRESENT LESS THAN 48 HOURS, 124 Two Ventricular Ectopic Foci, 147 Narrow Beats During Wide QRS SVT, 148 RECENT ONSET ATRIAL FIBRILLATION:
HEMODYNAMICALLY UNSTABLE, 125 ATRIAL FIBRILLATION PRESENT MORE THAN 48 HOURS: HEMODYNAMICALLY STABLE, 125 Difference Between the Bundle Branch Block Shape in Tachycardia and Sinus Rhythm, 148 ATRIAL FIBRILLATION PRESENT MORE THAN 48 HOURS: HEMODYNAMICALLY UNSTABLE, 127 THREE SIGNS AND SYMPTOMS THAT CANNOT BE USED IN THE DIFFERENTIAL DIAGNOSIS OF BROAD QRS TACHYCARDIA, 149 Hemodynamic Status and Age, 149 When No Left Atrial Thrombus Is Found by Transesophageal Echocardiogram, 127 When a Left Atrial Thrombus Is Found by Transesophageal Echocardiogram, 127 QRS Width During Tachycardia Less Than During Sinus Rhythm, 149 Ventricular Rate During the Tachycardia, 151 Regularity, 151
Contents Wide QRS Tachycardias in Patients with an Accessory AV Pathway, 152 REGULAR TACHYCARDIAS, 152 Antidromic Circus Movement Tachycardia, 152 Emergency Response, 152 IRREGULAR WIDE QRS TACHYCARDIA: ATRIAL FIBRILLATION WITH CONDUCTION OVER AN ACCESSORY PATHWAY, 153 Emergency Response, 154 XV ST-T SEGMENT CHANGES DURING DIGITALIS USE, 160 TYPICAL FEATURES OF DIGITALIS ARRHYTHMIAS, 160 SLOW RHYTHMS, 160 Sinus Bradycardia and SA Block, 160 AV Nodal Block, 160 RAPID RHYTHMS, 160 Atrial Tachycardia with Block Caused by Digitalis Toxicity, 160 Ventriculophasic PP Intervals, 166 Emergency Treatment of the Wide QRS Tachycardia, 154 AV Junctional Tachycardia Caused by Digitalis Toxicity, 166 WHEN IN DOUBT, 154 Fascicular VT Caused by Digitalis Toxicity, 168 WHEN VT IS THE DIAGNOSIS, 154 ECG Features Bifascicular VT, 170 WHEN SVT IS THE DIAGNOSIS, 154 VENTRICULAR BIGEMINY, 170 SUPERIORITY OF PROCAINAMIDE OVER LIDOCAINE IN VT OUTSIDE AN EPISODE OF ACUTE CARDIAC ISCHEMIA, 155 ATRIAL FIBRILLATION WITH DIGITALIS TOXICITY, 171 SYSTEMATIC APPROACH TO WIDE QRS TACHYCARDIA, 155 When the Patient Is Hemodynamically Unstable, 155 When the Patient Is Hemodynamically Stable, 155 FOLLOW-UP CARE, 155 When Cardioversion Was the First Therapeutic Response, 155 When VT Was the Diagnosis, 157 When SVT Was the Diagnosis, 157 Possible Causes When the Rhythm Is Regular, 171 Possible Mechanism for Group Beating, 171 ATRIAL FLUTTER, 172 ECG Signs of Digitalis Toxicity in Atrial Flutter, 172 SYMPTOMS OF DIGITALIS INTOXICATION, 172 MORTALITY RATE IN UNDIAGNOSED DIGITALIS TOXICITY, 173 FACTORS AFFECTING
DOSAGE REQUIREMENTS IN PATIENTS TAKING DIGITALIS, 173 CHAPTER 6 Drug Interaction, 173 Digitalis-Induced Emergencies, ise Drugs That Do Not Appear to Affect Digoxin Concentration, 173 ACTIONS, 159 TREATMENT OF DIGITALIS ARRHYTHMIAS, 173 MECHANISM OF DIGITALIS TOXICITY, 159 CONDITIONS THAT MAY PROMOTE DIGITALIS TOXIC ARRHYTHMIAS, 160 DANGERS OF PACING AND CAROTID SINUS MASSAGE, 174 SUPPRESSANTS OF TRIGGERED ACTIVITY, 160 A SYSTEMATIC EVALUATION OF PATIENTS TAKING DIGITALIS, 174 Digitalis Antibodies, 174
xvi Contents CHAPTER 7 Drug-Induced Arrhythmic Emergencies, 177 MECHANISMS OF DRUG-INDUCED ARRHYTHMIAS, 178 AFTERDEPOLARIZATIONS, 178 Delayed Afterdepolarizations, 178 Early Afterdepolarizations, 178 QT PROLONGATION, 178 TORSADES DE POINTES, 178 ECG Findings, 178 Causes, 178 Risk Factors, 178 Cytochrome P-450 3A4 Inhibitors, 181 Risks to Women, 181 Prevention, 182 Emergency Treatment, 182 REENTRY, 182 CLASS IC DRUG-RELATED EMERGENCIES, 182 Characteristics, 184 Emergency Treatment, 184 DRUG-INDUCED BRADYCARDIA, 184 Emergency Treatment, 185 Cause, 191 Treatment of Severe Potassium Deficiency, 191 Treatment of Moderate Hypokalemia, 191 CHAPTER 9 ECG Recognition of Acute Pulmonary Embolism, 193 VALUE OF THE ECG, 194 VALUE OF THE ECHOCARDIOGRAM, 194 ECG FINDINGS DURING THE ACUTE PHASE, 194 Arrhythmias, 194 Р-Wave Abnormalities, 194 QRS Complex Abnormalities, 194 ST Segment Elevation, 195 Т-Wave Abnormalities, 195 Clockwise Rotation, 195 Abnormal Q or S Waves, 195 ECG DURING THE SUBACUTE PHASE, 195 ECG DURING THE CHRONIC PHASE, 195 PATHOPHYSIOLOGY, 195 SIGNS AND SYMPTOMS, 195 Special Consideration, 196 PHYSICAL FINDINGS, 196 CHAPTER 8 Possible Results of RV Hypertension, 197 Potassium-Related Emergencies, i87 Possible Results of RV Failure, 197 POTASSIUM, 188 HYPERKALEMIA, 188 Electrophysiologic Consequences, 188 ECG Changes in Progressive Hyperkalemia, 188 ECG Changes in Mild Hyperkalemia (Less Than 6.0 mEq/L), 188 ECG Changes in Severe Hyperkalemia (Greater Than 6.0 mEq/L), 188 Treatment of Mild Hyperkalemia, 189 Treatment of Severe Hyperkalemia, 189 HYPOKALEMIA, 190 Mechanism,
190 ECG Changes in Progressive Hypokalemia, 191 Possible Results of Increased Pulmonary Artery Pressure, 198 INCIDENCE, 198 DIFFERENTIAL DIAGNOSIS, 199 MI, 199 EMERGENCY TREATMENT, 199 PREVENTION, 200 CHAPTER 10 Hypothermia, 202 HYPOTHERMIA, 202 Typical ECG Features, 202 Clinical Implications, 202 Treatment, 203
Contents HYPOTHERMIA NOT CAUSED BY EXPOSURE TO COLD, 203 xvii ECG SIGNS, 214 QT Interval, 214 The T Wave, 214 CHAPTER 11 Emergency Decisions in Monogenic Arrhythmic Diseases, 205 Hypertrophic Cardiomyopathy, 206 ECG FINDINGS, 206 During Sinus Rhythm, 206 Arrhythmias, 206 DIFFERENTIATION BETWEEN HYPERTROPHIC CARDIOMYOPATHY AND ATHLETE’S HEART SYNDROME, 206 RISK FACTORS FOR SUDDEN DEATH, 206 EMERGENCY RESPONSE, 206 LONG-TERM MANAGEMENT, 206 Arrhythmogenic RV Dysplasia/ Cardiomyopathy, 207 QT Interval in Women, 214 TORSADES DE POINTES, 214 RISK FACTORS: AGE AND SEX, 214 Long QT Syndrome Type 1, 214 Long QT Syndrome Type 2, 214 Long QT Syndrome Type 3, 216 CLINICAL CHARACTERISTICS, 216 EMERGENCY RESPONSE TO TORSADES DE POINTES IN CONGENITAL LONG QT SYNDROME, 217 LONG-TERM MANAGEMENT, 217 Checklist, 217 Beta-Blockers, 217 Pacemakers, 217 Left Cardiac Sympathetic Denervation, 217 Implantable Cardioverter-Defibrillators, 217 IMPORTANCE OF COUNSELING, 217 Physical and Emotional Stress, 217 ECG RECOGNITION, 208 Drugs to Avoid, 217 THE ECG DURING NONSUSTAINED AND SUSTAINED VT, 208 Electrolyte Loss, 219 DIFFERENTIATING ARRHYTHMOGENIC RV DYSPLASIA/CARDIOMYOPATHY VT FROM IDIOPATHIC VT, 209 INCIDENCE, 210 DIAGNOSIS, 210 Major Diagnostic Criteria, 211 SUMMARY OF INHERITED LQTS, 219 Brugada Syndrome, 219 ECG DIAGNOSIS, 220 Pseudo-Brugada Pattern, 221 UNMASKING CONCEALED AND INTERMITTENT FORMS, 222 Minor Diagnostic Criteria, 211 The Flecainide Test, 222 Magnetic Resonance Imaging, 211 Electrophysiologic Study, 211 Beta-Adrenergic Stimulation, 223 PATHOPHYSIOLOGIC CHARACTERISTICS, 223
SYMPTOMS, 211 INCIDENCE, 223 PROGNOSIS, 211 CAUSE, 211 RISK STRATIFICATION, 223 MANAGEMENT, 211 Emergency Response, 211 Long-Term Management, 212 TREATMENT, 223 Emergency Approach, 223 Long-Term Treatment, 223 SUMMARY OF BRUGADA SYNDROME, 223 Congenital Long QT Syndrome, 212 Catecholaminergic Polymorphic VT, 223 INCIDENCE, 214 MANAGEMENT, 224
xvïii Contents Short QT Syndrome, 224 CHAPTER 12 Pacemaker and Defibrillator Emergencies, 228 Pacing Emergencies, 228 INTRODUCTION, 230 FAILURE TO CAPTURE OR SENSE, 230 Causes, 230 ECG Recognition, 231 Treatment, 231 Summary, 231 PACING FAILURE, 232 Mechanism, 232 ECG Recognition and Treatment, 232 PACEMAKER SYNDROME, 232 INFECTION OR EROSION OF THE PULSE GENERATOR, 237 Treatment, 238 ELECTROMYOGRAPHIC INHIBITION, 238 Mechanism, 238 ECG Recognition, 239 Treatment, 239 ARRHYTHMIAS DURING PACEMAKER INSERTION, 239 The Implantable Cardioverter-Defibrillator, 239 IN CASE OF EMERGENCY, 240 ELECTRICAL STORM, 240 TREATMENT, 240 PSYCHOSOCIAL CONSIDERATIONS, 240 CHAPTER 13 Mechanism, 232 ECG Recognition, 232 Prehospital Cardiac Emergencies, 242 Symptoms and Physical Findings, 232 Reasons for Delay, 242 Treatment, 232 PACEMAKER-MEDIATED TACHYCARDIA, 233 Mechanism, 233 ECG Recognition, 233 Treatment, 233 Prevention, 233 MYOCARDIAL PERFORATION AND TAMPONADE, 233 ECG Recognition and Physical Findings, 234 Treatment, 234 PATIENT AND FAMILY EDUCATION, 242 TRAINING OF THE EMERGENCY RESPONSE TEAM, 243 INHOSPITAL RESPONSE, 243 Prehospital Assessment of High-Risk Patients with Chest Pain, 243 HISTORY, 243 PHYSICAL EXAMINATION, 244 THE ECG, 244 MANAGING OCCASIONAL ATRIAL TACHYCARDIAS IN PATIENTS WITH PACEMAKERS, 235 USEFULNESS OF LEAD V4R IN ACUTE INFERIOR MI, 244 BURST-TYPE ANTITACHYCARDIA PACING, 236 Procedure, 237 Pacing Options, 237 Thrombolytic Therapy, 244 THROMBOSIS AND PULMONARY EMBOLISM, 237 Treatment, 237 SIGNIFICANCE OF BUNDLE BRANCH BLOCK IN ACUTE ANTERIOR MI, 244 INITIATION OF
PREHOSPITAL THROMBOLYTIC POLICY, 245 EVALUATION OF THE PATIENT FOR THROMBOLYTIC THERAPY IN THE FIELD, 245
Contents WHEN REPERFUSION THERAPY IS INDICATED, 245 RESPONSE AT THE BASE HOSPITAL, 245 CAUSES FOR DELAY, 245 Unconscious Patient, 249 UNCONSCIOUS PATIENT IN TACHYCARDIA, 249 CANDIDATES FOR THROMBOLYSIS, 245 UNCONSCIOUS PATIENT IN BRADYCARDIA, 249 ABSOLUTE CONTRAINDICATIONS FOR THROMBOLYSIS, 246 Emergency Cardioversion, 249 RELATIVELY MAJOR CONTRAINDICATIONS (INDIVIDUAL EVALUATION OF RISK VERSUS BENEFIT), 246 RELATIVELY MINOR CONTRAINDICATIONS, 246 Unstable Angina with ST Segment Depression or Negative T Waves, 246 RECOGNITION OF CRITICAL PROXIMAL LAD CORONARY ARTERY STENOSIS, 246 RECOGNITION OF LEFT MAIN STEM AND THREE-VESSEL DISEASE, 246 Conscious Patient with a Tachycardia, 247 NARROW QRS TACHYCARDIA, 247 Physical Signs, 247 Effect of Carotid Sinus Massage, 247 BROAD QRS TACHYCARDIA, 247 ENERGY SETTINGS FOR DEFIBRILLATION AND CARDIOVERSION OF UNCONSCIOUS PATIENTS, 249 AUTOMATIC EXTERNAL DEFIBRILLATOR, 249 PRECORDIAL THUMP, 249 APPENDIX A Determining the Axis of the ECG Components, 250 APPENDIX В Electrical Treatment of Arrhythmias and the Automated External Defibrillator in Outof-Hospital Resuscitation, 258 Physical Signs of AV Dissociation, 247 ECG in Lead Vj-Positive Broad QRS (RBBBLike) Tachycardia, 247 ECG in Lead V^Negative Broad QRS (LBBBLike) Tachycardia, 247 APPENDIX C Emergency Drugs, 263 Other Helpful ECG Clues, 248 TREATMENT, 248 VT, 248 SVT with Aberration, 248 If in Doubt, 248 APPENDIX D Mechanisms of Aberrant Ventricular Conduction, 265 Broad and Irregular Rhythm, 248 Torsades de Pointes, 248 Possible Digitalis Intoxication, 248 A Conscious Patient in
Bradycardia, 248 xîx Perforated Decision-Making Cards, back of book
The ECG in Emergency Decision Making, SECOND EDITION by Hein J. J. Wellens, MD, and Mary Conover, dsn On-the-spot advice for informed decisions in cardiac emergencies! The ECG in Emergency Decision Making, Second Edition, explains and illustrates accurate 12-lead ECG interpretation for effective treatment strategies and optimal patient outcomes. Each chapter begins with a brief highlighted summary section that clearly outlines an authoritative, systematic, step-by-step approach to emergency decisions, followed by complete rationales and the underlying mechanisms of the condition. The second edition features the most up-to-date content on acute cardiac care including information on new ways to utilize the ECG in acute myocardial infarction to risk stratify the patient and select the optimal reperfusion strategy, localize the site of origin of atrial and ventricular arrhythmias, diagnose paroxysmal atrioventricular block, handle emergency situations in patients with pacemakers and defibrillators, and much more. With The ECG in Emergency Decision Making, Second Edition, you’ll discover. c Information on using the ST deviation vector in acute myocardial infarction to localize the site of occlusion in the coronary artery and thereby the site and size of the area at risk с How to risk stratify and treat patients with acute coronary syndromes showing ST segment depression с Noninvasive measures to determine the site of atrioventricular block с A guide to prehospital screening for patients with chest pain E The ECG features of myocardial infarction in patients with acute
myocardial infarction " New information on monogenic diseases leading to cardiac arrhythmias ’ " ' . The KG in Emergency Decision Making |
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| author | Wellens, Hein J. J. 1935- Conover, Mary |
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| discipline | Medizin |
| discipline_str_mv | Medizin |
| edition | Second edition |
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| illustrated | Illustrated |
| index_date | 2024-07-03T23:35:00Z |
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| isbn | 9781416002598 |
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| spelling | Wellens, Hein J. J. 1935- Verfasser (DE-588)1056118237 aut The ECG in emergency decision making Hein J.J. Wellens, Mary Conover Second edition St. Louis Saunders Elsevier [2006] xix, 281 Seiten Illustrationen txt rdacontent n rdamedia nc rdacarrier Herzkrankheit (DE-588)4024663-2 gnd rswk-swf Notfallmedizin (DE-588)4042676-2 gnd rswk-swf Elektrokardiografie (DE-588)4014280-2 gnd rswk-swf Elektrokardiografie (DE-588)4014280-2 s Herzkrankheit (DE-588)4024663-2 s Notfallmedizin (DE-588)4042676-2 s DE-604 Conover, Mary Verfasser aut Digitalisierung UB Augsburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034947515&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis Digitalisierung UB Augsburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034947515&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA Klappentext |
| spellingShingle | Wellens, Hein J. J. 1935- Conover, Mary The ECG in emergency decision making Herzkrankheit (DE-588)4024663-2 gnd Notfallmedizin (DE-588)4042676-2 gnd Elektrokardiografie (DE-588)4014280-2 gnd |
| subject_GND | (DE-588)4024663-2 (DE-588)4042676-2 (DE-588)4014280-2 |
| title | The ECG in emergency decision making |
| title_auth | The ECG in emergency decision making |
| title_exact_search | The ECG in emergency decision making |
| title_exact_search_txtP | The ECG in emergency decision making |
| title_full | The ECG in emergency decision making Hein J.J. Wellens, Mary Conover |
| title_fullStr | The ECG in emergency decision making Hein J.J. Wellens, Mary Conover |
| title_full_unstemmed | The ECG in emergency decision making Hein J.J. Wellens, Mary Conover |
| title_short | The ECG in emergency decision making |
| title_sort | the ecg in emergency decision making |
| topic | Herzkrankheit (DE-588)4024663-2 gnd Notfallmedizin (DE-588)4042676-2 gnd Elektrokardiografie (DE-588)4014280-2 gnd |
| topic_facet | Herzkrankheit Notfallmedizin Elektrokardiografie |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034947515&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034947515&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA |
| work_keys_str_mv | AT wellensheinjj theecginemergencydecisionmaking AT conovermary theecginemergencydecisionmaking |