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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
A new edition of this bestselling resource for emergency physicians seeking to expand their knowledge of the 12-lead electrocardiogram and how it relates to patient care ECGs for Acute, Critical and Emergency Care, 2nd Edition, Volume One, provides comprehensive guidance on the use and interpretation of the 12-lead electrocardiogram (ECG). Celebrating the 20th anniversary since initial publication, this book is an essential teaching and reference text that helps physicians with basic knowledge of electrocardiography quickly locate the objective criteria necessary for various diagnoses, understand different electrocardiographic waveforms and their meaning in individual patients, and interpret the ECG within the context of the patient's presentation. The second edition of ECGs for Acute, Critical and Emergency Care is fully updated and reviewed throughout, featuring ECG cases that are randomly presented to mirror the scenarios encountered in the emergency department. The text contains intermediate and more challenging ECGs representing the common electrocardiographic diagnoses that all acute care physicians need to know. Case histories, clinically focused reviews, ECG interpretations, and comments by the authors accompany each ECG presented. * Covers all key areas of accurate ECG interpretation * Contains 200 actual ECGs of patients treated in authors' emergency departments * Focuses on emergency situations, with increased emphasis on recent literature updates in this new edition * Includes appendices of differential diagnoses and commonly used abbreviations Written by two highly experienced specialists, ECGs for Acute, Critical and Emergency Care, Second Edition, Volume One, is a must-have resource for trainee physicians, senior medical students, and practicing physicians who manage patients in emergency departments and other clinical care settings.
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Seitenzahl: 186
Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Foreword
Preface
References
Dedications
Part 1
Case histories
ECG interpretations and comments
References
Part 2
Case histories
ECG interpretations and comments
References
Appendix A: Differential Diagnoses
Appendix B: Commonly used abbreviations
Index
End User License Agreement
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Foreword
Preface
Dedications
Begin Reading
Appendix A Differential Diagnoses
Appendix B Commonly used abbreviations
Index
Wiley End User License Agreement
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ECGs for Acute, Critical and Emergency Care
Second Edition, Volume 120th Anniversary Edition
Amal Mattu, MD
Professor and Vice Chair of Academic AffairsDepartment of Emergency Medicine, University of Maryland School of MedicineBaltimore, Maryland, USA
William J. Brady, MD
Professor, Vice Chair for Faculty Affairs and The David A. Harrison Distinguished Educator, Department of EmergencyMedicine, University of Virginia School of Medicine, Charlottesville, Virginia, United StatesandMedical Director, Albemarle County Fire Rescue, Charlottesville, Virginia, USA
This Second edition first published 2024© 2024 John Wiley & Sons Ltd
Edition HistoryBMJ Publishing Group (1e, 2003)
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 law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Amal Mattu and William J. Brady to be identified as the authors of this work has been asserted in accordance with law.
Registered OfficesJohn Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USAJohn Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats.
Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc. is not associated with any product or vendor mentioned in this book.
Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication DataNames: Mattu, Amal, author. | Brady, William, 1960– author.Title: ECGs for acute, critical and emergency care : 20th anniversary / Amal Mattu, William J. Brady.Other titles: ECGs for the emergency physician 2 | Electrocardiography for acute, critical and emergency careDescription: Second edition. | Hoboken, NJ : Wiley‐Blackwell, 2024. | Preceded by ECGs for the emergency physician 2 / Amal Mattu, William Brady. 2008. | Includes bibliographical references and index.Identifiers: LCCN 2023037647 (print) | LCCN 2023037648 (ebook) | ISBN 9781119986164 (paperback) | ISBN 9781119986171 (Adobe PDF) | ISBN 9781119986188 (epub)Subjects: MESH: Electrocardiography–methods | Heart Diseases–diagnostic imaging | Emergencies | Emergency Medical ServicesClassification: LCC RC683.5.E5 (print) | LCC RC683.5.E5 (ebook) | NLM WG 140 | DDC 616.1/207547–dc23/eng/20231128LC record available at https://lccn.loc.gov/2023037647LC ebook record available at https://lccn.loc.gov/2023037648
Cover Design: WileyCover Image: Courtesy of Amal Mattu
Foreword
There has been a great need for a user‐friendly ECG text that fills the void between an introductory text designed for students and an advanced reference source for cardiologists. “ECGs for the Emergency Physician” fills this void. It is an ECG teaching and reference textbook for acute, critical, and emergency care physicians written by two specialists practicing and teaching acute, critical, and emergency care.
Drs. Mattu and Brady have created an ECG text that facilitates self‐instruction in learning the basics, as well as the complexities, of ECG interpretation. They know that ECG interpretation requires knowledge, insight, and practice. They know “the eye does not see what the mind does not know.” In order to accomplish this goal of teaching ECG interpretation, they have divided their book into two parts. In Part I, as the authors state, are the “bread and butter” ECGs of clinical care. These are the ECG findings that form the core knowledge necessary for accurate ECG interpretation. In Part II, they teach recognition of more subtle ECG abnormalities, which when mastered, allow the practitioner to approach expert status.
The beauty of this text lies in the combination of a collection of ECGs with the authors’ insights and expert observations. This book has great utility as a reference text, a bound ECG teaching file, a board review aide or a resident in emergency medicine’s best friend for learning the art of advanced ECG interpretation. Its greatest value, however, is for all of us who want to be both challenged and taught by 200 great electrocardiograms and their interpretations.
May the forces be with you.
Corey M. Slovis, M.D.
Professor of Emergency Medicine and MedicineChairman Emeritus, Department of Emergency MedicineVanderbilt Medical CenterNashville, TennesseeMedical Director, Metro Nashville Fire EMS
Preface
We are happy to introduce you to ECGs for Acute, Critical and Emergency Care, Second Edition, Volume 1, 20th Anniversary Edition!
Emergency and other acute care physicians must be experts in the use and interpretation of the 12‐lead electrocardiogram (ECG). We have prepared this text with this basic, though highly important, thought in mind. This text represents our effort to further the art and science of electrocardiography as practiced by emergency physicians and other acute/critical care clinicians.
A significant number of the patients managed in the emergency department (ED) and other clinical settings present with chest pain, cardiovascular instability, or complaints related to the cardiovascular system. The known benefits of early, accurate diagnosis and rapid, appropriate treatment of cardiovascular emergencies have only reinforced the importance of physician competence in electrocardiographic interpretation. The physician is charged with the responsibility of rapid, accurate diagnosis followed by appropriate therapy delivered expeditiously. This evaluation does not infrequently involve the performance of the 12‐lead ECG. For example, the patient with chest pain presenting with STEMI must be rapidly and accurately evaluated so that appropriate therapy is offered in a prompt – and correct – fashion. Another example includes the hemodynamically unstable patient with atrioventricular block who must be cared for in a rapid manner. In these instances as well as numerous other scenarios, resuscitative and other therapies are significantly guided by information obtained from the ECG.
The ECG is used frequently in the ED and other acute care settings; numerous presentations may require a 12‐lead ECG. For instance, the most frequent indication for ECG performance in the ED is the presence of chest pain; other complaints frequently involving ECG analysis include dyspnea and syncope. Physicians obtain an ECG in the ED in the evaluation of suspected acute coronary syndrome, pulmonary embolism, and intentional medication overdose, among other situations; the ECG also plays a major role in various diagnostic strategies, such as the “rule‐out myocardial infarction” protocol.1
Regardless of the cause, the physician must be an expert in the interpretation of the 12‐lead ECG. Interpretation of the ECG is as much an art as it is a science. Accurate ECG interpretation requires a sound knowledge of the ECG, both the objective criteria necessary for various diagnoses of those patients encountered in the ED as well as a thorough grasp of the various electrocardiographic waveforms and their meaning in the individual patient. And, importantly, the physician must understand the vital concept of interpreting the ECG within the context of the patient’s presentation (i.e. clinical correlation suggested).
We have prepared this text for the physician who manages patients not only in the ED but also in other clinical care settings – whether it be in the office, the hospital ward, critical care unit, the out‐of‐hospital arena, or other patient‐care locale. We have used actual ECGs from patients treated in our EDs; a brief but accurate history has also been provided in each instance. In certain cases, the history may provide a clue to the diagnosis; yet in other situations, the clinical information will have no relationship to the final diagnosis – as is the case in the ED. We have made an effort to choose the most appropriate ECG for each patient, but as occurs in “real ED,” some of the ECGs are imperfect: the evaluation is hindered by artifact, incomplete electrocardiographic sampling, etc. We have also provided the ECGs in a random fashion, much the way actual patients present to the ED. We have endeavored to reproduce the reality of the ED when the reader uses this text to expand his or her knowledge of the 12‐lead ECG and how it relates to patient care.
The reader is advised to read the clinical history provided for each ECG and then, much as the clinician would interpret the ECG in the ED, review the 12‐lead ECG. After a clinically focused review of the ECG, the reader is then able to review the interpretation. This ECG text has been constructed in two basic sections. The first half of the text contains ECGs that we feel represent the “bread and butter” of emergency electrocardiography – the core material with which we feel that the acute care physician must be thoroughly familiar. These ECGs were chosen because they represent common electrocardiographic diagnoses that all emergency physicians should know. This section is prepared primarily for the physician‐in‐training (for example the emergency medicine resident), though practicing physicians and senior medical students will also benefit from reviewing the material. The second half of the text is composed of ECGs that are more challenging. Electrocardiographic diagnoses are more difficult to establish and will often be based on subtle findings. In some cases, the ECGs in this section were chosen not necessarily because of the related level of difficulty but because of subtle teaching points found, which are likely to be quite challenging for the physician‐in‐training.
It is also crucial to understand that this text is not intended for the “beginner in ECG interpretation.” The text, in essence an electrocardiographic teaching file, is intended for the physician who already possesses a basic understanding of electrocardiography, yet desires additional practice and review – a review which is highly clinically pertinent. The electrocardiography beginner is advised to begin by reading through one of the many outstanding books that have previously been written for novice students prior to studying this teaching file.
One last point must also be stressed to the reader of this text. Diagnostic criteria for various electrocardiographic diagnoses vary somewhat amongst authors. Therefore, in an effort to standardize the interpretations used in this text, we chose to use the following two references as the “gold standard” for electrocardiographic interpretations: Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric, 6th ed, and The Complete Guide to ECGs, 5th ed.2,3
References
1. Benner JP, Borloz MP, Adams M, Brady WJ. The impact of the 12‐lead electrocardiogram on ED evaluation and management.
Am J Emerg Med
2007; 25(8):942–948
2. Surawicz B, Knilans TK.
Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric
,
6
th
ed
. Philadelphia, PA: Saunders‐Elsevier, 2008.
3. O’Keefe JH, Hammill SC, Freed MS.
The Complete Guide to ECGs
,
5
th
ed
. Burlington, MA: Jones and Bartlett Learning, 2021.
Dedications
This work is dedicated to my wife, Sejal, for her tremendous patience and never‐ending support; to my three kids, Nikhil, Eleena, and Kamran, for constantly reminding me of the priorities in life; to the Emergency Department staff at Mercy Medical Center and University of Maryland Medical Center in Baltimore for their ECG contributions; to the faculty and residents of the University of Maryland Emergency Medicine Residency Program for providing the main inspiration for this work; to Wiley‐Blackwell for supporting and believing in this work; to Dr Bill Brady for his mentorship, friendship, and commitment to teaching and education; and to emergency physicians around the world – may your dedication to learning continue to strengthen our specialty and improve patient care.
Amal Mattu, MD
I would like to thank my wife, King, for her love, support, wise counsel, and patience – none of these efforts would be possible without her; my “all‐grown‐up” children, Lauren, an internal medicine physician; Anne, a cardiology nurse; Chip, a firefighter‐EMT; and Katherine, an ED nurse for not only being wonderful but also for “being there” for others; the Emergency Medicine residents, faculty, and nurses (past, present, and future) at the University of Virginia, for their hard work, astronomical dedication, and expertise – all directed at our patients in the emergency department; the firefighter‐EMTs of Albemarle County Fire Rescue for all that they do, every day; and my co‐author, Dr. Amal Mattu, for his dedicated effort on this book in particular and his dedication to Emergency Medicine education in general – a true gentleman, talented clinician, and distinguished scholar … and good friend.
William J. Brady, MD
Part 1
Case histories
45 year old woman, asymptomatic
24 year old man with chest ache after lifting weights
76 year old man with dyspnea
64 year old man, asymptomatic
48 year old woman reports severe lightheadedness with walking; she recently started a new medication for hypertension
79 year old man 45 minutes after receiving thrombolytic therapy for acute myocardial infarction; currently pain‐free
43 year old man, asymptomatic
82 year old man recently increased his dose of a beta‐receptor‐blocking medication; he now reports exertional lightheadedness
49 year old man with occasional episodes of chest pain
65 year old woman with a long history of smoking presents for treatment of an emphysema exacerbation
54 year old woman complains of midsternal chest pain and lightheadedness
86 year old woman complains of generalized weakness
61 year old man with palpitations and lightheadedness
44 year old woman with intermittent episodes of palpitations
24 year old pregnant woman with three days of frequent vomiting
37 year old man with pleuritic chest pain
63 year old man with palpitations and lightheadedness
33 year old obese man with sharp chest pain and dyspnea
81 year old woman with palpitations and generalized weakness
61 year old man, asymptomatic
57 year old woman with mild chest pain and palpitations
75 year old man presents with cough, dyspnea, and wheezing
43 year old man with severe palpitations
52 year old homeless, alcoholic man found lying in an alley
68 year old man with history of congestive heart failure complains of dyspnea
85 year old woman reports a recent syncopal episode
40 year old woman with palpitations and lightheadedness
35 year old woman with dyspnea
41 year old woman with chest pain after cocaine use
57 year old man with chest pressure and diaphoresis
57 year old man with chest pressure and diaphoresis (right‐sided precordial leads)
60 year old woman with acute onset of expressive aphasia
51 year old man presenting after a one‐hour episode of severe chest pressure with diaphoresis; currently asymptomatic
41 year old woman with nausea and vomiting
75 year old woman accidentally took too many of her beta‐blocker tablets
68 year old man with palpitations and generalized weakness
38 year old man with chest pain, nausea, and diaphoresis
62 year old woman with palpitations
74 year old man with chest pain and palpitations
45 year old man with severe left chest pressure, nausea, and dyspnea
45 year old man with left chest pressure
85 year old woman presents after a syncopal episode, and still reports lightheadedness
81 year old man being admitted for pneumonia
71 year old woman with chronic renal insufficiency presents with carpopedal spasm
46 year old man with chest and left arm pain, vomiting, and diaphoresis
53 year old diabetic woman with four days of nausea, vomiting, and lightheadedness
85 year old woman with chest pain
66 year old man with severe lightheadedness and diaphoresis
58 year old man with congestive heart failure reports increasing dyspnea and lower extremity edema
43 year old man reports eight hours of left chest and arm pain
52 year old woman with chest pain
62 year old man with renal failure complains of progressive dyspnea and orthopnea after missing his last two hemodialysis sessions
47 year old man with palpitations and dyspnea
48 year old woman presents after a clonidine overdose
23 year old man reports dyspnea and palpitations
57 year old man reports generalized weakness and palpitations
54 year old man with five days of anorexia, nausea, and vomiting
66 year old woman with epigastric pain, nausea, dyspnea, and diaphoresis
70 year old woman with nine hours of chest pain and dyspnea
52 year old alcoholic woman presents with frequent vomiting
45 year old woman with palpitations and lightheadedness
45 year old man with severe lightheadedness
52 year old man with sharp, pleuritic chest pain
71 year old woman with generalized weakness
34 year old woman presents unconscious with respiratory depression and pinpoint pupils
36 year old woman has had intermittent episodes of palpitations and lightheadedness
70 year old woman with chest discomfort and generalized weakness
41 year old man with end‐stage renal failure presents with generalized weakness after missing his last three hemodialysis sessions
45 year old woman with left chest and arm pain and dyspnea
78 year old woman with dyspnea and nausea
75 year old woman presents after a syncopal episode
50 year old woman with chest pain and diaphoresis for five hours
59 year old man presents with dyspnea, cough, and hypoxia
62 year old woman with chest pain and severe dyspnea gradually worsening for three days
40 year old man with sharp left‐sided chest pain and dyspnea
28 year old woman with palpitations and chest pain
53 year old man with left arm “squeezing sensation” and nausea for eight hours
69 year old woman with severe nausea and dyspnea
68 year old man presents unconscious with blood pressure 108/60
65 year old woman with “funny feeling in chest”
55 year old woman with occasional syncopal episodes and a recent episode of palpitations
69 year old man with dyspnea and diaphoresis
79 year old man with abdominal pain
85 year old man with palpitations and fatigue
