ECGs for Acute, Critical and Emergency Care, Volume 2 E-Book

Amal Mattu

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 260

Veröffentlichungsjahr: 2025

Beschreibung

Highly practical accompanying volume to a bestselling resource on the 12-lead electrocardiogram for emergency physicians

Volume 2 of the popular ECGs for Acute, Critical and Emergency Care (formerly titled ECGs for the Emergency Physician, Volume 2) delivers essential practical guidance on the use and interpretation of the 12-lead electrocardiogram (ECG). This enhanced edition enables readers to 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.

This Second Edition has been extensively revised throughout to present the latest cutting-edge literature and real-life scenarios that practitioners are likely to encounter in the emergency department. Within each ECG, readers will find case histories, clinically focused reviews, and additional comments from the authors.

The book is divided into three sections. The first section presents ECGs with a focus on dysrhythmias. The second and third sections are divided into intermediate- and advanced-level ECGs, respectively.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright Page

Foreword for second edition

Preface to second edition

Dedications

Part 1: Focus on dysrhythmias

Case histories

ECG interpretations and comments

Reference

Part 2: 12‐Lead ECGs (intermediate level)

Case histories

ECG interpretations and comments

References

Part 3: 12‐Lead ECGs (advanced level)

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 for second edition

Preface to second edition

Dedications

Begin Reading

Appendix A Differential diagnoses

Appendix B Commonly used abbreviations

Index

WILEY END USER LICENSE AGREEMENT

Pages

iii

iv

vi

vii

viii

ix

1

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

121

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

138

139

140

141

142

143

144

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

160

161

162

163

164

165

166

167

168

169

170

171

172

173

174

175

176

177

178

179

180

181

182

183

184

185

186

187

188

189

190

191

192

193

194

195

196

197

198

199

200

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

219

220

221

222

223

224

225

ECGs for Acute, Critical and Emergency Care

Volume 2, Second Edition

Amal Mattu, MD

Professor and Vice Chair of Academic Affairs

Department of Emergency Medicine, University of Maryland School of Medicine

Baltimore, Maryland, USA

William J. Brady, MD

Professor, Vice Chair for Faculty Affairs and The David A. Harrison

Distinguished Educator, Department of Emergency Medicine,

University of Virginia School of Medicine

Charlottesville, Virginia, USA

and

Medical Director, Albemarle County Fire Rescue, Charlottesville, Virginia, USA

This second edition first published 2025© 2025 John Wiley & Sons Ltd

Edition HistoryBMJ Publishing Group (1e, 2003)

All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. 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 Office(s)John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USAJohn Wiley & Sons Ltd, New Era House, 8 Oldlands Way, Bognor Regis, West Sussex, PO22 9NQ, UK

For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.

The manufacturer’s authorized representative according to the EU General Product Safety Regulation is Wiley‐VCH GmbH, Boschstr. 12, 69469 Weinheim, Germany, e‐mail: [email protected].

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 WarrantyWhile 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 Data Applied for:

Paperback ISBN: 9781119986287

Cover Design: WileyCover Image: Courtesy of Amal Mattu

Foreword for second edition

Learning how to read is hard. It is not simply recognizing letters and putting them together. Written language is a code to relay a message or story. The letters or words by themselves do not mean much. Reading is about interpreting the letters in front of you to make sense of what someone is trying to tell you. It takes practice and patience to learn how to read. At first it takes time to read a single word, but, over time, the skill expands, and reading becomes automatic and fluent.

Learning to read an ECG is even harder. As a Dutch emergency physician, I take great pride in the fact that over 120 years ago, Willem Einthoven was the first to use a galvanometer to record the electrical activity of the heart in Leiden, the Netherlands. Even though Leiden likes to take credit for this, it is a fun fact (to me) that he received his medical degree at the Universiteit Utrecht, my alma mater. Not only was Willem Einthoven the first to record ECGs, he was also the one to provide standardization to the ECGs, including the introduction of the Einthoven triangle. Interestingly, he also assigned letters to the ECG, with the P, Q, R, S, and T all representing a different part of the electrical cycle of the heart. As with learning how to read, we first learn what these letters and deflections represent in medical school. As with reading, by themselves, these letters do not mean much. Recognizing these letters alone does not provide us with the skill to interpret an ECG. Without interpretation, an ECG is useless. It takes much practice to learn how to truly read an ECG, mainly by reading numerous ECGs and placing them in clinical contexts.

This is exactly why this book is of such immense value to emergency physicians seeking to expand their ECG interpretation skills. The authors, Drs. Mattu and Brady, are internationally renowned for their expertise in emergency cardiology. More importantly, they are master educators. This book was uniquely designed to provide you with a stress‐free, and above all, fun opportunity to review 200 challenging ECGs. The ECGs are accompanied by short yet in‐depth background reviews. It almost feels like you are working alongside both Dr. Mattu and Dr. Brady, and you ask them to have a quick look at the ECG of this patient you just saw, followed by an interpretation with some quick teaching pearls. It would take many clinical hours to receive such extensive exposure and education on ECGs, while this book gives you the chance to receive this exposure in an easy, comprehensive way, whenever, wherever you like. I hope you treasure this wonderful read!

Maite A. Huis in’t Veld, MD

Emergency Physician

Senior Policy Advisor on National Emergency Care

Nederlands Zorginstituut (Dutch National Institutes of Health)

Board Member

Nederlandse Vereniging van Spoedeisende Hulp Artsen(Dutch Society of Emergency Medicine)

Preface to second edition

An adult male with chest pain and diaphoresis, ultimately diagnosed with STEMI. A fussy infant with a very rapid pulse, found to have Wolff–Parkinson–White syndrome‐related PSVT. A young adult female with altered mental status and a wide QRS complex, demonstrating significant cardiovascular end‐organ toxicity due to tricyclic antidepressant poisoning. An elderly female “found down,” pulseless, and apneic, presenting with a bradycardic PEA cardiac arrest rhythm. A hypothermic patient with bradycardia and significant J waves.

These clinical scenarios are quite familiar to practicing emergency physicians. In each presentation, the electrocardiogram (ECG) is a primary diagnostic tool used by emergency physicians for the early evaluation of these very ill patients. A significant number of the millions of patients cared for each year in emergency departments present with cardiovascular syndromes or issues related to the cardiovascular system. The widely recognized benefits of early diagnosis and rapid treatment of cardiovascular emergencies have only emphasized the importance of emergency physician competency in electrocardiographic interpretation. The emergency physician, frequently the first—if not the only—physician to evaluate such patients, is charged with the responsibility of rapid, accurate diagnosis followed by appropriate therapy delivered expeditiously. Emergency physicians are immediately available at all times of the day and night to care for patients with time‐sensitive cardiovascular emergencies. This evaluation frequently involves the performance of and interpretation of the ECG. These interpretations often occur without the benefit of past knowledge of the patient, without the results of exhaustive prior evaluations, and without prior electrocardiograms for comparison—and usually in the midst of a busy, or even chaotic, emergency department environment.

Further emphasizing the importance of electrocardiography is the fact that it remains one of the most cost‐effective and useful tests in medicine. It is inexpensive, rapid, and reliable. It can be performed at the bedside, even on the sickest patients—by anyone with minimal training—often providing information that will makes the difference between life and death. The knowledge to master this electrocardiography interpretation doesn’t require any special type of residency or fellowship training, nor does it require thousands of dollars to be paid for travel and tuition for continuing medical education courses. It can be learned from books.

This book, ECGs for Acute, Critical and Emergency Care, Volume 2, second edition, continues with the case‐based instruction and electrocardiographic experience that was so well‐received in Volume 1. Like Volume 1, this volume contains 200 ECGs accompanied by brief, focused case histories. However, in response to the enthusiastic feedback for Volume 1, we have further increased the overall level of difficulty of the ECGs, but without relying on esoterica—all cases are real emergency department presentations, the type that emergency physicians must always be ready to face. We’ve also added greater emphasis on dysrhythmias, including an initial section purely focused on dysrhythmia interpretation primarily from rhythms strips. Readers of Volume 1 enjoyed the pearls, pitfalls, and patient outcomes, so we’ve added more. Readers expressed appreciation for the repetition of key points in the Commentary sections that helped emphasize important points, so we’ve maintained this. Readers also gave positive feedback regarding the use of illustrations in the Commentary section, so we’ve increased the use of explanatory illustrations as well. As with Volume 1, we continue to focus on teaching the intermediate‐ and advanced‐level practitioner, and thus there is no basic section or “introduction to ECG interpretation.” Those readers who are new to the art of ECG interpretation are referred to the multitude of ECG books on the market that focus on beginners’ skills. This second edition adds recent advances in knowledge regarding electrocardiography, including further information about nontraditional predictors of acute coronary occlusion (ACO) and sudden cardiac death, refinements in the diagnosis of ACO in patients with left bundle branch block or pacers, and changes in guideline recommendations.

Lastly, we’d emphasize that Volume 2 was not written as a replacement for or an alternative to Volume 1, but rather as an extension of Volume 1. We strongly believe that although these two texts may be used individually, when used in combination, they represent one of the most comprehensive and educational ECG collections ever assembled for emergency physicians and other acute healthcare providers. Our sincerest hope is that these books will help emergency physicians around the world continue to save lives every day.

Amal Mattu and William J. Brady

Dedications

I thank my wife Sejal for her constant support and patience; to my children Nikhil, Eleena, and Kamran for helping me keep balance in my life; to the faculty and residents of the University of Maryland Emergency Medicine Residency Program for their inspiration and their ECG contributions; to Wiley Publishing for supporting our work; to Dr. Bill Brady for his friendship, mentorship, and for being a true academic role model; and to emergency physicians around the world—your dedication to patient care and commitment to education are a constant source of inspiration and reminder of why I am so proud to be a member of this profession.

Amal Mattu

I dedicate this work to all the emergency healthcare providers of the world who work long hours under challenging conditions and usually with limited resources to ensure the safety and well‐being of us all. I also thank my colleagues at the University of Virginia (UVA) Emergency Department and Albemarle County Fire Rescue for their dedication to providing expert care to our patients over the past three decades. I would also like to thank my friend and colleague, Dr. Amal Mattu, for his partnership, guidance, and opportunities; he is the academic physician’s academic physician. And, of course, I dedicate this book to my wife and four adult children—three nurses, one doctor, and one firefighter EMT—not only for who they are but also for what they do. And last, but certainly not least, to my two awesome grandsons.

William J. Brady

Part 1Focus on dysrhythmias

Case histories

63‐year‐old woman with palpitations, weakness, and dyspnea

71‐year‐old febrile man with pneumonia

54‐year‐old dehydrated woman with gastroenteritis and recurrent syncope: a) at the onset of an episode of “syncope” and b) after resolution of syncope, without medical intervention

a) 18‐year‐old woman with palpitations, dizziness, and hypotension, b) during treatment

68‐year‐old man with hypertension, managed with multiple cardiac medications, presenting with profound weakness

57‐year‐old woman with palpitations and exercise intolerance

42‐year‐old man, 30 minutes after receiving fibrinolytics for an acute myocardial infarction (MI)

53‐year‐old man, with a history of MI, presenting with weakness, palpitations, hypotension, and acute pulmonary edema

79‐year‐old woman, with hypertension and chronic congestive heart failure, complaining of weakness and dyspnea

29‐year‐old man presenting with an ankle fracture; he has no cardiovascular symptoms and is a long‐distance runner

71‐year‐old woman with syncope

79‐year‐old man with progressive weakness

59‐year‐old woman who is being transcutaneously paced

68‐year‐old woman with sudden loss of consciousness; note the continuous rhythm strip

66‐year‐old man, with a history of sick sinus syndrome and hypertension, who notes extreme dizziness

56‐year‐old woman with acute MI, which occurred one day earlier

26‐year‐old woman with extreme anxiety after cocaine use (nasal)

18‐month‐old child with fussiness and poor feeding

54‐year‐old man with chest pain: a) sudden development of cardiac arrest, b) after defibrillation, return of spontaneous circulation with blood pressure 115/72 mmHg, c) continued improvement with blood pressure 108/69 mmHg, and d) alert with chest pain and blood pressure 109/76 mmHg

60‐year‐old man, with a history of congestive heart failure, presenting with dyspnea, profound weakness, and hypotension

65‐year‐old woman presenting with chest pain suspected of acute coronary syndrome and sudden loss of consciousness

67‐year‐old woman with the sensation of a rapid heart beat

65‐year‐old man with chronic obstructive pulmonary disease and acute dyspnea

75‐year‐old woman with altered mental status

16‐year‐old boy presents after a syncopal episode, now with recurrent sudden loss of consciousness