The. ECG. Made Easy. EIGHTH EDITION. John R. Hampton. DM MA DPhil FRCP FFPM FESC. Emeritus Professor of Cardiology. University of Nottingham, UK. John R. Hampton-The ECG Made Easy-Churchill Livingstone ().pdf. Ashraf Alqudwa. Figure The structure of [M(N2S2)]. The ECG Made Easy For. 𝗣𝗗𝗙 | A true medical classic should be novel, stimulate thought and discussion, transcend both The ECG Made Easy I also enjoyed Hampton's perhaps.
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The ECG Made Easy. 8th Edition. Authors: John Hampton. eBook ISBN: eBook ISBN: Paperback ISBN. The ECG Made Easy. 9th Edition. Authors: John Hampton Joanna Hampton. eBook ISBN: eBook ISBN: Paperback ISBN. ECG Made Easy - John R Hampton - Free ebook download as PDF File .pdf), Text File .txt) or read book online for free. ECG Made Easy.
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Free Shipping Free global shipping No minimum order. The ECG in patients with chest pain or breathlessness 7. The ECG in patients with palpitations or syncope 8. Now test yourself Index vii 1 Contents 9. Before you can use the ECG as an aid to diagnosis or treatment, you have to understand the basics. This page intentionally left blank The ECG can provide evidence to support a diagnosis, and in some cases it is crucial for patient management.
It is, however, important to see the ECG as a tool, and not as an end in itself. The ECG is essential for the diagnosis, and therefore the management, of abnormal cardiac rhythms. It helps with the diagnosis of the cause of chest pain, and the proper use of early intervention in myocardial infarction depends upon it. It can help with the diagnosis of the cause of dizziness, syncope and breathlessness. With practice, interpreting the ECG is a matter of pattern recognition.
However, the ECG can be analysed from first principles if a few simple rules and basic facts are remembered. This chapter is about these rules and facts.
Since all muscular contraction will be detected, the electrical changes associated with contraction of the heart muscle will only be clear if the patient is fully relaxed and no skeletal muscles are contracting. Depolarization then spreads through the atrial muscle fibres.
The left bundle branch itself divides into two. Its origin is uncertain, though it may represent repolarization of the papillary muscles. If a U wave follows a normally shaped T wave, it can be assumed to be normal.
If it follows a flattened T wave, it may be pathological see Ch. The different parts of the QRS complex are labelled as shown in Figure 1. If the first deflection is downward, it is called a Q wave Fig. An upward deflection is called an R wave, regardless of whether it is preceded by a Q wave or not Figs 1.
Any deflection below the baseline following an R wave is called an S wave, regardless of whether there is a preceding Q wave Figs 1. Parts of the QRS complex Fig. Each large square 5 mm represents 0. Therefore, there are five large squares per second, and per minute. The heart rate can be calculated rapidly by remembering the sequence in Table 1. Just as the length of paper between R waves gives the heart rate, so the distance between the different parts of the P—QRS—T complex shows the time taken for conduction of the electrical discharge to spread through the different parts of the heart.
The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex, and it is the time taken for excitation to spread from the SA node, through the atrial muscle and the AV node, down the bundle of His and into the ventricular muscle. The normal PR interval is — ms, represented by 3—5 small squares.
Most of this time is taken up by delay in the AV node Fig. Relationship between the squares on ECG paper and time. The duration of the QRS complex shows how long excitation takes to spread through the ventricles. The QRS complex duration is normally ms represented by three small 1The different parts of the ECG 7 If the PR interval is very short, either the atria have been depolarized from close to the AV node, or there is abnormally fast conduction from the atria to the ventricles.
Table 1. A standard signal of 1 millivolt mV should move the stylus vertically 1 cm two large squares Fig. The QT interval varies with the heart rate. It is prolonged in patients with some electrolyte abnormalities, and more importantly it is prolonged by some drugs.
A prolonged QT interval greater than ms may lead to ventricular tachycardia. One electrode is attached to each limb, and six to the front of the chest. Each lead gives a different view of the electrical activity of the heart, and so a different ECG pattern. It is not necessary to remember how the leads or views of the heart are derived by the recorder, but for those who like to know how it works, see Table 1.
The electrode attached to the right leg is used as an earth, and does not contribute to any lead. Sometimes it is used to mean the pieces of wire that connect the patient to the ECG recorder. Properly, a lead is an electrical picture of the heart. The electrical signal from the heart is detected at the surface of the body through electrodes, which are joined to the ECG 1The ECG — electrical pictures 9 Table 1.
The six V leads V1—V6 look at the heart in a horizontal plane, from the front and the left side. Thus, leads V1 and V2 look at the right ventricle, V3 and V4 look at the septum between the ventricles and the anterior wall of the left ventricle, and V5 and V6 look at the anterior and lateral walls of the left ventricle Fig.
In each lead the pattern is characteristic, being similar in individuals who have normal hearts. The cardiac rhythm is identified from whichever lead shows the P wave most clearly — usually lead II.
The relationship between the six chest leads and the heart Fig. Depolarization spreads through the heart in many directions at once, but the shape of the QRS complex shows the average direction in which the wave of depolarization is spreading through the ventricles Fig.
If the QRS complex is predominantly upward, or positive i. If predominantly downward, or negative the S wave is greater than the R wave , the depolarization is moving away from that lead Fig.
When the depolarization wave is moving at right angles to the lead, the R and S waves are of equal size Fig. Q waves, when present, have a special significance, which we shall discuss later.
It is useful to decide whether this axis is in a normal direction or not. When the R and S waves of the QRS complex are equal, the cardiac axis is at right angles to that lead. The cardiac axis Fig. The deflection in lead I becomes negative predominantly downward because depolarization is spreading away from it, and the deflection in lead III becomes more positive predominantly upward because depolarization is spreading towards it Fig.
It is associated mainly with pulmonary conditions that put a strain on the right side of the heart, and with congenital heart disorders. When the left ventricle becomes hypertrophied, it exerts more influence on the QRS complex than the right ventricle.
Although left axis deviation can be due to excess influence of an enlarged left ventricle, in fact this axis change is usually due to a conduction defect rather than to increased bulk of the left ventricular muscle see Ch.
Right axis deviation Fig. The cardiac axis is sometimes measured in degrees Fig. Right and left axis deviation in themselves are seldom significant — minor degrees occur in tall, thin individuals and in short, fat individuals, respectively.
However, the presence of axis deviation should alert you to look for other signs of right and left ventricular hypertrophy see Ch. A change in axis to the right may suggest a pulmonary embolus, and a change to the left indicates a conduction defect. In a right ventricular lead the deflection is first upwards R wave as the septum is depolarized. In a left ventricular lead the opposite pattern is seen: In a right ventricular lead there is then a downward deflection S wave as the main muscle mass is depolarized — the electrical effects in the bigger left ventricle in which depolarization is spreading away from a right ventricular lead outweighing those in the smaller right ventricle.
In a left ventricular lead there is an upward deflection R wave as the ventricular muscle is depolarized Fig.
When the whole of the myocardium is depolarized, the ECG trace returns to the baseline Fig. The QRS complex in the chest leads shows a progression from lead Vl, where it is predominantly downward, to lead V6, where it is predominantly upward Fig. Seen from below, the heart can be thought of as having rotated in a clockwise direction.
This is particularly useful when the rhythm is not normal. If the limb electrodes are wrongly attached, the lead ECG will look very odd Fig. It is possible to interpret the ECG, but it is easier to recognize that there has been a mistake, and to repeat the recording.
Reversal of the leg electrodes does not make much difference to the ECG. The chest electrodes need to be accurately positioned, so that abnormal patterns in the V leads can be identified, and so that records taken on different occasions can be compared. Identify the second rib interspace by feeling for the sternal angle — this is the point where the manubrium and the body of the sternum meet, and there is usually a palpable ridge where the body of the sternum begins, angling downwards in comparison to the manubrium.
The second rib is attached to the sternum at the angle, and the second rib space is just below this. Having identified the second space, feel downwards for the third and then the fourth rib spaces, over which the electrodes for V1 and V2 are attached, to the right and left of the sternum, respectively. Good electrical contact between the electrodes and the skin is essential. The effects on the ECG of poor skin contact are shown in Figure 1. The skin must be clean and dry — in any patient using creams or moisturizers such as patients with skin disorders it should be cleaned with alcohol; the alcohol must be Abrasion of the skin is essential; in most patients all that is needed is a rub with a paper towel.
In exercise testing, when the patient is likely to become sweaty, abrasive pads may be used — for these tests it is worth spending time to ensure good contact, because in many cases the ECG becomes almost unreadable towards the end of the test.
Hair is a poor conductor of the electrical signal and prevents the electrodes from sticking to the skin. Shaving may be preferable, but patients may not like this — if the hair can be parted and firm contact made with the electrodes, this is acceptable. Even with the best of ECG recorders, electrical interference can cause regular oscillation in the ECG trace, at first sight giving the impression of a thickened baseline Fig. It can be extremely difficult to work out where electrical interference may be coming from, but think about electric lights, and electric motors on beds and mattresses.
ECG recorders are normally calibrated so that 1 mV of signal causes a deflection of 1 cm If the calibration setting is wrong, the ECG complexes will look too large or too small Figs 1. Large complexes may be confused with left ventricular hypertrophy see Ch. So, check the calibration. In theory this can make the P wave easier to see, but in fact flattening out the P wave tends to hide it, and so this fast speed is seldom useful.
So, the ECG recorder will do most of the work for you — but remember to: Then just press the button, and the recorder will automatically provide a beautiful lead ECG. However, the description of the rhythm and of the QRS and T patterns should be regarded with suspicion.
This should take the form of a description followed by an interpretation.
The description should always be given in the same sequence: Rhythm 2. Conduction intervals 3. Cardiac axis 4. A description of the QRS complexes 5.
A description of the ST segments and T waves. However, you must think about all the findings every time you interpret an ECG. The interpretation of an ECG indicates whether the record is normal or abnormal: Figures 1. Lead V1 is positioned over the right ventricle, and lead V6 over the left ventricle.
Recognizing the limits of normality is one of the main difficulties of ECG interpretation. If the first deflection is downward, it is a Q wave. Any upward deflection is an R wave. A downward deflection after an R wave is an S wave. When the wave spreads away from a lead, the deflection is predominantly downward. The conduction of this wave front can be delayed or blocked at any point.
However, conduction problems are simple to analyse, provided you keep the wiring diagram of the heart constantly in mind Fig. We can think of conduction problems in the order in which the depolarization wave normally spreads: Remember in all that follows that we are assuming depolarization begins in the normal way in the SA node. The rhythm of the heart is best interpreted from whichever ECG lead shows the P wave most clearly.
This is usually, but not always, lead II or lead V1. First degree heart block is not in itself important, but it may be a sign of coronary artery disease, acute rheumatic carditis, digoxin toxicity or electrolyte disturbances. There may be alternate conducted and nonconducted atrial beats or one conducted atrial beat and then two or three nonconducted beats , giving twice or three or four times as many P waves as QRS complexes.
It is important to remember that, as with any other rhythm, a P wave may only show itself as a distortion of a T wave Fig. There are three variations of this: This would enable you to improve your skills of interpretation, and the three titles bought over time would provide an adequate inexpensive reference shelf for most health care workers.
The ECG is never easy to understand for beginners, but this book does at least try.
Would you like to tell us about a lower price? If you are a seller for this product, would you like to suggest updates through seller support? This highly respected book is a simple, readable guide to the accurate identification and interpretation of abnormal electrocardiogram ECG patterns for medical students, nurses and junior doctors. The emphasis throughout is on the straightforward practical application of the ECG. It will prove useful to all medical and health care staff who require clear, basic knowledge about the ECG.
Provides a complete understanding of the ECG. Read more Read less. Customers who viewed this item also viewed. Page 1 of 1 Start over Page 1 of 1. ECGs Made Easy. Barbara J Aehlert RN. Lippincott Williams. Dale Dubin. Customers who bought related items also bought. Introduction to Critical Care Nursing. Worktext and Procedures Manual. Robin S. Warekois BS. Elizabeth Murray PhD. Read more. Product details Series: Made Easy Paperback: Churchill Livingstone; 6th edition May 19, Language: English ISBN Tell the Publisher!
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