Marriott’s Practical Electrocardiography

488 Pages·2013·32.45 MB·English

by  Galen S. Wagner MD

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11th Edition 2008 by LIPPINCOTT WILLIAMS & WILKINS
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10th Edition 2001 by LIPPINCOTT WILLIAMS & WILKINS
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This work was completed outside of Dr. Strauss’ duties at the U.S. Food and Drug Administration (FDA). This book
reflects the views of the authors and should not be construed to represent FDA’s views or policies.
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Library of Congress Cataloging-in-Publication Data
Wagner, Galen S., author.
Marriott’s practical electrocardiography. — Twelfth edition / Galen S. Wagner, David G. Strauss.
p. ; cm.
Practical electrocardiography
Includes bibliographical references and index.
ISBN 978-1-4511-4625-7 (alk. paper)
I. Strauss, David G., author. II. Title. III. Title: Practical electrocardiography.
[DNLM: 1. Electrocardiography. 2. Heart Diseases—diagnosis. WG 140]
RC683.5.E5
616.1’207547—dc23
2013036495
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10 9 8 7 6 5 4 3 2 1
Dedicated to Marilyn Wagner, Mya Sjogren,
and Molly and Michael Strauss
Contents
Digital Contents
Contributors
Foreword
Preface
SECTION I: BASIC CONCEPTS
CHAPTER 1 CARDIAC ELECTRICAL ACTIVITY
Galen S. Wagner, Tobin H. Lim, and David G. Strauss
The Book: Marriott’s Practical Electroardiography, 12th Edition
The Electrocardiogram
Anatomic Orientation of the Heart
The Cardiac Cycle
Cardiac Impulse Formation and Conduction
Recording Long-Axis (Base-Apex) Cardiac Electrical Activity
Recording Short-Axis (Left versus Right) Cardiac Electrical Activity
CHAPTER 2 RECORDING THE ELECTROCARDIOGRAM
Galen S. Wagner, Raymond R. Bond, Dewar D. Finlay, Tobin H. Lim,and David G.
Strauss
The Standard 12-Lead Electrocardiogram
Correct and Incorrect Electrode Placements
Alternative Displays of the 12 Standard Electrocardiogram Leads
Alternative Electrode Placement
Other Practical Points for Recording the Electrocardiogram
CHAPTER 3 INTERPRETATION OF THE NORMAL
ELECTROCARDIOGRAM
Galen S. Wagner, Tobin H. Lim, David G. Strauss, and Jacob Simlund
Electrocardiographic Features
Rate and Regularity
P-Wave Morphology
The PR Interval
6
Morphology of the QRS Complex
Morphology of the ST Segment
T-Wave Morphology
U-Wave Morphology
QTc Interval
Cardiac Rhythm
CHAPTER 4 THE THREE-DIMENSIONAL
ELECTROCARDIOGRAM
Charles W. Olson, E. Harvey Estes, Jr., Vivian Paola Kamphuis, Esben A. Carlsen,
David G. Strauss, and Galen S. Wagner
Perspective
Three-Dimensional Electrocardiography
Depolarization—The QRS Vector Loop
The Vectorcardiogram
Recording a Vectorcardiogram
The Vectorcardiogram and the Electrocardiogram
Visualizing Vector Loops from the Electrocardiogram
SECTION II: ABNORMAL WAVE MORPHOLOGY
CHAPTER 5 CHAMBER ENLARGEMENT
David G. Strauss, Ljuba Bacharova, Galen S. Wagner, and Tobin H. Lim
Chamber Enlargement
Atrial Enlargement
Systematic Approach to the Evaluation of Atrial Enlargement
Ventricular Enlargement
Right-Ventricular Dilation
Right-Ventricular Hypertrophy
Left-Ventricular Dilation
Left-Ventricular Hypertrophy
Ventricular Enlargement
CHAPTER 6 INTRAVENTRICULAR CONDUCTION
ABNORMALITIES
David G. Strauss, Tobin H. Lim, and Galen S. Wagner
Normal Conduction
Bundle-Branch and Fascicular Blocks
Unifascicular Blocks
Bifascicular Blocks
Systematic Approach to the Analysis of Bundle-Branch and Fascicular Blocks
Clinical Perspective on Intraventricular-Conduction Disturbances
CHAPTER 7 VENTRICULAR PREEXCITATION
Galen S. Wagner
Historical Perspective
Clinical Perspective
7
Pathophysiology
Electrocardiographic Diagnosis of Ventricular Preexcitation
Electrocardiographic Localization of the Pathway of Ventricular Preexcitation
Ablation of Accessory Pathways
CHAPTER 8 INHERITED ARRHYTHMIA DISORDERS
Albert Y. Sun and Galen S. Wagner
The Long QT syndrome
Electrocardiographic Characteristics
Electrocardiogram as Used in Diagnosis
The Short QT syndrome
Electrocardiographic Characteristics
Electrocardiogram as Used in Diagnosis
The Brugada Syndrome
Arrhythmogenic Right-Ventricular Cardiomyopathy/Dysplasia
J Wave Syndrome
CHAPTER 9 MYOCARDIAL ISCHEMIA AND INFARCTION
David G. Strauss, Peter M. van Dam, Tobin H. Lim, and Galen S. Wagner
Introduction to Ischemia and Infarction
Electrocardiographic Changes
CHAPTER 10 SUBENDOCARDIAL ISCHEMIA FROM
INCREASED MYOCARDIAL DEMAND
David G. Strauss, Tobin H. Lim, and Galen S. Wagner
Changes in the ST Segment
CHAPTER 11 TRANSMURAL MYOCARDIAL ISCHEMIA
FROM INSUFFICIENT BLOOD SUPPLY
David G. Strauss, Tobin H. Lim, and Galen S. Wagner
Changes in the ST Segment
Changes in the T Wave
Changes in the QRS Complex
Estimating Extent, Acuteness, and Severity of Ischemia
CHAPTER 12 MYOCARDIAL INFARCTION
David G. Strauss, Tobin H. Lim, and Galen S. Wagner
Infarcting Phase
Chronic Phase
Myocardial Infarction and Scar in the Presence of Conduction Abnormalities
CHAPTER 13 MISCELLANEOUS CONDITIONS
Galen S. Wagner and David G. Strauss
Cardiomyopathies
Pericardial Abnormalities
Pulmonary Abnormalities
Intracranial Hemorrhage
8
Endocrine and Metabolic Abnormalities
Electrolyte Abnormalities
Drug Effects
SECTION III: ABNORMAL RHYTHMS
CHAPTER 14 INTRODUCTION TO ARRHYTHMIAS
Galen S. Wagner and David G. Strauss
Approach to Arrhythmia Diagnosis
Problems of Automaticity
Problems of Impulse Conduction: Block
Problems of Impulse Conduction: Reentry
Clinical Methods for Detecting Arrhythmias
Dynamic (Holter) Monitoring
Transtelephonic Monitoring
Memory Loop Monitoring
Invasive Methods of Recording the Electrocardiogram
Incidences of Arrhythmias in Healthy Populations
Ladder Diagrams
CHAPTER 15 PREMATURE BEATS
Galen S. Wagner
Premature Beat Terminology
Differential Diagnosis of Wide Premature Beats
Mechanisms of Production of Premature Beats
Atrial Premature Beats
Junctional Premature Beats
Ventricular Premature Beats
The Rule of Bigeminy
Right- versus Left-Ventricular Premature Beats
Multiform Ventricular Premature Beats
Groups of Ventricular Premature Beats
Ventricular Premature Beats Inducing Ventricular Fibrillation
Prognostic Implications of Ventricular Premature Beats
CHAPTER 16 ACCELERATED AUTOMATICITY
Galen S. Wagner
Introduction to Accelerated Automaticity
Sinus Tachycardia
Atrial Tachyarrhythmias
Accelerated Junctional Rhythm
Accelerated Ventricular Rhythm
CHAPTER 17 REENTRANT ATRIAL TACHYARRHYTHMIAS
—THE ATRIAL FLUTTER/FIBRILLATION
SPECTRUM
Galen S. Wagner and David G. Strauss
9
Paroxysmal Atrial Tachycardia
Atrial Rate and Regularity in Atrial Flutter/Fibrillation
Ventricular Rate and Regularity in Atrial Flutter/Fibrillation
Onset of Atrial Flutter/Fibrillation
Termination of Atrial Flutter/Fibrillation
Atrial Flutter
Patterns of Atrioventricular Conduction
Atrial Fibrillation
Characteristics of the f Waves of Atrial Fibrillation
Patterns of Atrioventricular Conduction
Atrial Flutter/Fibrillation with Ventricular Preexcitation
CHAPTER 18 REENTRANT JUNCTIONAL
TACHYARRHYTHMIAS
Marcel Gilbert, Galen S. Wagner, and David G. Strauss
Introduction to Reentrant Junctional Tachyarrhythmias
Varieties of Reentrant Junctional Tachyarrhythmias
Conduction through the Atria and Ventricles
Differentiation from Other Tachyarrhythmias
Differentiation between AV Nodal and AV-Bypass Tachycardias
The Two Varieties of AV Nodal Tachycardia
The Three Varieties of AV-Bypass Tachycardia
CHAPTER 19 REENTRANT VENTRICULAR
TACHYARRHYTHMIAS
Marcel Gilbert, Galen S. Wagner, and David G. Strauss
Varieties of Ventricular Tachyarrhythmias
Description
Etiologies
Diagnosis
Variation of Duration in Ventricular Tachycardia
Variations in the Electrocardiographic Appearance of Ventricular Tachycardia: Torsades de
Pointes
Ventricular Flutter/Fibrillation
CHAPTER 20 VENTRICULAR VERSUS
SUPRAVENTRICULAR WITH ABERRANT
CONDUCTION
Galen S. Wagner
Circumstances Producing Aberrancy
Characteristics
Ventricular Aberration Complicating Atrial Flutter/Fibrillation
Critical Rate
Paradoxical Critical Rate
CHAPTER 21 DECREASED AUTOMATICITY
Galen S. Wagner
Mechanisms of Bradyarrhythmias of Decreased Automaticity
10