Enfermeria

ABC OF
CLINICAL ELECTROCARDIOGRAPHY

FRANCIS MORRIS
JUNE EDHOUSE
WILLIAM J BRADY
JOHN CAMM
BMJ Books

ABC OF
CLINICAL ELECTROCARDIOGRAPHY

ABC OF
CLINICAL ELECTROCARDIOGRAPHY

Edited by
FRANCIS MORRIS
Consultant in Emergency Medicine, Northern General Hospital, Sheffield

JUNE EDHOUSE
Consultant in Emergency Medicine, Stepping Hill Hospital, Stockport

WILLIAM J BRADYAssociate Professor, Programme Director, and Vice Chair, Department of Emergency
Medicine, University of Virginia, Charlottesville, VA, USA
and

JOHN CAMM
Professor of Clinical Cardiology, St George’s Hospital Medical School, London

© BMJ Publishing Group 2003

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted, in any form orby any means, electronic, mechanical, photocopying,
recording and/or otherwise, without the prior written permission of the publishers.
First published in 2003
by BMJ Books, BMA House, Tavistock Square,
London WC1H 9JR
www.bmjbooks.com
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 0 7279 1536 3
Typeset by BMJElectronic Production
Printed and bound in Spain by GraphyCems, Navarra
Cover image depicts a chest x ray and electrocardiogram trace
Composite image of an electrocardiogram trace showing termination of atrioventricular nodal
re-entrant tachycardia, overlaid onto a false-coloured chest x ray
With permission from Sheila Terry/Science Photo Library

Contents
Contributors

vi

Prefacevii

1

Introduction. I—Leads, rate, rhythm, and cardiac axis
Steve Meek, Francis Morris

1

2

Introduction. II—Basic terminology
Steve Meek, Francis Morris

5

3

Bradycardias and atrioventricular conduction block
David Da Costa, William J Brady, June Edhouse

9

4

Atrial arrhythmias
Steve Goodacre, Richard Irons

13

5

Junctional tachycardias
Demas Esberger,Sallyann Jones, Francis Morris

17

6

Broad complex tachycardia—Part I
June Edhouse, Francis Morris

21

7

Broad complex tachycardia—Part II
June Edhouse, Francis Morris

25

8

Acute myocardial infarction—Part I
Francis Morris, William J Brady

29

9

Acute myocardial infarction—Part II
June Edhouse, William J Brady, Francis Morris

33

10

Myocardial ischaemiaKevin Channer, Francis Morris

37

11

Exercise tolerance testing
Jonathan Hill, Adam Timmis

41

12

Conditions affecting the right side of the heart
Richard A Harrigan, Kevin Jones

45

13

Conditions affecting the left side of the heart
June Edhouse, R K Thakur, Jihad M Khalil

49

14

Conditions not primarily affecting the heart
Corey Slovis, Richard Jenkins

5315

Paediatric electrocardiography
Steve Goodacre, Karen McLeod

57

16

Cardiac arrest rhythms
Robert French, Daniel DeBehnke, Stephen Hawes

61

17

Pacemakers and electrocardiography
Richard Harper, Francis Morris

66

18

Pericarditis, myocarditis, drug effects, and congenital heart disease
Chris A Ghammaghami, Jennifer H Lindsey

70

Index

75

vContributors
William J Brady
Associate Professor, Programme Director, and Vice Chair,
Department of Emergency Medicine, University of Virginia,
Charlottesville, VA, USA
Kevin Channer
Consultant Cardiologist, Royal Hallamshire Hospital, Sheffield
David Da Costa
Consultant Physician, Northern General Hospital, Sheffield

Jonathan Hill
Specialist Registrar in Cardiology, Barts and the London
NHSTrust
Richard Irons
Consultant in Accident and Emergency Medicine, Princess of
Wales Hospital, Bridgend
Richard Jenkins
Specialist Registrar in General Medicine and Endocrinology,
Northern General Hospital, Sheffield

Daniel De Behnke
Department of Emergency Medicine, Medical College of
Wisconsin, Milwaukee, WI, USA

Kevin Jones
Consultant Chest Physician, Bolton Royal Hospital...