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Hypocalcemia

Other ECG Findings

Pulmonary Embolism

Chronic Cor Pulmonale

Early Repolarization

Hypothermia

Accessory Conduction Pathways and Preexcitation Syndromes

Supraventricular Versus Ventricular Tachycardia

Brugada Syndrome

Take-Home Points

15. Coronary Heart Disease and the 12-Lead ECG

Coronary Circulation

Coronary Heart Disease

Thrombus Formation and Lysis

Myocardial Ischemia, Injury, and Infarction

Pathophysiology of Myocardial Infarction

Take-Home Points

16. ECG Diagnosis of Myocardial Infarction

Septal Myocardial Infarction

Anterior Myocardial Infarction

Anteroseptal Myocardial Infarction

Lateral Myocardial Infarction

Anterolateral Myocardial Infarction

Extensive Anterior Myocardial Infarction

Inferior Myocardial Infarction

Posterior Myocardial Infarction

Right Ventricular Myocardial Infarction

Diagnosing MI in the Presence of Bundle Branch Block

Diagnosing MI in the Presence of Left Ventricular Hypertrophy

Distinguishing Pericarditis from Myocardial Infarction

Take-Home Points

17. Diagnosis and Treatment of Acute Coronary Syndrome

Presentation of Myocardial Infarction

History Taking in Suspected Acute Coronary Syndrome

Signs and Symptoms of Acute Coronary Syndrome

Management of Acute Coronary Syndrome

Goals of Management

Management of Specific Conditions

Take-Home Points

A. Methods of Determining the QRS Axis

B. Answers to Chapter Review Questions

C. Rhythm Interpretation: Self-Assessment

D. Self-Assessment Answer Key

As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Library of Congress Cataloging-in-Publication Data

Names: Huszar, Robert J. | Wesley, Keith. | Huszar, Robert J. Basic dysrhythmias.

Title: Huszar’s ECG and 12-lead interpretation. Other titles: Basic dysrhythmias | ECG and 12-lead interpretation

Description: Fifth edition / Keith Wesley, MD, FACEP, medical director, HealthEast Medical Transportation, St. Paul, Minnesota [and] medical director, United Emergency Medical Response, Wisconsin Rapids,

Wisconsin.

| St. Louis, Missouri : Elsevier, [2017] | Originally published as: Basic dysrhythmias : interpretation and management / Robert J. Huszar (St. Louis : Mosby, 1988). | Includes index.

Identifiers: LCCN 2016028810 | ISBN 9780323355759 (pbk.)

Subjects: LCSH: Arrhythmia. | Electrocardiography--Interpretation.

Classification: LCC RC685.A65 H89 2017 | DDC 616.1/207547--dc23

LC record available at https://lccn.loc.gov/2016028810

Content Strategist: Sandra Clark

Content Development Manager: Jean Sims Fornango

Content Development Specialist: Nicholson & Stillwell

Publishing Services Manager: Hemamalini Rajendrababu

Project Manager: Andrea Lynn Villamero

Design Direction: Renee Duenow

Printed in China

Last digit is the print number: 9 8 7

articles and papers and is a frequent speaker at state and national conferences. He is currently on the editorial board of JEMS magazine.

An active member of the American College of Emergency Physicians and the National Association of EMS Physicians, Dr. Wesley has been actively involved in creating educational programs for medical and nursing students, EMTs, and physicians.

When not engaged in EMS duties, Dr. Wesley enjoys spending time with his wife, Karen, who is a retired police officer and tactical paramedic. They live in Eau Claire, Wisconsin, with their golden retriever, Charly, and shitzu, Sammie.

Publisher’s Note

The author and publisher have made every attempt to check dosages and advanced life support content for accuracy. The care procedures presented here represent accepted practices in the United States. They are not offered as a standard of care. Advanced life support–level emergency care is performed under the authority of a licensed physician. It is the student’s responsibility to know and follow local care protocols as provided by his or her medical advisors. It is also the student’s responsibility to stay informed of emergency care procedure changes, including the most recent guidelines set forth by the American Heart Association and printed in their textbooks.

Preface

This text was written to teach medical, nursing, and EMS providers basic skills in cardiac rhythm interpretation. It also provides a wealth of advanced instruction in the clinical signs, symptoms, and management of patients presenting with cardiac dysrhythmias.

With the advent of ECG monitoring has come readily accessible 12-lead electrocardiography, an essential tool in the detection and management of acute coronary syndromes. Accordingly, this edition has several chapters dedicated to 12-lead ECG interpretation. The book also offers in-depth coverage of the pathophysiology, clinical signs and symptoms, and management of acute coronary syndromes.

Each rhythm is first presented in its classic form, with a quickreference box outlining its unique characteristics. The accompanying text contains a detailed explanation of these features, as well as a discussion of the range of normal variability and the possible exceptions to each pattern. Many of the rhythm strips are from real patients. Thus they do not necessarily have all of the classic characteristics described in the text. That’s the challenge of ECG rhythm interpretation.

The treatment algorithms are based on the latest resuscitation guidelines issued by the American Heart Association and the American College of Cardiology. However, because the science continues to evolve and local policy and protocol may vary, it’s important to stay abreast of new treatments as they evolve.

This edition of the text offers information in a more visual format that allows quick reference and review.

ECG Keys Boxes

Skillful diagnosis and treatment of rhythm disorders are based on mastery of a body of foundational knowledge. ECG Keys boxes highlight this core information, such as clinical indications and end points for administration of certain agents.

Author’s Notes

It’s critical to be aware of the broad range of variables that might make a patient’s rhythm look less than classic. In Author’s Notes, Dr. Wesley points out some of these considerations. Many of the notes pertain to diagnosis or treatment and not strictly interpretation. For example, Dr. Wesley advises asking patients about discomfort, not just pain, when taking a history. Author’s Notes also point out ways in which Dr. Wesley’s recommendations may differ from the course of action suggested in other texts or required by local protocol.

Key Definitions

This text contains a full glossary. Key Definitions call attention to the most relevant terms, making them easily accessible while you’re reviewing the surrounding topics. These on-page definitions often elaborate on the information given in the glossary.

Take-Home Points

When you don’t have time to read or re-read an entire chapter, Take-Home Points hit the highlights. This bulleted summary gives you need-to-know information about the most important topics covered.

Chapter Review Questions

The Chapter Review Questions section lets you check your knowledge of the main points presented. Along with the self-

The editors wish to acknowledge the reviewers of the fifth edition of this book for their invaluable assistance in developing and finetuning this manuscript.

Vincent M. DiGiulio Jr. BS, EMT-CC, EMT–Critical Care, Binghamton, New York

Prof.

Hugh Grantham, ASM, MBBS, FRACGP, Professor of Paramedics, Flinders University, South Australia

Brent M. Lopez, MSN, RN, LPN Instructor, Applied Tech, St Louis, Missouri

Lane Miller, MBA/HCM, BS/BM, Adjunct Faculty, Community College of Baltimore County, Baltimore, Maryland

Brooks Walsh, MD, Attending Physician, Department of Emergency Medicine, Bridgeport Hospital–Yale-New Haven, Bridgeport, Connecticut

Our continued thanks also go out to the previous edition reviewers, whose hard work continues to contribute to the ongoing success of this book: Robert Carter, Kevin T. Collopy, Robert Cook, Robert Elling, Janet Fitts, Timothy Frank, Mark Goldstein, Glen A. Hoffman, Robert L. Jackson, Kevin B. Kraus, Lynn PierzchalskiGoldstein, Ronald N. Roth, Mikel Rothenburg, Judith Ruple, Ronald D. Taylor, Glen Treankler, Andrew W. Stern, David L. Sullivan, and Gilbert N. Taylor.

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