The electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-in-Chief: Rim Halaby

Fundamentals of EKG

Basic Principles of Interpretation of an EKG

• Introduction to EKG
• How to read an EKG
• Normal sinus rhythm
• QRS axis and voltage
• Overall Overview on Electrocardiography

EKG Complexes

• P wave
• QRS complex
• ST segment
• T wave

EKG Intervals

• PR interval
• QRS interval
• QT interval
• ST interval

Abnormal Findings in EKG

• P wave alternans
• Retrograde P wave
• PR interval alternans
• QRS complex alternans
• Low QRS voltage
• Poor R wave progression
• T wave alternans
• Nonspecific ST-segment and T-wave changes
• T wave inversion
• QT prolongation
• Tombstone ST elevation
• U wave
• Osborn wave
• H wave
• K wave
• Delta wave
• NSSTW changes

Conduction System

• Cardiac pacemaker
• SA node
• AV node
• Bundle of His
• Purkinje fibers

EKG Abnormalities in Disease States

Tachyarrhythmias

Atrial Arrhythmias

• Sinus Tachycardia
• Premature Atrial Contractions (PACs)
• Ectopic Atrial Rhythm
• Paroxysmal Atrial Tachycardia (PAT)
• Paroxysmal Atrial Tachycardia (PAT) with Block
• Multifocal Atrial Tachycardia (MAT)
• Atrial Flutter
• Atrial Fibrillation
• Wandering atrial pacemaker

Ventricular Arrhythmias

• Ventricular tachycardia
• Ventricular fibrillation
• Differential Diagnosis of Tachycardia with a Wide QRS Complex
• Accelerated Idioventricular Rhythm
• Ventricular Parasystole
• Premature Ventricular Contractions
• Ventricular Tachycardia Including Torsades De Pointes and Polymorphic Ventricular Tachycardia
• Sudden cardiac death

Bradycardia and Conduction Abnormalities

• Sinus bradycardia
• First Degree AV Block
• Second Degree AV Block
• Complete or Third-Degree AV Block
• Concealed conduction
• AV Junctional Rhythms
• Wolff-Parkinson-White Syndrome
• Left Bundle Branch Block
  • LAHB
  • LPHB
• Right Bundle Branch Block
• Trifascicular block

Diagnosis of Hypertrophy and Enlargement

• Electrocardiographic Findings in Left Ventricular Hypertrophy (LVH)
• Electrocardiographic Findings in Right Ventricular Hypertrophy (RVH)
• Electrocardiographic Findings in Biventricular Hypertrophy
• Electrocardiographic Findings in Left Atrial Enlargement
• Electrocardiographic Findings in Right Atrial Enlargement
• Electrocardiographic Findings in Biatrial Enlargement

Electrocardiographic Abnormalities in Different Disease States

• The EKG in the Patient with an Atrial Septal Defect (ASD)
• EKG Changes of Hypothermia
• EKG Abnormalities in CNS Disease
• The EKG of Cardiac Transplantation
• The EKG in a Patient with a Pacemaker
• Electrocardiography of Traumatic Heart Disease

Drug Effects on the EKG

• Digitalis
• Quinidine
• Procainamide
• Disopyramide
• Lidocaine
• Tocainide and Mexiletine
• Phenytoin
• Encainide, Flecainide and Propafenone
• β-blockers
• Amiodarone
• Bretylium
• Ca Channel Blockers
• Adenosine
• Phenothiazines
• Tricyclic Antidepressants
• Lithium

EKG in Electrolyte Disturbances

• The EKG in Hyperkalemia
• The EKG in Hypokalemia
• The EKG in Hypercalcemia
• The EKG in Hypocalcemia

Additional Information

• History of the EKG