Dr. Malcolm Thaler MD - The Only EKG Book You’ll Ever Need

NINTH EDITION

MALCOLM S. THALER, M.D.

Physician, Internal Medicine, One Medical

Clinical Instructor in Medicine, Weill Cornell Medical College

Medical Staff, New York Presbyterian Hospital

New York, New York

Executive Editor: Rebecca Gaertner

Senior Product Development Editor: Kristina Oberle

Production Project Manager: Marian Bellus

Marketing Manager: Rachel Mante Leung

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Ninth edition

Copyright 2019 Wolters Kluwer

2015 by Wolters Kluwer; 1988 by Lippincott Williams & Wilkins; 1995 by J.B. Lippincott; 1999, 2002, 2007, 2010, 2012 by Lippincott Williams & Wilkins

All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer Health at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at (products and services).

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Printed in China

Library of Congress Cataloging-in-Publication Data

Names: Thaler, Malcolm S., author.

Title: The only EKG book youll ever need / Malcolm S. Thaler.

Description: Ninth edition. | Philadelphia : Wolters Kluwer, [2019] | Includes index.

Identifiers: LCCN 2017053867 | eISBN 9781975106072

Subjects: | MESH: Electrocardiography | Heart Diseasesdiagnosis | Case Reports

Classification: LCC RC683.5.E5 | NLM WG 140 | DDC 616.1/207547dc23 LC record available at https://lccn.loc.gov/2017053867

This work is provided as is, and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals' examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments.

Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer's package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contradictions, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.

LWW.com

For Nancy, Ali, Jon, and Tracey tooas well as for everyone toiling in the health care profession, trying to make peoples lives happier and healthier.

The torrid pace of technologic and scientific evolution shows no signs of letting up, and clinical medicine is both its beneficiary and, conspicuously, its victim, too, as we seem to have less and less time to actually spend with our patients. It is therefore comforting to know that at least one old friend still stands tallthe EKG. Almost 30 years have passed since the first edition of this little book, and nothing has yet supplanted the EKG as the essential tool for diagnosing many cardiac disorders (and many noncardiac ones as well). Does your patient have chest pain?get an EKG! Does your patient have palpitations?get an EKG! Syncope or dizziness?you get the point.

These three decades have not dimmed the principles outlined in the preface to the first edition:

This book is about learning. Its about keeping simple things simple, and complicated things clear, concise and, yes, simple, too. Its about getting from here to there without scaring you to death, boring you to tears, or intimidating your socks off. Its about turning ignorance into knowledge, knowledge into wisdom, and all with a bit of fun.

If I were writing this today, I would probably reword that business about the socks, but the sentiments remain and are, I hope, ones you share. New material has been added as new developmentsand there have been manyhave called for it, and everything is always discussed within its proper clinical context by putting you, the reader, right in the middle of real life situations. EKGs are not used in isolation; they are just one piecealbeit an important pieceof the puzzle that every patient presents and that you and I have to figure out over and over again.

I want to offer a very special thanks to Dr. Adam Skolnick, M.D., Associate Professor of Medicine, Leon H. Charney Division of Cardiology, NYU Langone Medical Center, whose keen editorial eye, incisive analysis, and unsurpassed expertise are the best guarantee that you will be reading the most current, clear, and accurate text that anyone could hope for. And allow me to add a shout out to Dr. Jeffrey Lorin, Assistant Professor of Medicine at NYU Medical Center, who graciously opened up his world-class collection of EKGs so that we all could benefit.

A special thank you as always to the wonderful folks at Wolters Kluwerlet me give a very personal standing ovation to Kristina Oberle and Rebecca Gaertnerwho always produce a beautiful, polished, limpid book (and have the good sense to edit out words like limpid when words such as clear and readable are far more serviceable and, well, limpid). They make every edition a joy to work on.

For those of you picking up this book for the first timeas well as for those of you coming back for a return visitI hope The Only EKG Book You Will Ever Need provides you with everything you need to start reading EKGs quickly and accurately.

Malcolm S. Thaler, M.D.

Getting Started

In this chapter you will learn:

1 | not a thing, but dont worry. There is plenty to come. Here is your chance to turn a few pages, take a deep breath or two, and get yourself settled and ready to roll. Relax. Pour some tea. Begin.