Malcolm S. Thaler MD - The Only EKG Book Youll Ever Need

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All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, 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.

Printed in China

Library of Congress Cataloging-in-Publication Data

Thaler, Malcolm S.

The only EKG book youll ever need / Malcolm S. Thaler. 7th ed.

p. ; cm.

Includes index.

ISBN 978-1-4511-1905-3

I. Title.

[DNLM: 1. Electrocardiography. 2. Heart Diseasesdiagnosis. WG 140]
616.1207547dc23

2011041429

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner.

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Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.

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Dedication

To Nancy, Ali, and Jonof course

Preface

New content! New cases! New color! New clinical pearls! Yet even as we keep adding, changing, and improving, the fundamentals remain. Its been about 25 years since the first edition of this little book, and we have remained resolute to the principles outlined in that very first preface:

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 .

We must be doing something right, because each year The Only EKG Book You Will Ever Need becomes more popular, more widely translated, and adopted and used in more medical and other professional schools.

This edition offers a host of revisions and refinements:

A whole new palette of colors to make the models, illustrations, and tracings clearer than ever

New clinical cases to expand on one of the most important distinctions of the book: to put everything into its proper clinical context (you are put right into the middle of real-life clinical situations) and to make the information usable

Expanded sections on subjects where new developments have made deeper understanding possible, including atrial fibrillation, long QT syndrome, apical ballooning syndrome, and others

Greater clarity where it is called for, new tracings where they help illuminate the points we are trying to make, andwherever possible shortening and simplifying

As ever, hats off to Glenn Harper, M.D., the worlds greatest cardiologist, whose help was invaluable in ensuring the text is up-to-date, clear, and accurate. And remove two more hats for Kerry Barrett and Sonya Seigafuse, who continue to lead the Lippincott Williams & Wilkins team thatyear after year, edition after editionproduces the best-looking, most readable EKG book that one could hope for.

To those of you who are picking up this book for the first time and for those of you who are making a return visit, I hope The Only EKG Book You Will Ever Need will provide you with everything you need to read EKGs quickly and accurately.

Malcolm Thaler, M.D .

Contents

Getting Started

In this chapter you will learn:

On the opposite page is a normal electrocardiogram, or EKG. By the time you have finished this bookand it wont take very much time at allyou will be able to recognize a normal EKG almost instantly. Perhaps even more importantly, you will have learned to spot all of the common abnormalities that can occur on an EKG, and you will be good at it!

Some people have compared learning to read EKGs with learning to read music. In both instances, one is faced with a completely new notational system not rooted in conventional language and full of unfamiliar shapes and symbols.

But there really is no comparison. The simple lub-dub of the heart cannot approach the subtle complexity of a Beethoven string quartet (especially one of the late ones!), the multiplying tonalities and rhythms of Stravinskys Rite of Spring, or the extraordinary jazz interplay of Keith Jarretts Standards trio.

Theres just not that much going on.

The EKG is a tool of remarkable clinical power, remarkable both for the ease with which it can be mastered and for the extraordinary range of situations in which it can provide helpful and even critical information. One glance at an EKG can diagnose an evolving myocardial infarction, identify a potentially life-threatening arrhythmia, pinpoint the chronic effects of sustained hypertension or the acute effects of a massive pulmonary embolus, or simply provide a measure of reassurance to someone who wants to begin an exercise program.