The 12-Lead Electrocardiogram for Nurses and Allied Professionals

By Dr. Mark Cowan

The purpose of this book is to teach nurses and other allied health professionals how to easily and confidently interpret 12-lead electrocardiograms using the principles of pattern recognition. We begin with some basic principles and then move on to more specific clinical topics. Areas covered include right and left bundle branch block as well as the fascicular blocks. A fast and easy way to determine axis deviation is presented. Other topics include chamber enlargement and hypertrophy. There is an elaborate section on coronary artery disease including the patterns associated with myocardial infarction. Numerous rhythm and conduction abnormalities are also examined. Special clinical cases such as pericarditis, Wolff Parkinson White, and permanent pacemaker patterns are also reviewed. All of the topics have a strong clinical correlation. The last section is a ten-case review to test the readers’ knowledge of the fundamental materials presented.

• Language: English
• Publisher: Page Publishing, Inc.
• Release date: Jun 23, 2017
• ISBN: 9781635686982

Book preview

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The 12-Lead Electrocardiogram

for Nurses and

Allied Professionals

Mark D. Cowan, MD, FACP, FACC, FHRS

Director, Clinical Cardiac Electrophysiology and Arrhythmia Service

UP Health System–Marquette

A Duke Life Point Hospital

Marquette, Michigan

Copyright © 2017 Dr. Mark Cowan

All rights reserved

First Edition

PAGE PUBLISHING, INC.

New York, NY

First originally published by Page Publishing, Inc. 2017

ISBN 978-1-63568-697-5 (Paperback)

ISBN 978-1-63568-698-2 (Digital)

Printed in the United States of America

Preface

The purpose of this book is to teach nurses and other allied health professionals how to easily and confidently interpret 12-lead electrocardiograms (ECGs). Using principles of pattern recognition, one could teach an individual with essentially no medical knowledge how to be fairly accomplished at interpreting electrocardiograms.

Many ECG books can be confusing and difficult to understand, especially when applying the information to actual patients and their clinical situations. For example, many books will spend a great deal of time devoted to axis deviation using complex graphs and diagrams in order to calculate a specific number. However, they may not explain what the significance of the axis deviation really is and how it applies to the patient. This book, by use of pattern recognition, can teach you how to determine the QRS axis in only a few seconds. Quite simply, you only need to know if the axis is normal, leftward, or rightward. Once this has been determined, we will show you how it applies to the patient.

Pattern recognition principles discussed in this book only require a limited number of the leads to look at. You do not have to concentrate on all 12 leads of the recording. The patterns tend to be represented in only a select handful of leads, making ECG interpretation easier.

We will begin with some basic principles and then move on to more specific topics. The topics include conduction abnormalities, such as right and left bundle branch block and the fascicular blocks. We will then look at a fast and easy way to determine axis deviation and what it means. Other topics covered will include chamber enlargement and hypertrophy, as well as, coronary artery disease including ischemia and myocardial infarction, both acute and remote.

Rhythm abnormalities such as atrial fibrillation and atrial flutter will also be examined. We will also cover all degrees of AV block, and review some special cases such as Wolff Parkinson White syndrome and permanent pacemaker patterns.

Once you learn to use pattern recognition, you will appreciate the fact that you can easily interpret 12-lead electrocardiograms and be a more valuable asset to your healthcare team. This will make your work situation more comfortable and enjoyable. You will also have the personal satisfaction of knowing that you can do this confidently.

Acknowledgments

I would like to thank Emily Carefoot for her excellent editorial assistance and to Angela Harris for her exceptional help in preparing the manuscript. I am indebted to Heather Retaskie for her help with the illustrations. I would also like to acknowledge the fine staff of the Cardiographics Department at UP Health Systems Marquette.

I would especially like to thank all of the wonderful people at Page Publishing in New York, particularly Phil Brown and Courtney Crum.

Dedication:

For Stacy, Heather and Bradley

Chapter 1

Basic Anatomy and Physiology

Before we begin to look at specific patterns needed to interpret ECGs, we are going to need to establish a common frame of reference; the electrical system of the heart.

If you look at an actual specimen of the heart, it seems as though the whole heart is all connected together. However, from an electrical standpoint, the upper chambers, called atria, are separated from the lower chambers, called ventricles. The separation occurs at the four valve annuli, which all lie in the same plane separating the atria from the ventricles. Electrical impulses can only pass from the atria to the ventricles through the normal conduction system, which occurs at one location in the floor of the right atrium.

The normal electrical impulse originates in the sinus node or SA node, which is located in the right