Insights into Electrocardiograms with MCQs

Foreword
Preface
Acknowledgments
Disclaimer
Contents
About the Author
1: Technical Errors and Artefacts
1 Technical Errors
1.1 Wrong Placement of Leads
1.2 Poor Electrode Contact
2 Artefacts
2.1 Related to Patient
2.2 Cable Malfunction
2.3 Electrical Noise
2.4 Artefacts Related to Motor Speed
2.5 Artefacts Related to Stylus
3 Computerized Interpretation
Summary
MCQs
References
2: Sinus Node Dysfunction
1 Etiology
2 ECG Manifestations
2.1 Sinus Node Dysfunction
2.1.1 Failure of Impulse Generation [1]
2.1.2 Failure of Impulse Transmission to Atria (Sinoatrial Exit Block)
2.2 Concomitant Intra-atrial Conduction Defect
2.3 Inadequate Subsidiary Pacemaker Activity
2.4 Escape-Capture Bigeminy
2.5 Concomitant Atrioventricular Block (Figs. 2.4b and 2.6a)
2.6 Concomitant Infra-His Conduction Defects (Figs. 2.4b, 2.6a, and 2.8b)
2.7 Repolarization Changes
Summary
MCQs
References
3: The P Wave and the PR Segment
1 Normal Sinus P Wave (Atrial Depolarization) [1]
2 Atrial Repolarization (Ta Wave) [2]
3 Atrial Depolarization Abnormalities [2, 3]
3.1 Left Atrial Depolarization Abnormality [2–4]
3.2 Right Atrial Depolarization Abnormality [1, 3, 4]
3.3 Biatrial Depolarization Abnormality [4]
4 Interatrial Block
5 Atrial Ectopics (Atrial Premature Beats, APB) [4, 5]
6 Post-Ectopic Pause [4]
7 Junctional Premature Beats [5]
8 The PR Segment [2]
Summary
MCQs
References
4: Narrow QRS Tachycardias
1 Sinus Tachycardia
2 Inappropriate Sinus Tachycardia (IST) [3]
3 Sinus Node Reentrant Tachycardia (SNRT) [3]
4 Accelerated Atrial Rhythm [2]
5 Atrial Tachycardia (Focal Atrial Tachycardia, Extra Systolic Atrial Tachycardia)
6 Multifocal Atrial Tachycardia (MAT, Chaotic Atrial Tachycardia)
7 Accelerated Junctional Rhythm
8 Atrioventricular Nodal Reentrant Tachycardia (AVNRT)
9 Orthodromic Atrioventricular Reentrant Tachycardia Using Atrioventricular Bypass Tract
10 Junctional Ectopic Tachycardia (His Bundle Ectopic Tachycardia)
Summary
MCQs
References
5: Atrial Flutter
1 Mechanism
2 Atrial Waves
3 Atrioventricular Conduction and Ventricular Rate
4 QRS Configuration
5 ST Segment
Summary
MCQs
References
6: Atrial Fibrillation
1 Mechanism
2 Atrial Waves
3 Atrioventricular Conduction and Ventricular Rate
4 QRS Configuration
5 ST Segment and T Wave Changes
Summary
MCQs
References
7: Short PR Interval, Ventricular Preexcitation
1 Introduction
2 Causes of the Short PR Interval
3 Variations in the PR Interval
4 Intermittent Shortening of the PR Interval (Intermittent Preexcitation)
5 Effect of Atrial Ectopic on the PR Interval in Preexcitation
6 Effect of Preexcitation on Amplitude of the QRS Complex
7 Repolarization Vector in Preexcitation
Summary
MCQs
References
8: Atrioventricular Accessory Path
1 Introduction
2 Localization of the Kent Bundle
2.1 Electrocardiographic Features of Preexcitation from Common Sites of the Kent Bundle [1]
2.1.1 Left Lateral
2.1.2 Left Posteroseptal
2.1.3 Right Lateral
2.1.4 Right Posteroseptal
2.1.5 Right Anteroseptal
2.1.6 Midseptal Pathway
2.2 Algorithms for Localization of Kent Bundle
3 Electrocardiographic Resemblance to Other Cardiac Abnormalities and Their Differentiation
3.1 Bundle Branch Block or Ventricular Hypertrophy
3.2 Myocardial Infarction [3]
4 Other Methods that Can Help in Correct Diagnosis of Underlying Disease
Summary
MCQs
References
9: Tachyarrhythmias Associated with Preexcitation
1 Tachyarrhythmias in which the Accessory Pathway Is Necessary for Initiation and Maintenance of the Tachycardia (WPW Syndrome)
1.1 Orthodromic AVRT
1.2 Antidromic AVRT
1.2.1 Antidromic AVRT Involving a Kent Bundle (Fig. 9.10)
1.2.2 Antidromic AVRT Involving the Atriofascicular Bypass Tract
1.3 Other Electrocardiographic Findings in AVRT
2 Tachycardias where Accessory Pathways Allow Fast Antegrade Conduction
2.1 Atrial Fibrillation [5] (Fig. 9.13)
2.2 Atrial Flutter
3 Tachycardias where the Accessory Path Is Just a Bystander (Fig. 9.17)
Summary
MCQs
References
10: Atrioventricular Block
1 First-Degree Atrioventricular Block
2 Second-Degree Atrioventricular Block
2.1 2:1 Atrioventricular Block
2.2 Mobitz Type I Second-Degree Atrioventricular Block
2.3 Mobitz Type II Second-Degree Atrioventricular Block
2.4 High-Degree Atrioventricular Block
Summary
MCQs
References
11: Third-Degree Atrioventricular Block (Complete Atrioventricular Block), Atrioventricular Dissociation
Summary
MCQs
References
12: Site and Etiology of Atrioventricular Block
1 Site of Atrioventricular Block
1.1 Following ECG Features Suggest Block at the Level of the Atrioventricular Node (Supra-His)
1.2 Block at More than One Level
1.3 Other Investigations
1.3.1 Modulation of Autonomic Tone
1.3.2 Holter Monitoring
1.3.3 External Loop Recorders or Implantable Loop Recorder
1.3.4 Electrophysiologic Study
2 Cause of Atrioventricular Block
2.1 Coronary Artery Disease
2.2 Idiopathic Progressive Fibrosis of the Conduction Tissue (Lenegre Disease)
2.3 Involvement in Fibrocalcific Pathology of the Aortic or the Mitral Annulus (Lev’s Disease)
2.4 Congenital Atrioventricular Block
2.5 Drugs
2.6 Vagotonia
2.7 Acute Rheumatic Carditis
2.8 Uncommon Causes
Summary
MCQs
References
13: Stokes-Adams’ Attacks
Summary
MCQs
Reference
14: Cardiac Pacing Systems and Their Normal Functioning
1 Nomenclature [1]
2 Indications for Various Pacemakers
3 Surface ECG in a Patient with Implanted Pacemaker
4 Normal Functioning of the Pacemaker
4.1 Normal Sensing
4.2 Normal Pacing
4.3 Retrograde Conduction of Paced QRS
Summary
MCQs
References
15: Pacemaker Malfunctions
1 Failure of Output [1] (Absence of the Pacing Spike)
2 Failure to Capture (Pacing Failure)
3 Undersensing
4 Oversensing
5 Erratic Prolongation of Spike to Spike Interval
6 Constant Pacing at a Rate Slower than the Programmed Rate
7 Constant Pacing at a Rate Faster than the Programmed Rate
8 Complications
9 ECG Diagnosis of Myocardial Infarction in Patients with Implanted Pacemaker [5]
10 Limitation
Summary
Differentiation of Pacemaker Malfunction
MCQs
References
16: Ventricular Ectopic Beats
1 Definition
2 Differentiation
3 Premature Beat vs Escape Beat
4 Site of Origin of the Ventricular Ectopic Beat
5 Configuration
6 Coupling Interval
7 Frequency (Fig. 16.6)
8 Repetitiveness
9 The ST Segment and the T Wave
10 Changes in the ECG Following a Ventricular Ectopic Beat
11 Clinical Significance [1, 2, 3]
Summary
MCQs
References
17: Broad QRS Tachycardias
1 Causes of Broad QRS Tachycardia
2 Differentiating Electrocardiographic Findings
Summary
MCQs
References
18: Ventricular Tachyarrhythmias
1 Definition
2 Accelerated Idioventricular Rhythm (Fig. 18.1)
3 Ventricular Tachycardia (VT)
3.1 Nomenclature [1, 2]
3.2 Specific Types of Ventricular Tachycardia [3–6]
4 Ventricular Flutter [2]
5 Ventricular Fibrillation [2, 5]
Summary
MCQs
References
19: The Q Wave
1 Nomenclature
2 Genesis of the Normal “Q” Wave
3 Normal Q Wave
3.1 Normal Variations in the “q” Wave
4 Other Causes of Noninfarct Q Waves [2, 3]
5 Abnormal Q Waves [1, 4]
6 Q Wave Myocardial Infarction
6.1 Localization of Myocardial Infarction by Q Wave [1, 2]
7 Q Wave Equivalent R Wave in Lead V1
7.1 Other Causes of Prominent R Wave in Lead V1
8 Differential Diagnosis of Causes of Q Waves in Different Leads
Summary
MCQs
References
20: Subtle ECG Changes in Early Phase of Anterior and Lateral Myocardial Infarction
1 Early uptake of the ST-segment
2 Tall T Waves in Leads V2 and V3
3 ST-Segment Depression
4 ST-Segment Elevation in Leads aVR and V1
5 Isolated ST-Segment Elevation in Leads I and aVL (High Lateral Myocardial Infarction)
6 ECG Changes Seen Only in Higher Intercostal Space (High Lateral Myocardial Infarction)
7 Small “q” Wave in Leads V2 and V3
8 Nonprogression of the “R” Wave
9 Reverse Progression of the R Wave
10 Ventricular Ectopics with Right Bundle Branch Block Configuration Showing “q” Wave
11 Mid QRS Change
12 Prolongation of the QT Interval
13 Inversion of the U Wave
14 Pseudonormalization of the ST-Segment During Evolution of the ECG Changes
15 Pseudonormalization with Recurrence of Ischemia in the Same Area
16 Late Appearance of the ECG Changes
17 Presentation as Atrial Fibrillation
18 Masking of Old Anterior Myocardial Infarction by Fresh Inferior Myocardial Infarction
19 Atrial Infarction
Summary
MCQs
References
21: Inferior or Posterior Myocardial Infarction
1 Notching of QRS (Mid QRS Change) in Leads II, III, and aVF
2 Prominent “R” Wave in Lead V1
3 Slight Elevation of the ST-Segment in Leads II, III, and aVF
4 Shallow T Wave Inversion in Leads II, III, and aVF
5 ST-Segment Depression in Leads I, aVL, and V2 to V6
6 Pseudonormalization of ST-Segment Elevation and Prominent T Waves
7 Normalization of the T Wave in a Patient with T Wave Inversion due to Previous Inferior Infarction
8 Prominent Upright T Wave in Leads V1 and V2
9 Inferior–Posterior–Lateral Myocardial Infarction
10 Isolated Right Ventricular Infarction
11 First-Degree Atrioventricular Block
12 Complete Atrioventricular Block
13 Atrial Fibrillation
14 Accelerated Ventricular Rhythm
Summary
MCQs
References
22: Mid–Late QRS Changes Suggestive of Myocardial Necrosis
1 Marked Loss of R Wave Voltage [2]
2 Slow (Poor) Progression of the R Wave [2]
3 Nonprogression of the R Wave
4 Reverse Progression of the R Wave
5 Slurring of the QRS Complex
6 Fragmented QRS
7 Peri-infarction Block
Summary
MCQs
References
23: Right Ventricular Infarction
1 Arterial Supply of Right Ventricle and Its Correlation with Electrocardiographic Findings
2 Correlation of Various Right Precordial Electrocardiographic Leads to Various Parts of the Right Ventricle (Fig. 23.6)
3 Correlation of Left-Sided Electrocardiographic Leads to Right Precordial Leads
4 Normal Configuration of the Electrocardiographic Wave Forms in the Right-Sided Chest Leads
5 Electrocardiographic Diagnosis of Right Ventricular Anterior Infarction
5.1 Effect of Size of Right Ventricular Infarction
5.2 Effect of Time on the ST-Segment Elevation
5.3 Differentiation from Left Ventricular Anteroseptal Infarction
5.4 Effects of Infarction of Other Walls of the Left Ventricle
5.5 Causes of ST Segment Elevation in Leads V1 to V4 R Other Than Right Ventricular Infarction
5.6 Effect of Ventricular Hypertrophy on Diagnosis of Right Ventricular Myocardial Infarction
5.7 Effect to Acute Pulmonary Embolism
5.8 Effects of Bundle Branch Block on the Diagnosis of Right Ventricular Infarction
5.9 Effects of Fascicular Blocks
5.9.1 Left Anterior Fascicular Block
5.9.2 Left Posteroinferior Fascicular Block
5.10 Effect of Left-Sided Accessory Pathway
5.11 Effect of Cardiac Malpositions
6 Electrocardiographic Diagnosis of Infarction of the Right Ventricular Inferior Wall
6.1 Leads I and aVL
6.2 The Magnitude of ST-Segment Elevation in Lead II Versus That in Lead III
6.3 ST-Segment in Leads V1 to V3
7 [G] Isolated (Pure) Right Ventricular Infarction
Summary
MCQs
Answers:
References
Untitled
24: Left Bundle Branch Block (Delay in Left Ventricular Depolarization Delay)
1 Nomenclature
2 Etiology
3 Electrocardiographic Diagnosis
4 Genesis of Electrocardiographic Findings
4.1 Leads V3 and V4 (The Transition Zone)
4.2 Leads V7 to V9
4.3 Leads V3 to V6R
5 Other Electrocardiographic Findings
5.1 S Wave in Lead V6
5.2 Left Axis Deviation
5.3 Right Axis Deviation
5.4 Prominent Negative Deflection of P Wave in Lead V1 and/or Broad and Notched P Wave in Lead II or Precordial Leads (Fig. 24.24)
5.5 Intermittent Narrow QRS
6 Effect of Left Ventricular Hypertrophy on Electrocardiographic Findings
7 Clinical Significance of Delayed Left Ventricular Depolarization
Summary
MCQs
Answers
References
25: Left Bundle Branch Block (Delay in Left Ventricular Depolarization) and Myocardial Necrosis
1 Diagnosis of Acute Myocardial Infarction
2 Old Myocardial Infarction
2.1 Changes in QRS Configuration
2.1.1 Septal Infarction
2.1.2 Inferior Infarction
2.1.3 Lateral Infarction
2.1.4 Septal+ Lateral Infarction
2.1.5 Cabrera Sign
2.1.6 Chapman Sign
2.1.7 Multiple Notches
2.1.8 Generalized Diminution in the Voltage of the QRS Complex
2.2 Changes in QRS Duration
2.3 Ventricular Ectopics
2.4 Changes in T Waves
Summary
MCQs
Answers
References
26: Left Anterior Fascicular Block (LAFB) (Delay in Left Anterosuperior Depolarization) (Left Anterior Hemiblock LAHB)
1 Nomenclature
2 Etiology
3 Electrocardiographic Diagnostic Criteria
4 Genesis of the ECG Changes
4.1 Effects on Limb Leads
4.2 Effect on Chest Leads [1, 3]
4.2.1 Leads V1 and V2
4.2.2 Leads V5 and V6
4.2.3 Right-Sided Chest Leads
4.2.4 Posterior Chest Leads
4.3 Effect on T Waves
5 Significance of Alterations in the QRS Complex
5.1 QRS Duration of 0.12 S or More [1]
5.2 Absence of q Wave in Leads I and aVL
5.3 QS or Qr in Lead I
5.4 QS Complexes in Leads II, III, and aVF
5.5 q Waves in Leads V2 to V6
6 Significance of Alteration in T Waves
7 Masking and Mimicking of Other Cardiac Disorders
7.1 Ischemic Heart Disease
7.2 Right Ventricular Hypertrophy
7.3 Left Ventricular Hypertrophy
8 Differential Diagnosis: Other Causes of Abnormal Left-Axis Deviation Include
8.1 Left Ventricular Hypertrophy [3]
8.2 Emphysema
8.3 Inferior Myocardial Infarction
8.4 Posteroseptal Preexcitation [2]
8.5 Left Coronary Injection
Summary
MCQs
Left Anterosuperior Fascicular Block
Answers
References
27: Left Posteroinferior Fascicular Block (Delay in Depolarization of the Posteroinferior Fascicle)
1 Nomenclature
2 Etiology
3 Diagnostic Criteria
3.1 Electrocardiographic Criteria
3.2 Necessary Criteria
3.3 Caveats
4 Genesis of Electrocardiographic Findings
5 Effect of Other Cardiac Disorders
5.1 Acute Myocardial Infarction
5.2 Old Anterolateral Myocardial Infarction
5.3 Infarction or Fibrosis in the Area Depolarized by the Left Anterior Fascicle
5.4 Old Inferior MI
5.5 Right Bundle Branch Block
5.6 QRS Duration of More Than 0.10 Second
5.7 Changes in the T Wave
6 Differential Diagnosis
Summary
MCQs
Answers
References
28: Right Bundle Branch Block (RBBB) (Delay in Right Ventricular Depolarization)
1 Nomenclature
2 Etiology
3 Electrocardiographic Features
4 Mechanism of ECG Changes
4.1 Ventricular Depolarization (QRS)
4.2 Posterior Leads (V7 to V9)
4.3 Right-Sided Chest Leads (V3R to V6R)
4.4 Limb Leads
5 Effect of Associated Cardiac Disorders
5.1 Atrial Enlargement
5.2 Ventricular Hypertrophy
5.3 Ventricular Dilatation
5.4 Myocardial Infarction
5.4.1 Septal Infarction
5.4.2 Anterior Myocardial Infarction
5.4.3 Other Causes of qR Pattern in Lead V1
5.4.4 Lateral Myocardial Infarction
5.4.5 Posterior Infarction
5.4.6 Right Ventricular Infarction
6 Differential Diagnosis
7 Clinical Significance
Summary
MCQs
Answers
References
29: Multifascicular Blocks (Delayed Conduction in More Than One Fascicle)
1 Bifascicular Block
1.1 Electrocardiographic Diagnosis
1.2 Clinical Significance
2 Trifascicular Block
2.1 Nomenclature
2.1.1 Electrocardiographic Diagnosis
2.2 Clinical Significance
Summary
MCQs
Answers
References
30: Other Localized Intraventricular Conduction Defects
1 Left Septal Fascicular Block (Left Middle Fibers Block)
2 Transient Intraventricular Conduction Defects
2.1 Rate-Dependent Conduction Defects (Aberration) [2]
2.1.1 Tachycardia Dependent
2.1.2 Bradycardia Dependent
2.2 Concealed Conduction in the Bundle Branches [2]
2.2.1 Antegrade
2.2.2 Retrograde
2.3 Effect of Changing Cycle Length on Refractoriness of the Conduction Tissue (Ashman Phenomenon) [2]
2.4 Peri-Ischemic Block [2]
3 Other Focal Blocks
3.1 Localized Notching in QRS [2]
3.2 Peri-Infarction Block [2]
Summary
MCQs
Answers
References
31: Chronic Left Ventricular Volume Overload
1 Etiology
2 Classical Electrocardiographic Findings of Chronic Left Ventricular Volume Overload and Their Genesis
3 Electrocardiographic Differences Amongst Various Causes of Chronic Moderate Left Ventricular Volume Overload [5]
3.1 Chronic Moderate Mitral Regurgitation (MR)
3.2 Ventricular Septal Defect with Large Left to Right Shunt
3.3 Atrioventricular Septal Defect [8]
3.4 Chronic Moderate Aortic Regurgitation [3]
4 Clinical Correlation
Summary
MCQs
References
32: Left Ventricular Systolic Overload (Pressure Overload)
1 Terminology
2 Etiology
3 Electrocardiographic Changes [3]
3.1 Abnormalities of the P Wave: Left Atrial Enlargement
3.2 Abnormalities of the QRS Complex
3.2.1 Increased Voltage of the QRS Deflection
In Limb Leads
In Precordial Leads
Combination of Limb and Precordial Leads
3.2.2 Decrease in Amplitude of Initial q Wave in Left Precordial Leads (Fig. 32.15)
3.2.3 Increase in Left Ventricular Activation Time (VAT)
3.2.4 Leftward Deviation of the Mean Frontal Plane QRS Axis
3.2.5 Counterclockwise Rotation in the Horizontal Plane
3.2.6 Fragmentation of the QRS Complex
3.3 Secondary Abnormalities of the ST-Segment and T Waves
3.4 Inversion of the U Wave in Left Precordial Leads
3.5 Prolongation of the QT Interval
3.6 Clinical Correlation
3.6.1 Systemic Hypertension
3.6.2 Aortic Stenosis (AS)
4 Conclusion
Summary
MCQs
References
33: Chronic Right Ventricular Volume Overload
1 Introduction
2 Etiology
3 Electrocardiogram
3.1 Small ASD with Small Left to Right Shunt
3.2 Large Secundum ASD with Large Left to Right Shunt
3.3 Secundum ASD with Pulmonary Artery Hypertension (PAH)
3.4 Secundum ASD with Mitral Valve Disease
3.5 Ostium Primum ASD
3.6 Sinus Venosus (Superior Vena Cava Type) Defect
3.7 Anomalous Pulmonary Venous Drainage
3.8 Nonpulmonary Artery Hypertensive Pulmonary Regurgitation [7]
4 Differential Diagnosis
4.1 Arrhythmogenic Right Ventricular Dysplasia [8]
4.2 Isolated or Dominant Right Ventricular Dilated Cardiomyopathy
4.3 Isolated Tricuspid Regurgitation Without Pulmonary Artery Hypertension
Summary
MCQs
References
34: Chronic Right Ventricular Pressure Overload (Systolic Overload)
1 Etiology
1.1 Pulmonary Artery Hypertension (PAH)
1.2 Right Ventricular Outflow Tract Obstruction
1.3 Congenital Heart Disease with Right Ventricle Attached to the Aorta
2 Electrocardiographic Changes
3 ECG Findings Depending on the Underlying Disease
3.1 Chronic Obstructive Airway Disease (COAD)
3.2 Chronic Nonobstructive Lung Diseases [7]
3.3 Congenital Heart Diseases
3.3.1 Pulmonic Stenosis (PS)
3.3.2 Tetralogy of Fallot (TOF)
3.3.3 Dextroposition of the Great Arteries (DTGA) with Intact Interventricular Septum
3.3.4 Double Outlet Right Ventricle [13]
3.3.5 General Criteria for the Diagnosis of Right Ventricular Hypertrophy in Neonates and Infants [14]
3.4 Chronic Pulmonary Thromboembolism [15]
3.5 Other Causes of Pulmonary Artery Hypertension
Summary
MCQs
References
Untitled
35: Acute Right Ventricular Pressure Overload: Acute Pulmonary Embolism
1 Small Pulmonary Embolism
2 Submassive Pulmonary Embolism [4]
3 Massive Pulmonary Embolism
4 ECG and Right Ventricular Dysfunction in Acute Pulmonary Embolism
4.1 ECG and Prognosis in Acute Pulmonary Embolism
5 ECG Findings Difficult to Explain by Right Ventricular Overload
6 Differential Diagnosis
6.1 Inferior Myocardial Infarction
6.2 Left Ventricular Anterior Myocardial Infarction
6.3 Right Ventricular Infarction (Fig. 35.9)
Summary
MCQs
References
36: Biventricular Enlargement/Hypertrophy/Overload
1 Etiology
2 Electrocardiographic Diagnosis
2.1 Specific Criteria
2.2 Nonspecific Criteria
3 Conclusions
Summary
MCQs
References
37: Hypertrophic Cardiomyopathy (HCM)
1 Genesis of ECG Changes
1.1 Genetic Factors
1.2 Site of Left Ventricular Hypertrophy
2 Other Abnormalities
2.1 Atrial Enlargement
2.2 Intraventricular Conduction Defects
2.3 Arrhythmias
2.4 ST-Segment and T Wave Changes
3 Differential Diagnosis
3.1 Myocardial Infarction
3.2 Left Ventricular Systolic Overload (Fig. 37.14b)
3.3 Exercise and Sports Cardiomyopathy [7] (Athlete’s Heart Syndrome)
3.4 Other Causes of Increased Thickness of Left Ventricular Walls on Echocardiography
3.4.1 Infiltrative Cardiomyopathies [8]
Cardiac Amyloidosis [9]
Fabry Disease
Hemochromatosis
3.4.2 Neurological Disorders
Friedreich Ataxia [10]
3.4.3 Endocrine Disorders
Acromegaly [11]
4 Clinical Correlation
Summary
MCQs
References
38: Low Voltage Electrocardiogram
1 Causes of Low Voltage QRS
1.1 Incorrect Standardization
1.2 Normal Variant Specially in the Elderly
1.3 Decreased Electrical Potentials Generated by the Myocardium
1.3.1 Multiple Infarcts [6]
1.3.2 Acute Coronary Syndrome
1.3.3 Acute Phase of Takotsubo Cardiomyopathy
1.3.4 Cardiac Amyloidosis
1.3.5 Fulminant Myocarditis
1.3.6 Dilated Cardiomyopathy
1.3.7 Heart Failure
1.3.8 Acute Pulmonary Embolism Complicated by Cardiogenic Shock
1.3.9 Hypothyroidism
1.4 Impaired Conduction of Electric Potentials to Recording Electrodes
1.4.1 Pericardial Effusion, Cardiac Tamponade
1.4.2 Pneumopericardium [29]
1.4.3 Pneumomediastinum [30]
1.4.4 Chronic Constrictive Pericarditis
1.4.5 Chronic Obstructive Pulmonary Disease
1.4.6 Left-Sided Pleural Effusion [22]
1.4.7 Left-Sided Pneumothorax [23]
1.4.8 Pulmonary Edema [32]
1.4.9 Morbid Obesity
1.4.10 Ascites
1.4.11 Edema, Anasarca
Summary
MCQs
Answers
References
39: J Point and the J Wave Syndrome
Summary
MCQs
Answers
References
40: ST-Segment Elevation
1 Causes of ST-Segment Elevation
1.1 ST-Segment Elevation with Concavity Upward
1.2 ST-Segment Elevation with Convexity Upward
2 Electrocardiographic Localization of Myocardial Infarction According to the Leads Showing ST-Segment Elevation [4] (Fig. 40.8)
3 Localization of Culprit Lesion [6, 7, 12, 16, 17]
4 Quantification of the Ischemic Burden
Summary
MCQs
Answers
References
41: ST-Segment Depression
1 Causes of ST-Segment Depression
1.1 Subendocardial Ischemia or Injury
1.1.1 Horizontal ST-Segment
1.1.2 Upsloping ST-Segment
1.1.3 Flat or Horizontal ST-Segment Depression
1.1.4 Down Sloping
2 Localization of Ischemia
2.1 Causes Other Than Ischemic Heart Disease
Summary
MCQs
Answers
References
42: T Wave: Normal Variations and Flat T Wave
1 Flat T Wave
Summary
MCQs
Answers
References
43: Prominent (Tall) T Waves
1 Causes of Prominent T Wave
1.1 Vagotonia
1.2 Early Repolarization
1.3 Ischemic Heart Disease
1.3.1 Acute Subendocardial Ischemia
1.3.2 Hyperacute Phase of Myocardial Infarction
1.3.3 Recovering Infarction
1.4 Left Bundle Branch Block
1.5 Moderate LVH with Chronic Diastolic Overload, for Example, Chronic Severe Aortic Regurgitation
1.6 Moderate LVH with Chronic Pressure Overload, for Example, Systemic Hypertension
1.7 Acute Pericarditis
1.8 Post Stokes–Adams’ Attack
1.9 Non-cardiac Causes
1.9.1 Cerebrovascular Accidents
1.9.2 Hyperkalemia
Summary
MCQs
Answers
References
44: Inverted T Waves
1 Normal Variants
2 Noncardiac Causes
3 Cardiac Causes
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45: The QT Interval
1 Definition
2 Measurement
3 Correction for the Heart Rate
4 Normal Value of QTc (QT Interval Corrected for Heart Rate)
5 Prolongation of the QT Interval
5.1 (A)Causes
6 Short QT Interval
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46: The U Wave
1 Introduction
2 Physiological U Wave
3 Prominent U Wave
4 Inverted U Wave
Summary
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47: Electrical Alternans
Summary
MCQ
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48: Electrocardiogram in Asymptomatic Acyanotic Congenital Heart Disease
Summary
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49: Electrocardiogram in a Neonate Presenting with Failure
1 Normal Examination of the Cardiovascular System
1.1 Electrocardiogram
2 Short Low Pitched Early Diastolic Murmur Along Left Upper Sternal Border
2.1 Electrocardiogram
3 Central Cyanosis without Any Murmur
3.1 Electrocardiogram
4 Central Cyanosis with Systolic Murmur Over Left Lower Sternal Border
4.1 Electrocardiogram
5 Central Cyanosis with Ejection Systolic Murmur Over Left Second Intercostal Space
5.1 Electrocardiogram
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50: Utility of Electrocardiogram in a Case Presenting with Heart Failure in Infancy (After Neonatal Period)
Summary
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51: Electrocardiogram in Children/ Adolescents/ Adults with Cyanosis Due to Congenital Cardiovascular Disease
Summary
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