Best Quotes from The Only Ekg Book You'll Ever Need by Malcolm S. Thaler with Page Numbers

Electricity, an innate biologic electricity, is what makes the heart go.

The EKG is nothing more than a recording of the heart's electrical activity.

It is through perturbations in the normal electrical patterns that we are able to diagnose many different cardiac disorders.

Repolarization is accomplished by the membrane pumps, which reverse the flow of ions.

Pacemaker cells are really good at what they do.

Every cell in the heart has the ability to behave like a pacemaker cell.

Each spontaneous depolarization serves as the source of a wave of depolarization that initiates one complete cycle of cardiac contraction and relaxation.

The electrical depolarization–repolarization cycle of a cardiac pacemaker cell... will repeat over and over for, let us hope, many, many years.

To read an EKG and extract as much information as possible, you need to understand the 12-lead system.

Out of chaos, some very simple patterns emerge.

"Hypertrophy refers to an increase in muscle mass. The wall of a hypertrophied ventricle is thick and powerful."

"Enlargement refers to dilatation of a particular chamber."

"In addition, over time, the increase in muscular thickness and/or size can compromise the heart's ability to adequately pump blood to the rest of the body, causing heart failure."

"The concept of axis is so important for diagnosing hypertrophy and enlargement."

"A single vector summarizes all of the instantaneous vectors. This summation vector is called the mean vector, and its direction is the axis of ventricular depolarization."

"The electrical axis of the QRS complex, normally between 0° and +90°, veers off between +90° and +180°."

"There should be increased R-wave amplitude in leads overlying the left ventricle and increased S-wave amplitude in leads overlying the right ventricle."

"Secondary repolarization abnormalities include asymmetric, T-wave inversion and downsloping ST segment depression."

"The more criteria that are positive, the greater the likelihood that the patient has left ventricular hypertrophy."

"The timely intervention proved lifesaving."

The diagnosis of an arrhythmia is one of the most important things an EKG can do, and nothing yet has been found that can do it better.

Many arrhythmias go unnoticed by the patient and are picked up incidentally on a routine physical examination or EKG.

Not every arrhythmia is abnormal or dangerous.

The heart is capable of only five basic types of rhythm disturbances.

First, once you have learned to recognize the basic patterns, nothing is easier than recognizing a classic arrhythmia.

Incrementally, the EKG has become helpful in identifying conditions that predispose to malignant arrhythmias and sudden death.

The heart rate is your window into the rhythm; it guides you to understanding the underlying cardiac condition.

In many cases, a single aberrant beat can signify significant underlying heart disease.

The Four Questions...should become an intrinsic part of your thinking.

With careful observation and understanding, the complexity of arrhythmias can transform from daunting to manageable.

"A conduction block can occur anywhere in the conduction system of the heart."

"First-degree AV block is not really a 'block' at all, but rather a 'delay' in conduction."

"Every QRS complex is preceded by a single P wave."

"In some individuals, bundle branch block only appears when a particular heart rate, called the critical rate, is achieved."

"A ventricular escape rhythm may look like a slow run of PVCs, but it is a lifesaving beat."

"The diagnosis of third-degree heart block requires the presence of AV dissociation in which the ventricular rate is slower than the sinus or atrial rate."

"In cases of 2:1 second-degree AV block, the distinction between Wenckebach block and Mobitz type II second-degree AV block is an important one to make."

"When used appropriately, pacemakers save lives."

"Pacemakers provide an alternate source of electrical stimulation for a heart whose own intrinsic source of electricity is impaired."

"Performing a service for others is the surest way to achieve true satisfaction in life."

In the preexcitation syndromes, there are accessory pathways by which the current can bypass the AV node and thus arrive at the ventricles ahead of time.

Wolff–Parkinson–White and Lown–Ganong–Levine are not the names of law firms.

Accessory pathways may occur in normal healthy hearts as an isolated finding, or they may occur in conjunction with mitral valve prolapse, hypertrophic cardiomyopathies, and various congenital disorders.

In both syndromes, the accessory conduction pathways act as short circuits, allowing the atrial wave of depolarization to bypass the AV node and activate the ventricles prematurely.

A true delta wave may be seen in only a few leads, so scan the entire EKG.

In LGL syndrome, the accessory pathway (called James fiber) is effectively intranodal.

The only electrical manifestation of LGL is a shortening of the PR interval as a result of the accessory pathway bypassing the delay within the AV node.

Paroxysmal supraventricular tachycardia is a perfect substrate for reentry.

The presence of an accessory bundle—an alternate pathway of conduction—is the perfect substrate for reentry.

Mapping the aberrant pathways in patients with WPW can be accomplished during EPS and has become routine in affected patients who are symptomatic or have documented arrhythmias.

Ischemia is potentially reversible: if blood flow is restored or the oxygen demands of the heart are eased, the T waves will revert to normal.

The recognition of the acute changes of a threatened or evolving myocardial infarction on the EKG is a critical diagnostic skill.

Therapy is widely available that—delivered within the first few hours of the onset of the event—can prevent the completion of an infarct and improve survival.

Once angioplasty has been successfully carried out, the placement of stents coated with cytotoxic drugs to prevent reocclusion... has reduced the rate of restenosis from about one-third of patients to virtually none.

The lives of patients with acute coronary syndrome are being saved every day by alert and informed health care providers.

Significant coronary artery disease of one or several coronary arteries limits blood flow to the myocardium and hence limits oxygen consumption.

Every few minutes, the speed and angle of incline of the treadmill are increased until... symptoms supervene.

The onset of symptoms and falling blood pressure are particularly poor prognostic signs, and the test must be stopped immediately.

A patient's resting EKG may be normal, the increased demands of exercise may bring out evidence of subclinical coronary artery disease.

Non–Q-wave infarctions seem to behave like small, incomplete infarctions, and cardiologists take a very aggressive stance with these patients.

In some of these instances, the EKG may actually be the most sensitive indicator of impending catastrophe.

Any change in the EKG due to hyperkalemia mandates immediate clinical attention!

Progression to ventricular fibrillation can occur with devastating suddenness.

The digitalis effect is normal and predictable and does not necessitate discontinuing the drug.

The prolonged QT interval on this tracing mandated reducing the patient's sotalol dosage.

A resting sinus bradycardia...is a testimony to the efficiency of their cardiovascular system.

Preparticipation screening makes much difference... but little evidence supports this practice.

Patients with sleep apnea are at increased risk of atrial and ventricular arrhythmias and heart block.

In a few patients... sympathetic denervation may be needed.

No patient has zero surgical risk.

Know your patient. The power of this tool only really emerges when it is integrated into a total clinical assessment.

Read EKGs. Then read some more. There are many outstanding textbooks, each with something special to offer.

The first four steps are largely data gathering. The remainder are directed at specific diagnoses.

Whenever you are interpreting the heart's rhythm, ask The Four Questions.

Information only becomes knowledge with wisdom and experience.

If you are still thinking, 'Is this really all there is to it?' The answer—reminding you that information only becomes knowledge with wisdom and experience—is, 'Yes!'

There are as many approaches to reading EKGs as there are cardiologists.

The more that are present, the greater the likelihood that left ventricular hypertrophy is present.

Never hesitate to ask for assistance.

This should give you an idea of how common EKG abnormalities can be and how important it is to be able to read the darn things.

How Do You Get to Carnegie Hall? Practice, practice, practice!

Take your time.

The broad, abnormal QRS complexes may immediately attract your attention.

This pacemaker fires whenever it senses a P wave, ensuring ventricular contraction.

When you see a tall R wave in lead aVR and a deep S wave in lead I, check your electrodes.

Everywhere you look, you see dramatic ST-segment elevation.

You are staring at the classic sawtoothed pattern of atrial flutter.

Extreme bradycardia resulting from hypoxemia in a patient with sleep apnea.

The rhythm is sinus tachycardia.

The rate is very fast and regular, and the QRS complexes are narrow.