The. ECG. Made Easy. EIGHTH EDITION. John R. Hampton. DM MA DPhil FRCP FFPM FESC. Emeritus Professor of Cardiology. University of Nottingham, UK. John R. Hampton-The ECG Made Easy-Churchill Livingstone ().pdf. Ashraf Alqudwa. Figure The structure of [M(N2S2)]. The ECG Made Easy For. 𝗣𝗗𝗙 | A true medical classic should be novel, stimulate thought and discussion, transcend both The ECG Made Easy I also enjoyed Hampton's perhaps.

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The ECG Made Easy. 8th Edition. Authors: John Hampton. eBook ISBN: eBook ISBN: Paperback ISBN. The ECG Made Easy. 9th Edition. Authors: John Hampton Joanna Hampton. eBook ISBN: eBook ISBN: Paperback ISBN. ECG Made Easy - John R Hampton - Free ebook download as PDF File .pdf), Text File .txt) or read book online for free. ECG Made Easy.

Nancy Arnott Designer: Erik Bigland and Helius lllustntor: Gecko Ltd and lllustntion Manager: Bruce Hogarth. All righls reserved. The right ol Protessor J. Hamplon lo be identitied ae arrlhor ol lhls work has been asserld by him ln accordance wilh lho Copyright.

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Doslgns and Patenls Acl No parl ol lhis publicalion may bo reproducod, slorod in a relrieva! Note Meciical knowledge is constantly changing. Standard safety precautions must b tolbtfled, hll ae new research and clinical experience broaden our knowledge. Roaderr art advltsd lo chcck lhe mosl cuncnl producl inlormalion provided by the manulactursr of each drug lo be adrninictered to vedly the rocommonded doso, lhe msthod and duration ol adminlrlrrlion.

In addition, it nray provide useful revision f6r those wlro lrave forgottcn wlrat they learned as students. There really is no need for the ECC to be clar-rnting: This book encourages the reader to accept that the ECG really is easy to understarrd, antl that its use is just a natural extension of tlre history arrd the physical examination.

This is the sixth edition of tlrc book. Ttrc tc'xt l'ras becn changed a little, but the changes to the illustratiorls are morsimportant.

There is a neiw emplrasis on fult lcacl ECGs, presented in as realistic a way as possible. The ECG Mnde Ensy shotrld hclp the student to prepare for examinations, but for tlrc clcvc'topnrcnt of clinical.

I am grateful to him and to the many pcople who have helped to refine the book ovcr lhc Vcat's, culd partictrlarly to many students for the.

ECG stands for electrocardiogram, or electrocardiograph. Irr some countries, the abbreviation used is 'EKC'.

By the time you have finished this book, you should be able to say'The ECC is easy to urrderstand'. Most abnormalities of the ECG are an'renable to reason. Clinical diagnosis depends mainly on a pratient's lristory, and to a lesser extent on the physical examinatiorr.

It can help with the diagnosis of the cause of brca thlessness. This chapter is about these rules and facts. The conlractiorr o.! Tlrcrc is a delay while thc clJpolarization;lireacls througlr anotheisp". Thereafter; the electricat discharge tiavels very rapiclly,Eiln specializecl conduction tissug: Fi-e leftr bundle branch itielf divicleffn-b two.

Within tir,ffiof ventricular muscle, concluction spreaclffiewhat n'lore slowly, through specialized tissue called 'Purkinje iibres'. The rhythm of. The different parts of the QRS conrplex are labelled as shown in Figure Times ond speeds ECC.

All ECC machines. Table 1. JtrsI as tlrc lcrrgtlr of l 'lpcr be twccn R wavcq gives the lrearl, ratc the distancc bctweerr thc cliffcrcsni'parts of the P-QRS-T conlplcx shows the Linrc taken for conduction of. Iowf the burrclle of His arncl intt vgltricular nruscE. Tlre normal PR interval is 0.

Most ol'[re time is taken trp by clelay irr the AV noclc lrig.

The ECG Made Easy

S; tlrt, I,R irrterval is veryshort, t'i[lrer the atria have [r. Tht, QRS duration is nornrally 0. Ttre wrtrcl 'lcacl' srlnretirncs cAusos c nfrrsirlrr. Sonrctinrcs it is used to nrean the pieces t'lf wire that connect tlre patient to the ECC recorclegr?

It nray be neccssary to shave the chest. The six 'statrclat'd' leads, rvhich are recorclccl from the electrodes attrtchetl to tlrc linrbs, carr bc tlrouglrt of as lookirrg at thc hcarrt iu a verlical pl. The six nnmbere'd V lcacls look at thc'hcart in a horizontal pla.

Thus, lcads V1 and V, lt-lok: CC prattern ltig. In each lead the pattern is characteristic, bcinl; sirnilar irr different individttals who htrve nornral lreirrts. Note that the 2nd, 3rd, and 4th rib sl aces are numbered. QIIS cornplexes ancl T waves, pr. A stanc-lard sigrral of 'l rnillivolt nrV shotrld nlovc the sjylus.

F x Moking o recording Y. Conuect up the limb electrodes,, making certain that they are applied to the correct linrb 3. Calibrate the record with Lhe L mV signal 4.

Record tlre six standard lcads - three or four complexes 1. Wc trorv treetl to consiclcr why the ECC has a characterisl. Depolarization moving a towards the lead, b away from the lead and c at right angles to the lead. I tflttre QRS conrplex is predornirrantly rrpwarcl, or positive i. S wave , thc' dqolarization is moving towards tlrat leacl f,ig. Ifl Pt". Q waves have a special significArlce, which lve shall discuss Iater.

Leads VR and II look at the heart fronr opposite c-lircctions. The average directiorr of sprcarJ of the depolarization wave l. A rrornral 11 o'ik: CBtlrc riglrt verrtriclc beiomc's lryl'rertrophied, tl're axis will svllg towards the right: It is, of course, likcly tlrat the axis will rrot be precisgly at right arnglcs to any of the lt'ads, but will be somewhere Lrctwct'rr Iwo of thcr-rr.

Leads VL arrd VR. For cxa: Tlrercforc tlre trr"re axis is at"- this is thc linrit of nortnality towarcls what is called the 'left'. This is tlrc linrit of nornrality towards thc'ri.

Why worry obout the cordioc oxis? V o In tlic normal lriart lltt'rc is rnt r' , r'r'rusctt: In a right ventricular leacl the'cleflection is first sl wi1'rls R wave as tlre septtrm is tlt,pota riz,,tl Fig. Irr l lc[t vcntrictrlirr lcltl tlrere is an trpwarcl cleflection l wavt as the vcrttricular nrusclc is clc;: Vhy worry obout the tronsition point? Ytru now know cnough about the ICG to understand the lrasis of a rcport. Tl'ris slrotrld take the form of a description, ' "' followcd by orr inte rprctation.

The interpretation indicates whethcr the record is normal the underlying pathology needs or to be id. Examples of lcacl llCCs are showtr itr Figures 1,23 and "1. Qln,;t-hylhm, q1 olr-ift 3 Xr' J.

John hampton ecg made easy pdf

Sinus rfrylhm, rala 75lmln. PR interval ms. ORg eornploxoo. Unfortunately, there are a lot of minor variallons in ECGs which ars consistont with perfectty normal hearts. Recofrizlng the limits of normality is one of the main dilflcultles of ECG intorpretation.

Atrial activation causcs tlrc P wave. Any'upward deflection is an I wave. A downward deflection after an. Wlren the depolarization wave sprcads towards alead, the deflection is predominantly upward. When the wave sprcads away from a lead, tlre dcflection is prcdt-rnr i rra rr tly downwa rd. Lead V, is'positioned vcr thc right venl,riclc, and lead V,, over the left vt.

We can ttiir',t of conduction problems in tlre orcler in whiclr the, depolariz. I enrernbcr in all tlrat follows that we are assuming clcpxrlarizatiotr bcgilrs in l,hc ntlrnral way in the SA node, The rhythm of the heart is best interpreted from whichever ECG lead shows the P wave most clearly.

This is usually, but not always, lead II or lead Vr. You can ilrinurnr. TIre tin're taketr for the spreacl of depolariz.

Q4d is not rrormally Sfeater than 0,2s one large squarclEcG events are usually timed in irrilliscctln. Interference with the conduction Process '", causcs tlrc ECC phcrr. AV node or ttrc bundle of I'lls. Wlrcn tlrisl. There may be progressive lengthening of thc, Pli irrtc'rvnl and thcn fallu rc of concluctlon of arr atrial Lreat,. Tlris is called '2: F'ff Qt ll. Wlren this occtrrs the 33 i. Abnorrnally-slraporJ QRS comploiog bocauso ol abnorm al apread ol dopolarlzation from a vontricutar focus.

Broad ORS complexes ms Blght bundlo hranch block pallorn Ths cause ol the block could not tlo determlned, though ln most pationts it rcsulla lrom llbrosls of lhe bundlo ol Hls. If llrc dcpolariz. Thc extra time taken for depolarization of the whole of the ' vcrrtricular rrrusclc causes widcning of tlre QRS complcx, lrr tl're rrorrrral heart, tlre tirrre taken for the depolarizr,tion.

Illock of both bundle branchcs has the same effect as block of the His bundle, and causes complete third degree ': Remembep see Ch.

The eeptum ie nornrally clepolirriz. Excitation spreading towards a leacl caLlses an uprward. Excitation tlren spreacls to tlre left ventricle, causinll arl in lead V1 and an R wave in tcacl V6, Fig. It takes longer than in a nornral Ircart for excitation to reaclr tlre righ"t ventricte bccausc of tlrc faiturc oI ltrc normal conducting pathway.

The right ventriclc, thert,forc' ctepolarir,esafter ttrc lcft. Tlris causr,lr il! It is seldom of significance, ancl can be congidered to be a normal variant. S wave. Tlre right ventrlcle is clepolar. Subrequent depolarization of llrc tcft vcrltrictc causes nn lead V1 and another R wave irr leacl V6, trig. The cardi. Upr,vards Fig. Always remelnber that it is the patient who should be treatt: I elief of symptoms always comes first.

I lowcvcr; sotllc gcrrcral ptlintr can bc made about the action that rnight bc takur if tlrc liCC shows conduclion arbnornra litics. First degree block. Often sccn in nornral pcople, Think about acute myocardial infarction. No specific action needed. Third degree block Atwnyn inclicntcn conductirrg timue diseasc - lrlor often fibrosiE tlrarr isclracnric. Consider a temporary or Pcrmanent pacemaker.

Risht buncllebronch block t? B t3E. Think about an atrial septal defcct. No spccific treatnrent. P0irr, I-ll lil i may indicate. Left oxis d"r,iotion olia ,rnt',t bundle bronch btock o lndlcafclr severe conductllrg tisstrc cliscttsc.

No specific treatment needed. Pacemaker rgquired if the paticnt ltas synrptoms suggcstive of intermittent complctc heart block. A conduction abnormality citn dcvclop at arty of tltesc. Conduction problems.

IJlock of the anterior division or fascicle of the left bundle. Depolarization can, lrowever, bcgirr in otlter pllccs. Abnormalltlcs of carcliac rtrythnl ilrc casy: The two things to look at are the P waves and tl're widtl-r of tlre QRS conrplexes. Atrial contractiorr is associated wil. Tl'rerefrlre the rate of t rrrrlr',rt'liorr of llrrt vt,rrtrir: Conslant PR interval.

Progresslve beal-lo-beat change in R-R interval. Supraventricular rhythms. Ventricular rhythms have wide QRS complexes. Abnormal;ftythms arising in the atrial nrttscle', thc iuncfionrdl resion or the ventricular rDrtscle can t're slt-lw arrd 'sustgy'ne.

Whclr activation of the atria or ventriclcs is Iotrrlly tlisor'1ialr. Tl'ris is erchit: If the SA node fails to depolarize, control will bc i. These slow and protective rhythrns are called escape rhyl.

Escape rhythms are trot primary disordcrs, but are the rcsporlsc to problcrlts Irighcr in thc'conducting pathway. A ,atriol escope t-- tf the rate of depolarization of the SA node slows down and a focus in the atrium takes over control of tlre hear't, tlte rhyl.

Atrial t'scaire beats can occrrr singly. After one sinus beat,the SA node fails to depolarize.

J-R-Hampton-ECG-made-easy 6a.pdf

After a delay, an". Thd remaining beats show a return to sinus. U ';'. Ventricular escape rhythms can occur withotrt conlpletc heart block. Ventricrrlar e'scapc beats carr be single i. The rlrl,tlinr is called'accelerated idioventricular rhyth rn' Fig. Althougl'r the appearance of the ECC is sinrilar to ttrat of ventricular tachycardia descriLred la ter , accelcra [c.

Vc'ntricular tachycarclia shoulcl not trc-rliagnosecl rrnlcss tlrc heart rate exceeds lnrin' e. L-vL'r'rtric,rar nrtrsctC, iS trrc sa,lle as rtrat. I Ir t QIis c rrpl" rrig. I atri;rr arrtr jtlrrctiort. Supraventricular beats look thc sanre, velrtricular beats look different.

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Is tlrc T wave the sanre way up as in the normal beat? In sa' l.

Docs thc rrcxt P wave aftcr thc cxtrasystole appear at an cxpcctcrl tirnc? SA noclc clischarge and P wrrve collles late. QRS complex and an abnormal T wave: A ventricular extrasystolc, orr the othe.

Three sinus beats are followed by a junctlonal extrasystole. Three sinus beats are followed by a ventricular extrasystole. No P wave is seen after this beat, but the next P wave arrives on time. Jr Foci in the atria, the junctional AV nodal region, and ventricler.

The criteria already descritrt'd carr ['re trsctl to decicle the origin of the arrhythrnia, ancl trs before tht nrost important thing is to try to identify a P wave.

P waves can be seen superimposed on the T waves of the prececling beats. The QRS complexes have the same shape as those of the sinus. If the irtrial rate is faster than this, 'atrioverrtricular block' occurs, with some P waves not followcd by QRS complexes.

When atrial tachycardia or atrial flutter is associatecl with 2: Any arrhytlrfiia should be identified from the lead in which P wlfus can most easily be seen. Full lcacl ECCs are thgre-fore better than 'rhythm strips'. In the record in Figure 3. The lirst ol the two P waves associated with each ORS complex can be mistaken lor the T wave ol the preceding beat, but P waves can be identilied by their regularity. Narrow QBS complexes of normal shape. NormalT waves best seen in the V leacls; ln the limb leads it is dilficult to distinguish.

Caroticl sirrus pressLlrc ntay havr: Cnroticl sirrtrs prcssurc rrctivates a icflex thai lcar. It is the latter which is important in the cliagnosis ancl treatment of arrhythmias.

Carotid sirrtrs pressnre slows thc ventricular ratc in sonle s!!

Junctionol nodol tachycordio arci'l art t,u1cl thc AV rrorlc dcpolrrrizcs. The lower lraco is lrorn lho same patienl, in sinus rhythm. The ORS complexes have esscnlially llrc same slrape as tltose ol the junctional tacltycardia. Ventriculqr tochycordins If a focus in thc ventricular muscle dcpolarizes with high f re-elue ncyrGu si rU, in e ffec t, ra pidly repea ted ven tri.

The QBS complexes become broad, and lhe T waves are ditlicult to identify. The final beat shows a return to -sinus rhythm. The QRS cornplexes are wide and the T waves are inverted.

I-t'l'I axis tlcvi. Il'tltrrirrl; thc t. No P wavcs - irreuul;rr ltir: Narrow QnS complexcs of normal shapo. Doprossorj Sl' soglrtcrrts in lontls Vs-V,. Sonre peol'rlc,, horvever, lrarrc ntr cxtt'a 'rr'ilcccss r'y' concltrcting lrtrirr'!

While such an 'enhanced atrtonrat'icity' ccrtainly accounts for somc tarchycardias, others are due to re-errtry circuits withirr the heart muscle. It is not possible to distirrguish enhanced automaticiLy from re-entry tachycardia on standard ECCs, but fortunately this c-liffcrcntiation has no practical.

Althotr13,h this book is not interrclecl to discuss thcrapy irr any dctail, it seenrs appr'opriatc [o outlinc sot'ltc sinrp-rlc a-lpproaches to paticnt nlanagernent tl'rat logictrlly follow interpretation of an IICC;.

For fast or slow sinus rhythnr, trc;rt tlte r,rnderlying callsc. Ilxtrasystc'llcs rarcly neccl treatlnent. Irr patients with acute heart failure or. Patier-rts with arry bradycarrdia tlrat is affectirrg the circulatioll catl be trcatec-l with atropine, but if this is incffc,ctivc thcy will ncccl tcnrpt or lrcrntanent p".

Occasi6nat P waves are visible, but are not related to the QRS complexes. Tlre OnS conrplexes are precedcd by a brief sJliltt', representing lhe pacemakcr stimulus. The ORS comptexe-ar': Abrrormal rhythms can arise irr tl're atrial muscle, the region arourrd the AV node the f unctional region and in tlre ventricular muscle.

L ccusional carly clcpolariz;rtion of any part of the heart ca uscs arr cxtrasystolc. Asytrclrrotrous cr. Apal'[ fronr the rate, the ECC pfltte'rn of an escape rhytlun, an extrasystole arrcl a tachycar.

All sLlpravcntricular. Iiccogrrizirrg ECC abrrorn'ralitics is to a large extent like ilrr clcPlrun[ - ncc scen, llcvcr forgottcn. Are tl'rc vcntricles contracting regularly or irregularly? Arc thcrc atry abtrornralitics of thu P wave?

What is tlrc Jarcliac axis? The sr segment can only be rrormal, elevated or. Left atria. Lclt ventricular leads rnfritslrow Q waves dtte to septal. Tlrt'rc will [ru n clct,P s wnvc irr lt,ntl v,,. In pulmonary embolism the ECC may show features of rigirt vutt l rir,'trlrtr lrypcrtruphy,. I'cakccl P wtrvcs ,,..

A shil't ol' tr. Part 2: The basics: The fundamentals of ECG recording, reporting and interpretation. Part 3: Making the most of the ECG: The clinical interpretation of individual ECGs.

For over forty years The ECG Made Easy has been regarded as the best introductory guide to the ECG, with sales of over half a million copies as well as being translated into more than a dozen languages.

Hailed by the British Medical Journal as a "medical classic", it has been a favourite of generations of medical and health care staff who require clear, basic knowledge about the ECG. It directs users of the electrocardiogram to straightforward and accurate identification of normal and abnormal ECG patterns.

Provides a full understanding of the ECG in the diagnosis and management of abnormal cardiac rhythms. Emphasises the role of the full 12 lead ECG with realistic reproduction of recordings. The unique page size allows presentation of lead ECGs across a single page for clarity. We are always looking for ways to improve customer experience on Elsevier. We would like to ask you for a moment of your time to fill in a short questionnaire, at the end of your visit. If you decide to participate, a new browser tab will open so you can complete the survey after you have completed your visit to this website.

Thanks in advance for your time. Skip to content.Tell the Publisher! However, Q waves greater than one sniall square in wirltlr r't-,Pt'uriulltlug,11l rus , rtnrl greitter tltrttr 2 tuttr irr tlepth have a quite different significance. Depolarization can certainly accounts for some tachycardias, others IP spread down the His bundle and back up the are due to re-entry circuits within the heart For more accessory pathway, and so reactivate the atrium. You may 2. We are always looking for ways to improve customer experience on Elsevier.

In addition, it nray provide useful revision f6r those wlro lrave forgottcn wlrat they learned as students.