In this chapter you will learn:
not a thing, but don’t worry. There is plenty to come. Here is your chance to turn a few pages, take a deep breath or two, and get yourself settled and ready to roll. Relax. Pour some tea. Begin.
On the opposite page is a normal electrocardiogram, or EKG.1 By the time you have finished this book—and it won’t take very much time at all—you 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 the late ones!), the multiplying tonalities and polyrhythms of Stravinsky’s Rite of Spring, or the extraordinary jazz interplay of Keith Jarrett’s Standards Trio.
There’s just not that much going on.
The EKG is a tool of remarkable clinical power, both because of the ease with which it can be mastered and because of 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 lifethreatening arrhythmia, pinpoint the chronic effects of sustained hypertension or the acute effects of a massive pulmonary embolus, or determine the likelihood of underlying coronary artery disease in a patient with chest pain.
Remember, however, that the EKG is only a tool and, like any tool, is only as capable as its user. Put a chisel in my hand and you are unlikely to get Michelangelo’s David.
The nine chapters of this book will take you on an electrifying voyage from ignorance to dazzling competence. You will amaze your friends (and, more importantly, yourself). The road map you will follow looks like this:
• Chapter 1: You will learn about the electrical events that generate the different waves on the EKG, and—armed with this knowledge—you will be able to recognize and understand the normal 12-lead EKG.
• Chapter 2: You will see how simple and predictable alterations in certain waves permit the diagnosis of enlargement and hypertrophy of the atria and ventricles.
• Chapter 3: You will become familiar with the most common disturbances in cardiac rhythm and learn why some are life threatening, whereas others are merely nuisances.
• Chapter 4: You will learn to identify interruptions in the normal pathways of cardiac conduction and be introduced to pacemakers.
• Chapter 5: You will see what happens when the heart’s electrical current bypasses the usual channels of conduction and arrives more quickly at its destination.
• Chapter 6: You will learn to diagnose ischemic heart disease: myocardial infarctions (heart attacks) and angina (pain that results when regions of the heart are deprived of oxygen).
• Chapter 7: You will see how various other cardiac and noncardiac phenomena can alter the EKG.
• Chapter 8: You will put all your newfound knowledge together into a simple method for reading all EKGs.
• Chapter 9: A few practice strips will let you test your knowledge and revel in your astonishing skill.
The whole process is straightforward and should not be the least bit intimidating. Intricacies of thought and great leaps of creative logic are not required.
This is not the time for deep thinking.
1If you are suddenly worried that you have purchased the wrong book——“but I wanted to learn about ECGS, not EKGS! ”—rest assured that an ECG and EKG are one and the same. As much as we can give credit to any one person for inventing this remarkable tool, that credit belongs to Willem Einthoven, the Dutch Nobel Laureate who created the first real electrokardiogram machine. Notice the “k” stuck in the middle there? Whereas most of the world has converted to the English spelling—electrocardiogram, hence ECG—in America, where obstinacy is too often a virtue, we have clung to the EKG acronym, although even here the bonds of tradition are slowly loosening. So please calm down. You don’t panic when you are invited to a barbecue instead of a barbeque, do you?