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Books by H. Thomas Milhorn

Electrocardiography for the Family Physician: The Essentials: Second edition
ISBN #1581124414

The electrocardiogram can serve as an independent identifier of myocardial disease or reflect anatomic, metabolic, hemodynamic, or electrophysiological alterations in the heart. It can provide information that is often essential for the proper diagnosis and therapy of a variety of disorders and is without equal as a method for diagnosing cardiac arrhythmias. It is the procedure of choice for patients who present with chest pain, dizziness, syncope, or symptoms that may indicate risk of myocardial infarction or sudden death.

Family physicians are often the first, and sometimes the only, point of contact for many patients within the health care system. The standard 12-lead electrocardiogram is one of the most common tests obtained and interpreted by the family physician, with most of the physicians reading their own recordings and basing clinical decisions on their findings. It has been shown that family physicians can achieve proficiency in the interpretation of over 95 percent of all electrocardiogram findings seen in the primary care setting.

Although computerized interpretation is widely available, it is considered unreliable in up to 20 percent of the cases, making competency and interpretation by family physicians an essential skill. This book provides the necessary skills for family physicians to use in interpreting electrocardiograms, both in their offices and in the emergency rooms of their hospitals. It also should prove of value to other primary care physicians, as well as medical students and residents of nearly all medical specialties. As the subtitle states, this book is about the essential elements involved in electrocardiographic interpretation. It is not all inclusive; however, it does cover the abnormalities most likely to be seen by family physicians in their everyday practice of medicine.

This book is an outgrowth of a course I taught in the Department of Family Medicine at the University of Mississippi School of Medicine and five articles titled Electrocardiography for the Family Physician I subsequently published in Family Practice Recertification. In short, this book is the one I wish I had access to during the many years I actively practiced family medicine and when I was a resident in family medicine.

I have made several changes in the second edition. These include adding sections on hypertrophic cardiomyopathy, the Sgarbossa criteria for diagnosing myocardial infarction in the face of left bundle branch block, left ventricular aneurysm, myocarditis, bigeminy, electrical alternans, Takotsubo cardiomyopathy, Brugada syndrome, and upgrading the terminology for acute coronary syndrome.

I currently teach an ECG course to family medicine residents in the EC-Healthnet Family Medicine Residency Program in Meridian, Mississippi.

Chapter 1. The Electrocardiogram   1

Electrocardiograph Paper   2

Conduction System of the Heart   2
Parts of the Electrocardiogram   3

Electrocardiographic Interpretation   12


Chapter 2. Leads and the Normal Electrocardiogram   13

Leads  13

Normal Electrocardiogram   21


Chapter 3. Heart Rate and Axis   24

Heart Rate   24

Axis   25

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Chapter 6. Coronary Artery Disease      48

Stable Angina   49

Prinzmetalís Angina   51

Unstable Angina   52

Myocardial Infarction   52

Old STEMI   60

Left Ventricular Aneurysm   61  

Silent Myocardial Infarction   62

STEMI and Bundle Branch Blocks   62

Pseudoinfarction Syndromes   63

Athletic Heart Syndrome   64

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Chapter 7. Rhythm Disturbances     66

Sinus Rhythms   67

Non-sinus Atrial Arrhythmias    69

Junctional Rhythms   73

Atrioventricular Heart Block   75  

Ventricular Rhythm Disturbances   78  

Bigeminy   84

Electrical Alternans   84

 

Chapter 8. Preexcitation Syndromes, Pulmonary Embolus, Pericarditis, Early Repolarization, and Myocarditis      86

Preexcitation Syndromes   86

Pulmonary Embolus   90

Pericarditis   91

Early Repolarization   93

Myocarditis   94

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Chapter 9. Hypothermia, Low Voltage ECG, Neurological Insult, Dextrocardia, Pacemakers, Takotsumo Cardiomyopathy, and Brugada Syndrome   96

Hypothermia   96

Low Voltage ECG   97

Neurological Insult   98

Dextrocardia   98

Pacemakers   99

Takotsumo Cardiomyopathy   100

Brugada Syndrome   101

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Chapter 10. Drug Effects, Electrolyte Effects, and ECG Worksheet   103

Drug Effects   103

Electrolyte Effects   105

ECG Worksheet   107

Practice ECG   108

 

Appendix: A Quick Reference Guide   110

 

References   150

 

Index   153     

 

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