I assume that the reader of this book will have the level of knowledge of the ECG that is contained in The ECG Made Easy, to which this is a companion volume. The ECG is indeed easy in principle, but the variations in pattern seen both in normal people and in patients with cardiac and other problems can make the ECG seem more complex than it really is. This book concentrates on these variations, and contains several examples of each abnormality. It is intended for anyone who understands the basics, but now wants to use the ECG to its maximum potential as a clinical tool. The ECG is not an end in itself, but is an extension of the history and physical examination. Patients do not visit the doctor wanting an ECG, but come either for a health check or because they have symptoms. Therefore, this book is organized according to clinical situations, and the chapters cover the ECG in healthy subjects and in patients with palpitations, syncope, chest pain, breathlessness or non-cardiac conditions.
To emphasize that the ECG is part of the general assessment of a patient, each chapter begins with a brief section on history and examination and ends with a short account of what might be done once the ECG has been interpreted. This sixth edition continues the philosophy of its predecessors in that the patient is considered more important than the ECG. However, the ECG is a vital part of diagnosis and, increasingly, dictates treatment. Electrical devices of various sorts are standard treatment in cardiology, and patients with such devices are now commonly seen in patients who present with non-cardiological problems. Those who are not specialists in cardiology need to understand them. Therefore there is a series of changes in the text compared with previous editions, and the sections on pacemakers, defi brillators and electrophysiology have been integrated into the relevant chapters. WHAT TO EXPECT OF THE ECG The ECG has its limitations. Remember that it provides a picture of the electrical activity of the heart, but gives only an indirect indication of the heart’s structure and function. It is, however, invaluable for assessing patients whose symptoms may be due to electrical