Preface

Learning about ECG interpretation from books such as The ECG Made Easy or The ECG in Practice is fine as far as it goes, but it never goes far enough. As with most of medicine there is no substitute for experience, and to make the best use of the ECG there is no substitute for reviewing large numbers of them. ECGs need to be interpreted in the context of the patient from whom they were recorded. You need to learn to appreciate the variations of normality and of the patterns associated with different diseases, and to think about how the ECG can help patient management.

Although no book can be a substitute for practical experience, 150 ECG Problems goes a stage nearer the clinical world than books that simply aim to teach ECG interpretation. It presents 150 clinical problems in the shape of simple case histories, together with the relevant ECG. It then invites the reader to interpret the ECG in the light of the clinical evidence provided, and to decide on a course of action before looking at the answer. Having seen the answers, the reader may feel the need for more information, so each one is cross-referenced to The ECG Made Easy and/or The ECG in Practice.

The ECGs in 150 ECG Problems range from the simple to the complex. About one-third of the problems are of a standard that a medical student should be able to cope with, and should be answered correctly by anyone who has read The ECG Made Easy. A junior doctor, specialist nurse or paramedic should get another third right, if they have read The ECG in Practice. The remainder should challenge the MRCP candidate. As a very rough guide to the level of difficulty of each problem, each answer is graded using stars (see the summary box of each answer): one star represents the easiest records, and three stars the most difficult.

The ECGs are arranged in random order, not in order of difficulty, to maintain the reader’s interest. Readers are invited to attempt their own interpretation before looking at the star rating – after all, in a real-life situation one never knows which patient will be easy and which will be difficult to diagnose or treat.

There have been several changes in this new edition. About a fifth of the ECGs have been changed, mainly to provide clearer examples. Chest X-rays have been added where appropriate, and these can also be regarded as ‘problems’, because the plain chest X-ray is still important for cardiac diagnosis, despite the pre-eminence of echocardiography. The most obvious change to the book is its new format, which has also been introduced for the new editions of The ECG Made Easy and The ECG in Practice. This format has been chosen to allow the ECGs to be presented horizontally on a single page with the X-rays, and also to allow pairs of ECGs – such as before and after exercise – to be printed on the same page.

I am extremely grateful to Alison Gale, my copy-editor, and to Rich Cutler of Helius. Their patience, understanding and attention to detail made the preparation of this new edition an easy and satisfying experience for me.