Few textbooks have been written on the subject of EKG interpretation for the generalist with the combination of a broad array of clinical examples and detailed clinical application as the one we have produced here. Most textbooks on the subject have focused upon the electrophysiology underpinning the analog expression of the surface EKG we have come to know. Some have focused upon the vectorcardiography that drives the pattern recognition most clinicians rely upon when interpreting the EKG. It seems technology has been a late comer to EKG’s in spite of two decades of EKG interpretation software. Working with some of the best systems on the market today, we must conclude their sensitivity is quite high, but their specificity is disappointing. More than half the interpretations contain misleading overkill and often are laden with overlapping diagnoses. Overall, we are not convinced they offer a benefit worth reading through. As I type EKG reports on a daily basis, I simply highlight the provided software analysis (including the intervals) and start from scratch with my own reports. We have gone to great lengths in this text to provide the reader with real life EKG analysis from real (not simulated) tracings taken from patients we have personally cared for. Because of this, we often know clinical details that are most helpful to the interpreting physician and the referring physician alike. Because of this real-life array of tracings, we do apologize for the occasional low quality of the printed tracings, particularly the background grid. Many of these tracings date back more than forty years. But the print quality notwithstanding, we think you will have no problem discerning the detail we point out in each chapter’s text. With a topic as complex as EKG’s, one would have to expect overlap in the chapter topics, and so there is. For example, Chapter 23 focuses on the T-wave Axis because so few clinicians understand what this is. But there are other T-wave changes that point to underlying abnormalities that have nothing to do with the T-wave axis. These are covered in Chapter 24. When these inevitable overlaps occur, we have cross referenced the content to make it easier for the reader to understand both topics separately. The reader will also notice that we have repeated important information, and this is not an oversight. Most of us tend to learn better by repetition. You will notice most of the text of this read uses the collective, “We” in referring to our contributions. However, on occasion, you will notice the inevitable “I” slipping in. When you see this, the “I” is referring specifically to Dr. Sheppard’s aged insight. As a matter of form, each chapter begins with an “Overview” page intended to give the reader a taste of what the examples will bring. We hope you find this text as gratifying to read and study as we observed in producing it for you.

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