Interpretation of the ECG is an art which wrongly has received less attention in recent graduate and postgraduate teaching, whereas high‐tech imaging techniques and specific biomarkers are increasingly popular. As highlighted by the authors in their introduction, the ability of the ECG to provide information on the function and the structure of the heart, as well as on the localization of processes, makes it a still‐invaluable tool. The ECG can also provide repeated and even continuous information about the course of a specific cardiac condition. In addition, it does not interfere with or alter the substrate that it assesses. In these ways, it represents an ideal method, especially when used to monitor the evolving process of acute or subacute ischemia. In certain instances, like those in which a coronary angiogram does not clearly indicate the culprit lesion, the ECG can be the most valuable and readily available tool for decision‐making.

This compendium was first published in 2008 by Antoni Bayés de Luna and Miquel Fiol‐Sala. These two prominent and internationally renowned electrocardiography experts were determined to demonstrate the ECG’s significant role in diagnosing, monitoring, and managing the various manifestations of ischemic heart disease. Both are now complemented by another two internationally renowned scientists and clinicians: Yochai Birnbaum and Kjell Nikus. Together, these four authors have written the 15 chapters that comprise this book, while also acknowledging the valued support of an array of experts and peers.

The unique character of this book is exemplified by the numerous correlations of the ECG to cardiac anatomy and function, based on a spectrum of cardiac imaging modalities like coronary angiography, echocardiography, radioisotope imaging, magnetic resonance imaging, and computer tomography. As in the first edition, the ECG changes in ischemia and their electrophysiologic basis have been systematically assessed and then specified in different clinical settings of ischemic heart disease, including their prognostic implications. All chapters have been updated and adapted to reflect the present nomenclature. Also, more recent, emerging topics, like the role of telemedicine in the diagnosis of ischemic heart disease, are dealt with.

In the foreword to the first edition, I wrote that this book has the potential to become the “bible” in its field. Indeed, the second edition will continue to serve as a valuable teaching source and as a standard reference tool.

This book can be highly recommended to all cardiologists and internists who care for the large number of patients with manifestations of ischemic heart disease.

The readily available and inexpensive nature of the electrocardiogram (ECG) makes it a particularly attractive diagnostic tool. One of the most important applications of the ECG is in the evaluation of patients with ischemic heart disease. This second edition of an elegant textbook offers a refreshing, modernistic look at the surface electrocardiogram by experts in the field. In a single volume, the reader finds a richly illustrated resource that integrates clinical findings, coronary angiography, contemporary imaging modalities, echocardiography (computed tomography, SPECT perfusion studies, cardiac magnetic resonance studies), and cutting‐edge biomarker findings with a 100‐year old diagnostic test – the 12‐lead surface ECG. The book is again divided into two parts. First, electrocardiographic patterns of ischemia, injury, and infarction are discussed. Polar maps, vectorial illustrations, and simple diagrams illustrating the relationship between myocyte action potentials and the surface electrocardiogram are appealing for both the novice and experienced reader. The second part of the book explores the use of the surface electrocardiogram in a variety of clinical settings of ischemic heart disease, touching on the correlations with coronary anatomy and the prognostic implications that can be gleaned from the ECG.

The authors of the first edition, Drs. Bayés de Luna and Fiol‐Sala added two internationally recognized experts, Drs. Birnbaum and Nikus, in the present edition. This collective group of innovative authors have kept pace with the contemporary nomenclature in the acute coronary syndrome spectrum, evolving universal definitions of myocardial infarction and the alterations that occur when a patient transitions from the acute to the chronic phase of ischemic heart disease. A particularly attractive feature of this second edition is the incorporation of case studies − not only a useful resource for the individual practitioner, but an invaluable pedagogical resource as well.

This textbook is a marvelous example of what can be accomplished when clinicians who are comfortable at the patient’s bedside also have the visionary insight to incorporate new knowledge from contemporary cardiac imaging procedures into a fresh view of an older, but still extremely useful, diagnostic test. As with the classical 12‐lead electrocardiogram itself, readers of this textbook will find themselves returning to it over and over again because of the depth and breadth of its clinical usefulness.

The electrocardiogram (ECG), which was discovered more than 100 years ago, appears to be more alive than ever. The ECG is an important tool for identifying different ECG morphological abnormalities, including arrhythmias, conduction blocks at all levels, pre‐excitation, and acute and chronic changes of ischemia and infarction for which ECG has been the “gold‐standard” diagnostic technique. In addition, the ECG assists in detecting morphologic changes related to remodeling and hypertrophy.

The ECG undergoes continuous re‐evaluation in scientific publications, and it has proved its value as an important clinical tool in the diagnosis and risk stratification of various cardiac diseases. Every year there is more and more evidence to demonstrate that the ECG provides important clinical information, and its applications are growing and will be expanded in the future.

Although the usefulness of the surface ECG is important in all types of heart disease, it stands out particularly in the case of ischemic heart disease (IHD), for various reasons. The ECG is the key diagnostic tool both in the acute phase of IHD (acute coronary syndromes, ACS) and in the chronic one (Q‐wave infarction). Furthermore, it is crucial for risk stratification in patients with acute ischemic pain. Based on the ECG findings, critical therapeutic decisions are made about reperfusion therapy in ST‐elevation ACS (STE‐ACS). In the case of an ACS, especially in STE‐ACS, careful evaluation of ST‐segment deviations in different leads allows us to predict not only the occluded artery but also the level of occlusion. Therefore, the ECG helps to stratify risk and, consequently, to take the most appropriate therapeutic decisions.

In the chronic phase of Q‐wave infarction, the ECG is also very useful, since the identification of different ECG patterns gives a reliable approximation of the infarcted area.

Lastly, the ECG is of great importance, as the number of patients with IHD is very large, and therefore the repercussion of proper decisions made based on the ECG changes in combination with the clinical situation may have an extraordinary social and economic impact.

In spite of all the above‐mentioned arguments, there are only a few books that have dealt in depth with the value of ECG in IHD. Over 40 years ago, Schamroth and Goldberger wrote two important works, dedicated more to the chronic phase of IHD, but the information provided therein has inevitably become outdated in many aspects. Years later, works done by two groups of investigators, those of Wellens and Sclarovsky, published pioneering studies on the importance of the ECG in the acute phase of IHD. We nevertheless considered that, in the overall context of the ECG´s importance in IHD, there remained a space to fill in the field. That is what we intend to do with this publication.

One of the most important and new aspects of the book is the great number of correlations, not only with coronary angiography, but also with echocardiography, nuclear studies, and new imaging techniques, especially cardiovascular magnetic resonance (CMR) imaging and coronary multidetector computer tomography (CMDCT). All these correlations have given us a huge amount of important new information.

In the book, we also explain the ECG patterns of chronic Q‐wave myocardial infarction (MI) based on the correlation with the vectorcardiographic loops, although the use of this technique is time‐consuming and has not become popular in clinical practice.

When necessary, we also comment on the role of other non‐invasive electrocardiographic techniques, especially exercise ECG, Holter monitoring, and tele‐ECG. Invasive electrophysiological techniques do not have a central role in IHD, although they are necessary in some aspects of arrhythmic sequalae such as ablation procedures in ventricular arrhythmias.

This book consists of two parts. In the first one, following comments on the most important aspects of the anatomy of the heart related to IHD and based on coronary angiography and imaging correlations, we discuss ECG concepts and patterns of subendocardial and transmural ischemia and necrosis. We eliminated the term injury as we consider this term pathophysiologically irrelevant when dealing with the ECG in IHD. We discuss electrophysiological mechanisms behind the ECG presentations in different types of myocardial ischemia and describe the correlations between the ECG patterns in different leads and the myocardial area involved. Correlations between ECG curves and vectocardiographic loops constitute a key to understanding the ECG morphologies.

In the second part of the book, the ECG patterns are dealt with in different settings of IHD, including prognostic implications. The new chapters added compared with the first edition are: Differentiating ST‐elevation Myocardial Infarction from Non‐Ischemic ST elevation; common mistakes in the diagnosis of Acute Coronary syndromes; Telemedicine in the diagnosis of Ischemic Heart Disease through the surface electrocardiogram.

This second edition of the book has incorporated the contributions of two established experts in the ECG of IHD: Yochai Birnbaum and Kjell Nikus. With their extensive experience, they have extended the clinical and practical levels of ECG information’s utilization in IHD patient treatment. This is important, because all information is presented in a homogeneous manner, without the contradictory opinions that often appear in “edited” books. The text has been excessively updated and 183 new bibliographical references have been added.

An important novelty of this second edition is the incorporation of four case reports for self‐assessment after each chapter, described in a practical sense. It is our wish that the case reports will be of help to the reader when facing ECG tracings of patients with a suspected IHD.

We want to express our gratitude to Elliott Antman, pioneer in many aspects of IHD, who again has written a generous foreword to this second edition of the book. Also, our thanks to Günter Breithardt, an expert and pioneer in electrocardiology, who also has written an outstanding foreword emphasizing the electrocardiographic aspects of the book. We also very much appreciate the advice and friendship of Hein J.J. Wellens, Wojciech Zareba, and Samuel Sclarovsky, with whom we have shared many aspects of the new ideas expressed in this book.

Finally, we would like to express our gratitude to Andres Carrillo, Alberto Rodriguez, and Maria Riera from the Intensive and Coronary Care Unit of Hospital Son Espases, Miquel B. Fiol, Jr. for his help in improving the quality of some figures, Ramón Rotger from the Radiology Department of Clinica Rotger, and Vicente Peral, Jaume Maristany, Mar Alameda, Marcos Pascual, and Alfredo Gómez from the Cath Lab of Hospital Son Espases.