Function of the valves Flow of Electrical Currents in the chest Aortic Pressure Curve 109 Around the hea 126 Relationship of the Heart Sounds to Electrocardiographic Leads 127 Heart Pumping Three bipolar Limb leads 127 Work Output of the Heart Chest Leads(Precordial Leads) 129 Graphical Analysis of Ventricular Pum Augmented Unipolar Limb leads l29 Chemical Energy Required for Cardi Contraction: Oxygen Utilization by the heart Regulation of Heart Pumping CHAPTER 1 2 trinsic Regulation of Heart Pumping- Electrocardiographic Interpretation The Frank-starling Mechanism of Cardiac Muscle and Coronary Effect of potassium and calcium lons on Heart Function Blood flow abnormalities: vectorial Effect of Temperature on Heart Function Analysis 131 ncreasing the Arterial Pressure L Principles of Vectorial Analysis of up to a Limit) Does Not Decrease the Electrocardiograms 13l 14 Use of Vectors to Represent Electrical Potentials Direction of a vector is denoted in terms CHAPTER 1 0 of Degrees Rhythmical Excitation of the Heart Ⅰl6 Axis for Each Standard Bipolar Lead and Specialized Excitatory and Conductive Each Unipolar limb Lead Ⅰl6 Vectorial Analysis of Potentials Recorded Sinus(Sinoatrial) Node l16 in Different Leads l33 nternodal Pathways and Transmission of Vectorial Analysis of the Normal the Cardiac Impulse Through the Atria Electrocardiogram Atrioventricular Node, and Delay of Impulse Vectors That occur at successive Intervals Conduction from the atria to the ventricles n 8 During depolarization of the ventricles- Rapid Transmission in the Ventricular The QRS Complex 134 Purkinje System Electrocardiogram During Repolarization- Transmission of the Cardiac Impulse in the The T Wave 134 Ventricular Muscle Depolarization of the Atria-the p ave Summary of the Spread of the Cardiac Vectorcardiogram mpule Through the Hea l20 Mean Electrical Axis of the ventricular Control of excitation and conduction QRS--And Its significance in the heart 120 Determin he Electrical Axis from The Sinus Node as the pacemaker of the Standard Lead Electrocardiograms Heart l20 Abnormal Ventricular Conditions That Cause Role of the Purkinje System in Causing Axis Deviation Synchronous Contraction of the Conditions That Cause Abnormal Ventricular Muscle Voltages of the QRS Complex l40 Control of Heart Rhythmicity and Impulse Increased voltage in the standard bipolar Conduction by the Cardiac Nerves: the Limb leads Sympathetic and Parasympathetic Nerves 121 Decreased Voltage of the Electrocardiogram 140 Prolonged and Bizarre Patterns of the 141 CHAPTER 11 Prolonged QRS Complex as a Result of The Normal Electrocardiogram Cardiac Hy pertrophy or Dilatation 23 Prolonged QRS Complex Resulting from Characteristics of the normal Purkinje System Blocks Electrocardiogram Conditions That Cause Bizarre QRS Depolarization Waves versus Complexes Repolarization Waves 123 Current of Injury Relationship of Atrial and ventriculat Effect of Current of Injury on the QRS Contraction to the waves of the Electrocardiogram 125 The j Point-The Zero Reference Potential Voltage and Time Calibration of the for Analyzing Current of Injur Electrocardiogram 125 Coronary Ischemia as a Cause of Injury Meth。 ds for Recording otential 126 Abnormalities in the T wave Pen Recorder 126 Effect of Slow Conduction of the Flow of current Around the heart During the Cardiac Cycle 126 Characteristics of the t wave Recording Electrical Potentials from a Shortened Depolarization in Portions of Partially Depolarized Mass of Syncytial the ventricular muscle as a cause o Cardiac Muscle 126 T Wave abnormalitiesTable of Contents xv Function of the Valves 109 Aortic Pressure Curve 109 Relationship of the Heart Sounds to Heart Pumping 109 Work Output of the Heart 110 Graphical Analysis of Ventricular Pumping 110 Chemical Energy Required for Cardiac Contraction: Oxygen Utilization by the Heart 111 Regulation of Heart Pumping 111 Intrinsic Regulation of Heart Pumping— The Frank-Starling Mechanism 111 Effect of Potassium and Calcium Ions on Heart Function 113 Effect of Temperature on Heart Function 114 Increasing the Arterial Pressure Load (up to a Limit) Does Not Decrease the Cardiac Output 114 CHAPTER 10 Rhythmical Excitation of the Heart 116 Specialized Excitatory and Conductive System of the Heart 116 Sinus (Sinoatrial) Node 116 Internodal Pathways and Transmission of the Cardiac Impulse Through the Atria 118 Atrioventricular Node, and Delay of Impulse Conduction from the Atria to the Ventricles 118 Rapid Transmission in the Ventricular Purkinje System 119 Transmission of the Cardiac Impulse in the Ventricular Muscle 119 Summary of the Spread of the Cardiac Impulse Through the Heart 120 Control of Excitation and Conduction in the Heart 120 The Sinus Node as the Pacemaker of the Heart 120 Role of the Purkinje System in Causing Synchronous Contraction of the Ventricular Muscle 121 Control of Heart Rhythmicity and Impulse Conduction by the Cardiac Nerves: The Sympathetic and Parasympathetic Nerves 121 CHAPTER 11 The Normal Electrocardiogram 123 Characteristics of the Normal Electrocardiogram 123 Depolarization Waves Versus Repolarization Waves 123 Relationship of Atrial and Ventricular Contraction to the Waves of the Electrocardiogram 125 Voltage and Time Calibration of the Electrocardiogram 125 Methods for Recording Electrocardiograms 126 Pen Recorder 126 Flow of Current Around the Heart During the Cardiac Cycle 126 Recording Electrical Potentials from a Partially Depolarized Mass of Syncytial Cardiac Muscle 126 Flow of Electrical Currents in the Chest Around the Heart 126 Electrocardiographic Leads 127 Three Bipolar Limb Leads 127 Chest Leads (Precordial Leads) 129 Augmented Unipolar Limb Leads 129 CHAPTER 12 Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities: Vectorial Analysis 131 Principles of Vectorial Analysis of Electrocardiograms 131 Use of Vectors to Represent Electrical Potentials 131 Direction of a Vector Is Denoted in Terms of Degrees 131 Axis for Each Standard Bipolar Lead and Each Unipolar Limb Lead 132 Vectorial Analysis of Potentials Recorded in Different Leads 133 Vectorial Analysis of the Normal Electrocardiogram 134 Vectors That Occur at Successive Intervals During Depolarization of the Ventricles— The QRS Complex 134 Electrocardiogram During Repolarization— The T Wave 134 Depolarization of the Atria—The P Wave 136 Vectorcardiogram 136 Mean Electrical Axis of the Ventricular QRS—And Its Significance 137 Determining the Electrical Axis from Standard Lead Electrocardiograms 137 Abnormal Ventricular Conditions That Cause Axis Deviation 138 Conditions That Cause Abnormal Voltages of the QRS Complex 140 Increased Voltage in the Standard Bipolar Limb Leads 140 Decreased Voltage of the Electrocardiogram 140 Prolonged and Bizarre Patterns of the QRS Complex 141 Prolonged QRS Complex as a Result of Cardiac Hypertrophy or Dilatation 141 Prolonged QRS Complex Resulting from Purkinje System Blocks 141 Conditions That Cause Bizarre QRS Complexes 141 Current of Injury 141 Effect of Current of Injury on the QRS Complex 141 The J Point—The Zero Reference Potential for Analyzing Current of Injury 142 Coronary Ischemia as a Cause of Injury Potential 143 Abnormalities in the T Wave 145 Effect of Slow Conduction of the Depolarization Wave on the Characteristics of the T Wave 145 Shortened Depolarization in Portions of the Ventricular Muscle as a Cause of T Wave Abnormalities 145