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1．Introduction 13
History 13
Electrical Activity of the Heart 14
The Electrocardiogram 16
Unipolar Technique 21
Unipolar Terminology 26
2．Physiologic Principles 31
Experimental Data 31
Depolarization 38
Repolarization 44
The Five Basic Unipolar Ventricular Patterns 48
3．Electrical Position of the Heart 59
The Common Clinical Electrocardiographic Positions 59
Relationship of Unipolar to Standard Limb Leads 66
4．Ventricular Enlargement 71
Left Ventricular Hypertrophy 71
Diagnostic Electrocardiographic Signs 72
Right Ventricular Hypertrophy 78
Diagnostic Electrocardiographic Signs 80
5．Bundle Branch Block 89
General Considerations 89
Right Bundle Branch Block 92
Characteristic Unipolar Lead Changes 93
Incomplete Right Bundle Branch Block 96
Significance of Right Bundle Branch Block 97
Left Bundle Branch Block 98
Characteristic Unipolar Lead Changes 98
Incomplete Left Bundle Branch Block 102
Significance of Left Bundle Branch Block 102
Ventricular Hypertrophy and Bundle Branch Block 102
Arborization Block 104
Aberrant Atrioventricular Conduction(Wolff-Parkinson-White Syndrome) 106
6．Myocardial Infarction 108
Ischemia,Injury and Infarction Patterns 109
Interpretation of Infarction Pattern 114
Interpretation of Injury Pattern 115
Current of Injury Theory 115
Blocking of Depolarization Theory 121
Evolution of Myocardial Infarction 122
Localization of Infarction 124
Infarction Pattern in Extremity Leads 127
Acute Infarct Superimposed on Old Infarct 128
Myocardial Infarction Complicated by Bundle Branch Block 129
With Right Bundle Branch Block 129
With Left Bundle Branch Block 131
7．Abnormal Electrocardiographic Pattern 135
Ventricular Aneurysm 135
Myocarditis 136
Pericarditis 136
Pulmonary Embolism—Acute Cor Pulmonale 137
Digitalis Effect 139
Quinidine Effect 140
Potassium and Calcium Effect 140
Juvenile Precordial Lead Pattern 142
The Two Step(Master)Exercise Test 144
Hyperventilation Syndrome 146
8．Congenital Heart Disease 147
9．General Comments on Interpretation 150
The P Wave 150
The QRS Complex 150
The S-T Segment and the T Wave 151
Unipolar Esophageal Leads 152
Summary 154
10．Cardiac Arrhythmias 155
Normal Sinus Rhythm 156
Sinus Tachycardia 156
Sinus Bradycardia 157
Sinus Arrhythmia 157
Sinus Arrest and Sinoauricular Block 157
Auricular Premature Contraction 159
Nodal Premature Contraction 161
Ventricular Premature Contraction 161
Paroxysmal Auricular Tachycardia 163
Auricular Flutter 164
Auricular Fibrillation 165
Nodal Tachycardia 165
Ventricular Tachycardia 166
Ventricular Flutter and Fibrillation 167
Auriculoventricular Block 168
Auriculoventricular Dissociation 170
Illustrative Unipolar Electrocardiograms 171
Illustrative Electrocardiograms of the Arrhythmias 239
Bibliography 289
Index 301