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Fundamentals of Electrocardiography by Roger W. Jelliffe (auth.)

By Roger W. Jelliffe (auth.)

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I ... ~,--- TIM E 0 V. C. G. RIGHT VENTRICULAR HYPERTROPHY This record shows regular sinus rhythm. 00, and the P axis is +15 degrees. The horizontal (JIS axis has a double transition, one between V2 and V3, the other at VII-V6. There is clearly excess anterior force. The horizontal T axis is about -110, the P axis is about +10 degrees. There is evidence of left and possible right atrial enlargement. The rightward and anterior QRS forces suggest right ventricular hypertrophy, and the T changes suggest right ventricular strain (and/or anterior ischemia).

0] SEC. /\..... STANDARD LEFT ATRIAL ENLARGEMENT 40 Courtesy III Dr. 10lIl14 Selvesl« IIJncho los Amigoi Hospili. -- I'~ ~ -----........ $. = ~ -'\~r SEQUENCE Of "YOCAIIOIAL DEPOLAl\llATlOfl I 10 SEC. OR LESS PEAKED IN LEAD II TEND. nihl Courtesy 01 Dr. ROIIIId S••••i1er (EXCEPT PUL EMPHYSEMA) PREDOM. 1\.. I~ II:::JC STANDARD RIGHT ATRIAL ENLARGEMENT Courtesy III Dr. ROIIII4 Selvesw IIJnchQ los Ami905 Hoipili' TIME RELATIONSHIPS ATRIAL ENLARGEMENT clinical explanation for the ST-T changes that occur with ischemia and "injury", and for the changes seen with hyper- and hypokalemia.

This difference is greatest during diastole, and is least just after the spike potential, when the cells are on the plateaus of their action potentials. This is why an "ST segment shift" is really a baseline shift. We also see that it is not telling us anything about the mystical word "injury", and we see no "current of injury". The EKG does not measure current. 41 It is simply a voltmeter. An ST segment shift therefore usually tells us that we have a significant group of cells that is working under severe ischemia or under adverse mechanical circumstances, and that the resting potentials of these cells are reduced compared to that of the normal cells.

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