Textbook of Clinical Electrocardiography

1 Cardiac electrophysiology.- 1.1 Heart cells.- 1.1.1 Types.- 1.1.2 Properties.- 1.2 Cellular activation.- 1.2.1 Diastolic polarization phase.- 1.2.2 Systolic cellular depolarization phase.- 1.2.3 Systolic cellular repolarization phase.- 1.2.4 TAP morphology in different heart structures.- 1.3 Cell electrogram.- 1.4 Concept of dipole.- 1.4.1 Depolarization dipole.- 1.4.2 Repolarization dipole.- 1.4.3 Depolarization and repolarization dipole in an ischemic cell.- 1.5 Concept of hemifield.- 1.6 Cardiac activation.- 1.6.1 Atrial activation: P loop.- 1.6.1.1 Atrial depolarization: P loop.- 1.6.1.2 Atrial repolarization.- 1.6.2 Ventricular activation: QRS and T loops.- 1.6.2.1 Ventricular depolarization: QRS loop.- 1.6.2.2 Ventricular repolarization: T loop.- 1.6.3 The domino theory.- 1.7 Correlation between the TAP curve and ECG curve.- 2 The normal electrocardiogram.- 2.1 Wave nomenclature.- 2.2 Inscription system.- 2.3 Leads.- 2.3.1 Frontal plane leads.- 2.3.1.1 Bipolar limb leads: triaxial system of Bailey.- 2.3.1.2 Unipolar limb leads: hexaxial system of Bailey.- 2.3.2 Horizontal plane leads.- 2.4 Hemifields.- 2.4.1 Positive and negative hemifields of the frontal and horizontal plane leads.- 2.4.2 Loop-electrocardiographic morphology correlation.- 2.5 Interpretation routine.- 2.5.1 Heart rate.- 2.5.2 Rhythm.- 2.5.3 PR interval and segment.- 2.5.4 QT interval.- 2.5.5 Calculation of the electrical axis of the heart.- 2.5.5.1 Indeterminate electrical axis.- 2.5.6 The normal P wave.- 2.5.6.1 Axis in the frontal plane (AP).- 2.5.6.2 Polarity and morphology.- 1 Polarity.- 2 Morphology.- 2.5.6.3 Duration and voltage.- 2.5.7 The normal QRS complex.- 2.5.7.1 Axis on the frontal plane (AQRS).- 2.5.7.2 Polarity and morphology: modifications with different rotations.- 1 Heart rotations.- 1. a Rotation on the anteroposterior axis.- 1. b Rotation on the longitudinal axis.- 1. c Rotation on the transversal axis.- 1. d Combined rotations.- 2 Normal notches and slurrings.- 3 Normal ‘Q’ wave.- 2.5.7.3 QRS duration and voltage.- 2.5.8 ST segment and T wave.- 2.5.8.1 ST segment.- 2.5.8.2 T wave.- 1 Axis on the frontal plane (AT).- 2 Normal polarity and morphology.- 3 Voltage.- 2.5.9 U wave.- 2.6 Electrocardiographic variations with age.- 2.6.1 Infants, children and adolescents.- 2.6.2 Elderly people.- 2.7 Other normal variants.- 2.7.1 P wave and atrial repolarization wave (ST-Ta).- 2.7.2 Ventricular depolarization.- 2.7.2.1 Hyperdeviation of AQRS in the frontal plane.- 2.7.2.2 Morphology of first degree right or left ventricular block.- 1 Morphology with r? in V1 with QRS lt; 0.12 sec.- 2 Morphology of first degree left ventricular block.- 2.7.3 Repolarization alterations.- 2.7.4 Arrhythmias.- 2.8 Sensitivity and specificity of the ECG.- 3 Other electrocardiological techniques.- 3.1 Vectorcardiography: x,y,z leads.- 3.1.1 Methodology.- 3.1.2 Clinical utility of vectorcardiography and the orthogonal leads.- 3.2 Exercise ECG test.- 3.2.1 Methodology.- 3.2.2 Utility.- 3.2.3 Interpretation.- 3.2.3.1 Physiologic responses to exercise.- 3.2.3.2 Abnormal responses to exercise.- 1 Alterations of the ST Segment.- 1. a Normal basal ECG.- 1. b Altered basal ECG.- 2 Other repolarization alterations.- 3 Increase in R wave voltage.- 4 Appearance of ventricular block.- 5 Arrhythmias.- 3.2.4 Comparison with other tests.- 3.2.5 Limitations.- 3.3 Holter ECG and allied techniques.- 3.3.1 Methodology.- 3.3.2 Utility.- 3.3.2.1 Arrhythmias.- 1 Evaluation of the electrophysiologic mechanism of the arrhythmias.- 2 Arrhythmia-symptom correlation.- 3 Investigation of the prevalence of arrhythmias.- 4 Frequency and duration of supraventricular or ventricular tachycardia crises.- 5 Noninvasive evaluation of antiarrhythmic therapy.- 6 Control of pacemaker function.- 7 Patients with syncope or near-syncope.- 3.3.2.2 Repolarization alterations.- 1 Repolarization alterations other than in coronary heart disease.- 2 Repolarization alterations due to coronary heart disease.- 2. a Secondary versus primary angina.- 2. b Sensitivity and specificity of the Holter ECG for the diagnosis of coronary disease.- 2. c Control of antianginal treatment.- 3.3.3 Limitations.- 3.3.4 Allied techniques.- 3.3.4.1 Alteration analyzer.- 3.3.4.2 Transtelephonic ECG: SAMTI system.- 3.4 Intracavitary electrocardiography.- 3.4.1 Methodology.- 3.4.2 Utility.- 3.4.2.1 To measure functional and effective refractory period.- 3.4.2.2 Topographic localization of AV block.- 1 Suprahisian AV blocks.- 1. a Intraatrial block.- 1. b Intranodal block.- 2 Intrahisian blocks.- 3 Infrahisian blocks.- 3.4.2. 3 Study of the characteristics of AV conduction.- 3.4.2. 4 Study of the sinus function.- 3.4.2. 5 Study of the characteristics of the accessory bundles.- 3.4.2. 6 Study of the characteristics of a tachycardia.- 3.4.2. 7 Topographic localization of right ventricular block.- 3.4.2. 8 Pharmaco-electrophysiology.- 3.4.2. 9 Other therapeutic uses.- 3.4.2.10 Differentiating patients with high risk of sudden death (SD).- 3.4.2.11 Enhancing the diagnostic precision of the conventional ECG.- 3.4.2.12 When intracavitary electrophysiologic study should be realized.- 3.4.3 Limitations.- 3.5 Unified ECG interpretation.- 3.5.1 Minnesota Code.- 3.5.2 Interpretation by computer.- 3.6 Other electrocardiologic techniques.- 3.6.1 Spatial velocity technique.- 3.6.2 Cardiac mapping.- 3.6.3 External techniques to record late potentials.- 3.6.4 Other techniques.- 4 Alterations in the atrial electrocardiogram.- 4.1 Alterations in the P wave.- 4.1.1 Atrial enlargement.- 4.1.1.1 Right atrial enlargement (RAE) (dilation).- 1 Changes in the P wave.- 2 Changes in the QRS complex.- 3 Diagnostic criteria: ECG and VCG.- 4.1.1.2 Left atrial enlargement (LAE) (dilation).- 1 Changes in the P wave.- 2 Diagnostic criteria: ECG and VCG.- 4.1.1.3 Biatrial enlargement.- 1 Electrocardiogram.- 2 Vectorcardiogram.- 4.1.2 Atrial block.- 4.1.2.1 Sinoatrial block.- 4.1.2.2 Interatrial block.- 4.1.2.3 Intraatrial block.- 4.2 Alterations in atrial repolarization.- 4.2.1 Depressed ST-Ta.- 4.2.2 Elevated ST-Ta.- 5 Ventricular enlargement.- 5.1 Preliminary considerations: definition of terms.- 5.2 Left ventricular enlargement (LVE).- 5.2.1 Left ventricular hypertrophy (LVH).- 5.2.1.1 Electrocardiographic alterations.- 1 Changes in the QRS complex.- 2 Changes in ST segment and T wave.- 5.2.1.2 Diagnostic ECG criteria.- 1 Limitations of the diagnostic criteria.- 1. a Methodological considerations.- 1. b Limitations conditioned by constitutional factors.- 5.2.1.3 Diagnostic VCG criteria.- 5.2.1.4 Value of the echocardiogram in the diagnosis of left ventricular enlargement (LVE).- 5.2.1.5 Value of other electrocardiologic techniques.- 5.2.1.6 Special characteristics of some types of left ventricular enlargement (LVE).- 1 LVE in children.- 2 Left ventricular dilation associated with LVH.- 3 Indirect signs of LVE.- 5.2.1.7 Differential diagnosis.- 1 Left ventricular enlargement versus left ventricular block.- 2 WPW preexcitation Type 1.- 3 Ischemic heart disease.- 3. a Lateral ischemia vs. left ventricular enlargement.- 3. b QS morphology in right precordial leads in patients with LVE.- 5.2.1.8 Final considerations.- 5.3 Right ventricular enlargement (RVE).- 5.3.1 Right ventricular hypertrophy (RVH).- 5.3.1.1 Electrocardiographic alterations.- 1 Electrocardiographic changes due to progressively anterior and right QRS loop situation.- 2 Electrocardiographic changes due to progressively posterior and right QRS loop.- 5.3.1.2 Electrocardiographic diagnostic criteria.- 5.3.1.3 Vectorcardiographic diagnostic criteria.- 5.3.1.4 Value of other techniques for the diagnosis of right ventricular enlargement.- 5.3.1.5 Special characteristics of some types of right ventricular enlargement.- 1 Right ventricular dilation.- 2 RVE in children.- 3 Indirect signs of RVE.- 5.3.1.6 Differential diagnosis.- 1 Differential diagnosis of RVH with dominant R morphology in V1.- 2 Differential diagnosis of RVH with rS pr QS morphology in V1.- 5.4 Biventricular enlargement.- 5.5 Enlargement of the four cavities.- 6 Ventricular block.- 6.1 Concept of heart block.- 6.2 Ventricular block.- 6.2.1 Definition of terms.- 6.2.2 General considerations.- 6.2.3 Global right ventricular block (GRVB).- 6.2.3.1 Third degree (advanced) block.- 1 Activation.- 2 ECG-VCG diagnosis.- 2. a QRS duration.- 2. b AQRS in the fontal plane.- 2. c ECG-VCG morphologies: Diagnostic criteria.- 3 Intracavitary ECG.- 4 Association with ventricular enlargement.- 5 Association with myocardial infarction.- 6 Clinical implications.- 6.2.3.2 Second degree block.- 6.2.3.3 First degree (not advanced) block.- 6.2.3.4 Dominant R morphology in V1 not due to RVB.- 6.2.4 Zonal or divisional right ventricular blocks.- 6.2.5 Global left ventricular block (GLVB).- 6.2.5.1 Third degree (advanced) block.- 1 Activation.- 2 ECG-VCG. Diagnosis.- 2. a QRS duration.- 2. b AQRS in the frontal plane.- 2. c ECG-VCG morphologies: Diagnostic criteria.- 3 Intracavitary ECG.- 4 Association with ventricular enlargement.- 5 Association with myocardial infarction.- 6 Clinical impUcations.- 6.2.5.2 Second degree block.- 6.2.5.3 First degree (not advanced) block.- 6.2.5.4 Other causes of GLVB-like morphology.- 6.2.6 Left zonal (or divisional) block.- 6.2.6.1 Superoanterior hemiblock (SAH).- 1 Activation.- 2 ECG-VCG diagnosis.- 2. a QRS duration.- 2. b AQRS in the frontal plane.- 2. c ECG-VCG morphologies: Diagnostic criteria.- 3 Differential diagnosis.- 4 Special characteristics.- 5 Clinical implications.- 6.2.6.2 Inferoposterior hemiblock (IPH).- 1 Activation.- 2 ECG-VCG diagnosis.- 2. a QRS duration.- 2. b AQRS in the frontal plane.- 2. c ECG-VCG morphologies: Diagnostic criteria.- 3 Differential diagnosis.- 4 Special characteristics.- 5 Clinical impHcations.- 6.2.7 Anteroseptal medial fiber block.- 6.2.8 Combined blocks.- 6.2.8.1 Bifascicular blocks.- 1 Global right ventricular block + global left ventricular block (bitruncal block).- 2 Superoanterior hemiblock with inferoposterior hemiblock.- 3 Global left ventricular block (trunk block) with superoanterior or inferoposterior hemiblock.- 4 Alternating block of two of the four fascicles.- 5 Global advanced right ventricular block (GARVB) with advanced superoanterior hemiblock (SAH).- 5. a Activation.- 5. b ECG-VCG diagnosis.- 5. c Masked blocks.- 6 Global advanced right ventricular block (GARVB) with advanced inferoposterior hemiblock (IPH).- 6. a Activation 227.- 6. b ECG-VCG diagnosis.- 7 Clinical implications of the bifascicular block.- 6.2.8.2 Trifascicular block.- 7 Preexcitation.- 7.1 Definition of the term.- 7.2 Interest of the diagnosis.- 7.3 Types of preexcitation.- 7.4 Classic WPW type preexcitation.- 7.4.1 Accessory connections.- 7.4.1.1 Anatomic characteristics.- 7.4.1.2 Electrophysiologic characteristics.- 7.4.2 Electrocardiologic diagnosis.- 7.4.2.1 Alterations in the atriogram.- 7.4.2.2 PR interval.- 7.4.2.3 Alterations in the ventriculogram.- 1 Morphology of the QRS complex and loop.- 2 Localization of the accessory bundle by surface ECG.- 3 Repolarization alterations.- 7.4.3 Electrophysiologic techniques for differentiating types of preexcitation.- 7.4.4 Differential diagnosis of classic WPW type preexcitation.- 7.4.5 Peculiar electrocardiologic characteristics of classic WPW type preexcitation.- 7.4.5.1 Spontaneous induced changes of anomalous morphology.- 7.4.5.2 Association with arrhythmias.- 7.4.5.3 Association with ventricular block.- 7.4.5.4 Association with coronary heart disease.- 7.4.5.5 WPW preexcitation and normal PR interval.- 7.4.6 Prognostic considerations.- 7.5 Mahaim type preexcitation.- 7.5.1 Types of Mahaim fibers.- 7.5.1.1 Anatomic characteristics.- 7.5.1.2 Electrophysiologic correlation.- 7.5.2 Electrocardiologic diagnosis.- 7.5.2.1 Nodoventricular (NV) fibers.- 7.5.2.2 Fasciculoventricular (FV) fibers.- 7.5.3 Epidemiological and clinical considerations.- 7.6 Short PR type preexcitation.- 7.6.1 Mechanism of preexcitation.- 7.6.2 Electrocardiologic diagnosis.- 7.6.3 Epidemiological and clinical considerations.- 8 ECG morphologies of ischemia, injury and necrosis.- 8.1 Coronary artery disease: general considerations.- 8.2 Morphology of ischemia.- 8.2.1 Electrophysiologic concept of ischemia.- 8.2.2 ECG morphology of subendocardial ischemia (tall, peaked T wave).- 8.2.2.1 Differential diagnosis.- 8.2.3 ECG morphology of subepicardial ischemia (flattened or negative, symmetric T wave).- 8.2.3.1 Differential diagnosis.- 8.2.4 VCG morphology of ischemia.- 8.3 Morphology of injury.- 8.3.1 Electrophysiologic concept of injury.- 8.3.2 ECG morphology of subendocardial injury (ST depression).- 8.3.2.1 Differential diagnosis.- 8.3.3 ECG morphology of subepicardial injury (ST elevation) 274 8.3.3.1 Differential diagnosis.- 8.3.4 VCG morpohology of injury.- 8.4 Morphology of necrosis.- 8.4.1 Electrophysiologic concept of necrosis: electrically necrotic tissue.- 8.4.2 Electrogenesis of the electrical necrosis morphology seen in the surface ECG.- 8.4.2.1 Transmural necrosis.- 8.4.2.2 Nontransmural necrosis.- 8.4.3 ECG-VCG characteristics of the morphology of necrosis.- 8.4.3.1 Abnormal Q wave (Q wave of necrosis).- 8.4.3.2 Anatomic localization of the necrosis when ventricular conduction is normal: ECG- VCG criteria.- 1 Transmural necrosis.- 1. a Inferior necrosis.- 1. b Anterior necrosis.- 1. c Lateral necrosis.- 1. d Septal necrosis.- 1. e Posterior necrosis.- 2 Other types of necrosis.- 2. a Subendocardial infarction.- 2. b Atrial infarction.- 2. c Right ventricular infarction.- 2. d Exclusively subepicardial or intramural infarcts.- 8.4.3.3 Diagnosis of necrosis in the presence of ventricular block.- 1 ECG diagnosis of necrosis in the presence of global right ventricular block.- 2 ECG diagnosis of necrosis in the presence of left ventricular block.- 2. a Global advanced left ventricular block.- 2. b Global not advanced left ventricular block.- 2. c Diagnosis of necrosis associated with hemiblock.- 2. d Necrosis versus medial anteroseptal fibers block.- 2. e Necrosis with bifascicular block.- 8.4.3.4 Diagnosis of necrosis in patients with pacemakers.- 1 Acute phase.- 2 Chronic phase.- 8.4.3.5 Diagnosis of necrosis in patients with WPW syndrome.- 8.4.3.6 Diagnosis of necrosis by extrasystolic morphology.- 8.4.3.7 Differential diagnosis of the morphology of necrosis (abnormal Q wave).- 1 Artifacts.- 2 Variants of normahty.- 3 Thoracic abnormalities.- 4 Congenital heart disease.- 5 Right ventricular enlargement.- 6 Left ventricular enlargement.- 7 Left ventricular block.- 8 WPW.- 9 Pacemaker rhythm.- 10 Myocarditis and cardiomyopaties.- 11 Cardiac tumors and cysts.- 12 Cardiac trauma.- 13 Acute ischemia without necrosis.- 14 Miscellaneous.- 9 Arrythmias.- 9.1 Definition of the term.- 9.2 General electrophysiology of the arrhythmias.- 9.2.1 Automaticity.- 9.2.2 Excitability: refractory period.- 9.2.3 Conduction.- 9.2.3.1 Conduction alterations.- 1 Better than expected conduction.- 2 Anomalous pathway conduction.- 3 Slower than normal conduction: heart block 333.- 3. a Types of block.- 3. b Aberrant conduction.- 3. c Concealed conduction.- 3. d Reentry.- 9.3 Classification of the cardiac arrhythmias.- 9.4 Electrocardiologic diagnosis.- 9.4.1 Preliminary considerations: Lewis diagrams.- 9.4.2 Hyperactive arrhythmias.- 9.4.2.1 Isolated premature ectopic impulses.- 1 Extrasystoles.- 1. a Supraventricular extrasystoles.- 1. b Ventricular extrasystoles.- 2 Parasystoles.- 3 Reciprocal impulses.- 4 Aberrancy versus ectopy in premature impulses.- 9.4.2.2 Rapid supraventricular rhythms.- 1 Atrial fibrillation.- 1. a ECG characteristics.- 1. b Clinical significance.- 2 Atrial flutter.- 2. a ECG characteristics.- 2. b Clinical significance.- 3 Supraventricular tachycardia.- 3. a Atrial tachycardia.- 3. a.1 Increased automaticity: sinus and ectopic focus (unifocal and multiform).- 3. a.2 Atrial reentrant tachycardia.- 3. b AV junctional tachycardia.- 3. b.1 Junctional tachycardia caused by ectopic focus.- 3. b.2 Junctional tachycardia due to reentry (RJT).- 3. b.2.1 ECG features: paroxysmal and permanent.- 3. b.2.2 Differential diagnosis of paroxysmal RJT.- 3. b.2.3 Clinical features of RJT.- 3. b.2.4 Utility of other electrocardiologic techniques.- 9.4.2.3 Rapid ventricular rhythms.- 1 Ventricular tachy. Dia.- 1. a ECG classification and clinical manifestations.- 1. b Monomorphic ventricular tachycardia.- 1. b.1 Classic or typical type.- 1. b.1.1 Differential diagnosis.- 1. b.2 Other types.- 1. b.2.1 Tachycardias with QRS lt; 0.12sec.- l. b.2.2 Slow ventricular tachycardia (accelerated idioventricular rhythm).- l. b.2.3 Parasystolic ventricular tachycardia.- 1. c Polymorphic ventricular tachycardia.- 1. c.1 Bidirectional tachycardia.- 1. e.2 ‘Torsade de pointes’.- 1. e.3 Other types (pleomorphism).- 2 Ventricular flutter.- 3 Ventricular fibrillation.- 4 Chaotic ventricular rhythm.- 9.4.3 Hypoactive arrhythmias.- 9.4.3.1 Escape impulse or complex.- 9.4.3.2 Escape rhythm.- 9.4.3.3 Bradycardia due to depression of sinus automaticity.- 9.4.3.4 Sinoatrial block.- 9.4.3.5 Sick sinus syndrome.- 9.4.3.6 Atrioventricular block.- 1 First degree block.- 2 Second degree block.- 3 Third degree or complete A-V block.- 4 Paroxysmal A-V block.- 5 Topographic diagnosis of the location of A-V block.- 9.4.3.7 Cardiac arrest.- 9.4.3.8 The pacemaker ECG.- 1 Pacemakers: types and interpretation code.- 2 Pacemaker electrocardiology: normal pacemaker ECG, arrhythmias in car¬diac pacing, and pacemaker malfunction.- 9.5 Analytic study of an arrhythmia.- 9.5.1 Determination of the existence of a dominant rhythm.- 9.5.2 Analysis of the atrial deflection.- 9.5.3 Analysis of the QRS complex.- 9.5.4 Analysis of the atrioventricular relation.- 9.5.5 Analysis of premature complexes.- 9.5.6 Analysis of pauses.- 9.5.7 Analysis of delayed complexes.- 9.5.8 Analysis of the intermediate morphology complexes.- 9.5.9 Analysis of alloarrhythmias.- 9.5.10 Sequential analysis of continuous rhythms.- 10 Electrocardiology in different heart diseases and situations.- 10.1 Ischemic heart disease.- 10.1.1 Stable ischemic heart disease.- 10.1.1.1 Conventional electrocardiogram.- 1 Basal ECG.- 2 The ECG during crises.- 10.1.1.2 Other electrocardiologic techniques.- 1 Exercise ECG test and Holter ECG.- 2 Vectorcardiography.- 3 Intracavitary eletrophysiological studies.- 4 Signal averaging techniques to detect late potentials.- 10.1.2 Unstable angina.- 10.1.2.1 Basal ECG between angina crises 0.- 10.1.2.2 ECG during crises.- 10.1.3 Myocardial infarction.- 10.1.3.1 Electroanatomic correlation.- 1 Chronology.- 2 Location.- 10.1.3.2 Evolution of the ECG of acute infarction.- 10.1.3.3 Ventricular block (VB) previous to acute infarction and acquired VB.- 10.1.3.4 Arrhythmias in acute infarction.- 1 Hyperactive arrhythmias.- 2 Hypoactive arrhythmias.- 10.1.3.5 Atypical ECG in acute myocardial infarction.- 1 A typical evolution of the electrocardiogram.- 1. a Pseudonormalization of the electrocardiogram in the acute phase.- 1. b Normal ECG in the acute phase.- 1. c Rapid evolution of the electrocardiographic signs of infarction.- 1. d Discordance between the clinical and ECG course.- 1. e Absence of arrhythmias in the acute phase.- 10.1.3.6 The eletrocardiogram of infarction complications.- 1 Pulmonary embolism.- 2 Stroke.- 3 Pericarditis.- 4 Cardiac rupture.- 5 Left ventricular failure.- 6 Left ventricular aneurysm.- 10.1.3.7 Other electrocardiologic techniques in acute infarction.- 1 Vectorcardiography.- 2 Thoracic mapping.- 3 Intracavitary techniques.- 10.1.4 Usefulness of electrocardiography in the evaluation of ischemic heart disease.- 10.1.4.1 Prognostic value of exercise ECG test.- 10.2 Congenital heart disease.- 10.2.1 Atrial septal defect (ASD).- 10.2.2 Ventricular septal defect (VSD).- 10.2.3 Patent ductus arteriosus.- 10.2.4 Aortic stenosis.- 10.2.5 Aortic coarctation.- 10.2.6 Pulmonary stenosis.- 10.2.7 Tetralogy of Fallot.- 10.2.8 Transposition of the great arteries.- 10.2.9 Corrected transposition of the great arteries.- 10.2.10 Single ventricle.- 10.2.11 Tricuspid atresia.- 10.2.12 Ebstein’s disease.- 10.2.13 Fibroelastosis.- 10.2.14 The ECG in cardiac malpositions.- 10.3 Rheumatic fever.- 10.4 Valvular heart disease.- 10.4.1 Mitral valve disease.- 10.4.1.1 Mitral stenosis.- 10.4.1.2 Mitral regurgitation.- 10.4.1.3 Mitral prolapse.- 10.4.2 Aortic valve disease.- 10.4.2.1 Aortic stenosis.- 10.4.2.2 Aortic regurgitation.- 10.4.3 Tricuspid valve disease.- 10. 5 Arterial hypertension.- 10. 6 Cor pulmonale.- 10.6. Chronic cor pulmonale.- 10.6.2 Acute cor pulmonale: pulmonary embolism.- 10. 7 Infectious endocarditis.- 10. 8 Pericardial disease.- 10.8.1 Acute pericarditis.- 10.8.2 Pericardial effusion; cardiac tamponade.- 10.8.3 Constrictive pericarditis.- 10.9 Myocarditis and cardiomyopathies.- 10.9.1 Myocarditis.- 10.9.2 Dilated cardiomyopathy.- 10.9.3 Restrictive cardiomyopathy.- 10.9.4 Hypertrophic cardiomyopathy.- 10.10 The transplanted heart00F.- 10.11 Heart failure 462.- 10.12 Cardiac tumors.- 10.13 Electrolyte imbalance.- 10.13.1 Potassium alterations.- 10.13.1.1 Hyperkalemia.- 10.13.1.2 Hypokalemia C4.- 10.13.2 Calcium alterationsC.- 10.13.3 Magnesium alterations.- 10.14 Sportive activities.- 10.15 Hypothermia.- 10.16 Cerebral diseases.- 10.17 Endocrine disease.- 10.17.1 Hypothyroidism.- 10.17.2 Hyperthyroidism.- 10.17.3 Parathyroid diseases.- 10.17.4 Diabetes.- 10.17.5 Other endocrine diseases.- 10.18 Pheumothorax.- 10.19 Miscellaneous diseases.- 10.19.1 Livercirrhosis.- 10.19.2 Anemia.- 10.19.3 Pheochromocytoma.- 10.19.4 Others.- 10.20 Drug administration.- 10.20.1 Antiarrhythmic drugs.- 10.20.1.1 Effect on the specialized conduction system.- 10.20.1.2 Changes visible in the surface ECG.- 1 Ajmaline.- 2 Amiodarone.- 3 Aprindine.- 4 Atropine.- 5 (3-blocking agents).- 6 Diphenylhydantoin.- 7 Digitalis glycosides.- 8. Disopyramide.- 9. Isoproterenol.- 10.Lidocaine.- 11.Parasympathomimetic drugs.- 12.Quinidine.- 13.Propaphenon.- 14 Flecainide.- 15 Verapamil.- 10.20.2 Other cardioactive drugs.- 10.20.3 Other drugs.- 10.21 The ECG in anesthesia and surgery.- 10.21.1 Preoperative evaluation.- 10.21.2 The ECG during anesthesia and surgery.- 10.21.2.1 Artifacts.- 10.21.2.2 Alterations during anesthesia and surgery.- 10.21.2.3 Alterations in special situations.- 10.21.2.4 ECG warning signs.- 10.21.3 The ECG in postoperative care.- 10.21.4 The ECG and cardiac surgery.- 10.22 The ECG in alcoholism.- Index of subjects.