The Morphology of the Electrocardiogram
Antoni Bayés de Luna, Velislav N. Batchvarov andMarek Malik
The 12-lead electrocardiogram (ECG) is the single mostcommonly performed investigation. Almost everyhospitalized patient will undergo electrocardiography,and patients with known cardiovascular disease will doso many times. In addition, innumerable ECGs recordedare made for life insurance, occupational ﬁtness androutine purposes. Most ECG machines are now able toread the tracing; many of the reports are accurate butsome are not. However, an accurate interpretation of the ECG requires not only the trace but also clinicaldetails relating to the patient. Thus, every cardiologistand physician/cardiologist should be able to understandand interpret the 12-lead ECG. Nowadays, manyother groups, for example accident and emergencyphysicians, anaesthetists, junior medical staff, coronarycare, cardiac service and chest pain nurses, also need a
good grounding in this skill. In the last several decadesa variety of new electrocardiographic techniques, suchas short- and long-term ambulatory ECG monitoringusing wearable or implantable devices, event ECGmonitoring, single averaged ECGs in the time,frequency and spatial domains and a variety of stressrecoding methods, have been devised. The cardiologist,at least, must understand the application and value of these important clinical investigations. This chapterdeals comprehensively with 12-lead electrocardiographyand the major pathophysiological conditions that canbe revealed using this technique. Cardiac arrhythmiasand other information from ambulatory and averagingtechniques are explained only brieﬂy but are more fullycovered in other chapters, for example those devoted tospeciﬁc cardiac arrhythmias.
Broadly speaking, electrocardiography, i.e. the science andpractice of making and interpreting recordings of cardiacelectrical activity, can be divided into morphology andarrhythmology. While electrocardiographic morphologydeals with interpretation of the shape (amplitude, widthand contour) of the electrocardiographic signals, arrhyth-mology is devoted to the study of the rhythm (sequenceand frequency) of the heart. Although these two parts of electrocardiography are closely interlinked, their metho-dological distinction is appropriate. Intentionally, thischapter covers only electrocardiographic morphologysince rhythm abnormalities are dealt with elsewhere inthis book.
Morphology of the ECG
The electrocardiogram (ECG), introduced into clinicalpractice more than 100 years ago by Einthoven, comprisesa linear recording of cardiac electrical activity as it occursover time. An atrial depolarization wave (P wave), aventricular depolarization wave (QRS complex) and aventricular repolarization wave (T wave) are successively
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