Showing papers on "QRS complex published in 1969"
TL;DR: The findings suggest that the appearance of high-frequency components in the vectorcardiogram or electrocardiograms may relate to the struggle between competing generator sites of ventricular enlargement as well as to the classic concept of shattering of the wave of activation on the shoals of infarction.
Abstract: In a correlative study between selected body-surface potential recordings and anatomic findings, multilead sets of high-fidelity, high-speed records from 128 persons were studied in connection with the results of our detailed postmortem dissections of their hearts. Attention was focused on high-frequency components (notching and slurring of the expanded QRS) as described by Langner. We found that (1) groups with ventricular enlargement without scarring were indistinguishable from groups with infarction on the basis of the number of high-frequency components; (2) both of these groups were clearly distinguishable from normal subjects on this basis alone; and (3) the high-frequency component count in the group with ventricular enlargement showed high negative correlation with age and high positive correlation with right and left ventricular weights. These findings suggest that the appearance of high-frequency components in the vectorcardiogram or electrocardiogram may relate to the struggle between competing...
226 citations
TL;DR: All ventricular extrasystoles originating within the "Purkinje network of the anterior division of the left bundle branch ''t.z" or bordering places in the ventricular wall, should closely resemble each other, and their electrocardiographic pattern should be that of RBBB with left posterior hemiblock (LPH).
136 citations
TL;DR: The triad of an accentuated first sound, systolic murmur and presystolic and diastolic gallops, especially in the absence of congestive heart failure, should strongly suggest the diagnosis of papillary muscle dysfunction.
85 citations
TL;DR: Inability to stimulate the atria, using the internal pacemaker, indicates that the myocardium, rather than the sinus node, is responsible for the atrial standstill.
84 citations
TL;DR: The ECG changes and pulmonary edema appear to be the result of a neurohumoral myocarditis with left ventricular damage and failure, and implications for heart transplantation are cited.
78 citations
TL;DR: These cases can be considered exceptional experiments of nature, providing both invaluable evidence for the existence of left anterior hemiblock and useful material for studying the changes that this conduction disturbance produces on the previously normal or abnormal electrocardiogram in man.
Abstract: The first 5 cases of intermittent left anterior hemiblock (block in the anterior division of the left bundle branch) are reported. These cases can be considered exceptional experiments of nature, providing both invaluable evidence for the existence of left anterior hemiblock and useful material for studying, with great accuracy, the changes that this conduction disturbance produces on the previously normal or abnormal electrocardiogram in man. The three major electrocardiographic features of left anterior hemiblock are found to be: (1) An ÂQRS directed at approximately −60 °; (2) the presence of a Q 1 S 3 pattern, simulating a counterclockwise rotation of the heart; and (3) a QRS widening of not greater than 0.02 sec.
73 citations
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TL;DR: Evidence obtained supports the concept that the His bundle and not the A-V node is the pacemaker site in nodal rhythms, and it is suggested that in so-called lower and middle nodal rhythm thepacemaker site is within the Hisundle.
Abstract: Traditionally the site of impulse formation in so-called A-V nodal rhythms has been considered to be within the upper, middle, and lower portions of the A-V node. In this study, evidence obtained supports the concept that the His bundle and not the A-V node is the pacemaker site in nodal rhythms. His bundle activity was recorded in clinical cases of nodal rhythms and A-V dissociation by using an electrode catheter positioned at the tricuspid valve. In these studies a single His deflection preceded each QRS complex. From the results of this study, it is suggested that in so-called lower and middle nodal rhythms the pacemaker site is within the His bundle. It is further suggested that so-called upper nodal rhythms may represent a coronary sinus or inferior left atrial rhythm.
56 citations
TL;DR: The morphology of pacemaker-induced QRS complexes is not an infallible criterion to locate the position of the stimulating electrodes, but the patterns are specific enough to have clinical importance and should be considered diagnostic of perforation.
56 citations
TL;DR: In atrial fibrillation aberrant ventricular beats were distinguished from premature Ventricular beats by the presence of a preceding His deflection in the former and its absence in the latter and the zone of concealment could be localized to the region proximal to the His bundle.
Abstract: Seven patients with atrial fibrillation and six patients with atrial flutter were studied using the technic of His bundle recordings. All 13 patients received digitalis. In atrial fibrillation each QRS complex (except for premature ventricular beats) was preceded by a single His bundle deflection. Complete block distal to the His bundle was not observed. Thus, the zone of concealment could be localized to the region proximal to the His bundle. The clinical findings were confirmed in three animal experiments. In atrial flutter the nonconducted P waves were also blocked proximal to the His bundle. In atrial fibrillation aberrant ventricular beats were distinguished from premature ventricular beats by the presence of a preceding His deflection in the former and its absence in the latter.
48 citations
TL;DR: The addition of RBBB produced a further delay in deflection time in epicardial leads from the RV and a further increase in QRS interval, emphasizing the need for caution in the diagnosis of left posterior fascicular block alone or in combination with RBBBs.
Abstract: To determine the electrocardiographic consequences of experimentally produced left posterior fascicular block, electrocardiograms of three baboons and three dogs were recorded from extremity and chest leads, from an esophageal lead, and from atraumatic exploring epicardial leads both before and after left posterior fascicular block and again after right bundle-branch block. The following electrocardiographic changes were noted: In direct epicardial leads from sites overlying zones of delayed myocardial excitation (1) increased ratio of R to S; (2) later intrinsic deflection time; and (3) appearance or augmentation of the Q wave. These altered potentials also appeared as rotations of the mean spatial QRS electrical axis. The QRS duration increased slightly. The addition of RBBB produced a further delay in deflection time in epicardial leads from the RV and a further increase in QRS interval. The epicardial envelopment by the excitation process is portrayed in diagrams. These observations emphasize the need...
42 citations
TL;DR: The tracings of two patients with acute myocardial infarction showing complete right bundle branch block and alternating block in the divisions of the left branch are presented, indicating a view departing from conventional electrocardiographic theory.
Patent•
11 Apr 1969TL;DR: In this paper, a system for DIAGNOSING HEART DISEASES EMPLOYS ANALOG and DIGITAL CIRCUITRY WHICH SEPARATES the P WAVE OR the QRS WAVE FROM a WAVEFORM OF CARDIAC POTENTIAL.
Abstract: A SYSTEM FOR DIAGNOSING HEART DISEASES EMPLOYS ANALOG AND DIGITAL CIRCUITRY WHICH SEPARATES THE P WAVE OR THE QRS WAVE FROM A WAVEFORM OF CARDIAC POTENTIAL. THIS WAVEFORM OF CARDIAC POTENTIAL INCLUDES THE P WAVE, THE QRS WAVE AND THE T WAVE. THROUGH A PLURALITY OF STORAGE AND SAMPLING ELEMENTS, THE WIDTH AND AMPLITUDE OF THE QRS WAVE OR THE WIDTH NUMBER OF PEAKS AND CHARACTERISTICS OF THE P WAVE ARE DETERMINED.
Journal Article•
TL;DR: Study of orthogonal leads in right sternal recumbency indicated that ventricular activation is spatially oriented dorsad, sinistrad and slightly caudad, and no essential difference was noticed in the conventional and miniature swine.
Abstract: Standard, augmented limb leads and lead V10 (representing the Z axis) taken in sequence and three semi-orthogonal leads (I, aVF, and V10) taken simultaneously were recorded from 43 healthy pigs. Records were analyzed for rate, rhythm, interval duration and component amplitudes. The wave form of QRS complexes were analyzed in all leads studied. P, QRS, and T vectors were calculated for the mean dorsal (frontal), sagittal, and transverse planes. study of orthogonal leads in right sternal recumbency indicated that ventricular activation is spatially oriented dorsad, sinistrad and slightly caudad. No essential difference was noticed in the conventional and miniature swine. Ventricular fibrillation induced electrically in four older pigs was a progressive, terminal event; in two newborn piglets, ventricular fibrillation induced several times was terminated in each case by spontaneous recovery to sinus rhythm.
TL;DR: Epicardium in the ischemic zone depolarized tardily, whereas in the control state, epicardium from all areas on the left ventricle was activated early during QRS and nearly simultaneously.
TL;DR: In this paper, vectorcardiographic criteria for the diagnosis of acute inferior wall myocardial infarction were described based on the study of serial vector-cardiograms taken in 10 consecutive cases.
TL;DR: Electrocardiograms demonstrating QRS complexes of supraventricular origin were obtained on 55 of 82 consecutive patients referred for management of Stokes-Adams episodes related to intermittent or permanent complete heart block.
TL;DR: The abnormal initial QRS vector on the vectorcardiogram observed in most cases of single ventricle as well as lack of a normal transitional zone of the precordial QRS complexes on the scalar electrocardiograms are perhaps the result of an abnormal ventricular conduction pathway.
Abstract: The electrocardiograms and vectorcardiograms of 29 patients with single ventricle are described and analyzed. The electrocardiographic and vectorcardiographic findings of these cases in relation to the anatomic position of the great vessels and the presence or absence of pulmonary stenosis were correlated. In the 10 cases of single ventricle with transposition of the great vessels with inversion, the electrocardiogram and vectorcardiogram exhibited an abnormal initial QRS vector in the horizontal plane directed posteriorly and to the left forming abnormal Q waves in the right precordial leads. The Q wave was absent in the left precordial leads of the scalar electrocardiogram. Right axis deviation was frequently observed. These features are commonly seen in congenital corrected transposition of the great vessels and indicate the importance of the position of the great vessels regardless of the presence of one or two ventricles. Among the 12 cases of single ventricle with transposition of the great vessels with the aorta anterior and to the right of the pulmonary artery, an abnormal direction of the initial QRS vector anteriorly and to the left was commonly observed. This was represented by absence of Q waves in the precordial electrocardiographic leads V 1 through V 6 . Left axis deviation or an axis beyond −90 ° was frequently seen. On the other hand, in cases of single ventricle and normally related great vessels the QRS axis was commonly normal or slightly to the left, and there were stereotype Rs or rS patterns across the precordial leads. Although in our series the presence of pulmonary stenosis in single ventricle had no effect on the QRS pattern, it commonly altered atrial depolarization. Cases of single ventricle and pulmonary stenosis or pulmonary hypertension showed right atrial enlargement, but cases without pulmonary stenosis and with a large left to right shunt showed left atrial enlargement. The abnormal initial QRS vector on the vectorcardiogram observed in most cases of single ventricle as well as lack of a normal transitional zone of the precordial QRS complexes on the scalar electrocardiogram are perhaps the result of an abnormal ventricular conduction pathway.
TL;DR: It is concluded that the timed Frank vectorcardiogram is of value in the study of cardiac arrhythmias and that it recorded in many situations information which was not readily available on the routine electrocardiograms.
TL;DR: The electrocardiograms of 18 infants and children with congenital heart disease and necropsy evidence of infarction of the papillary muscle or free wall, or both, were reviewed and a Q wave in lead V3R assumes diagnostic significance for infarctions when accompanied by a diminishing R wave amplitude over the right precordial leads.
Abstract: The electrocardiograms of 18 infants and children with congenital heart disease (4 with aortic stenosis and 14 with total anomalous pulmonary venous connection) and necropsy evidence of infarction of the papillary muscle or free wall, or both, were reviewed. In the presence of left ventricular hypertrophy, a Q wave in lead V3R followed by a small R wave is strong evidence of infarction of the anterior left papillary muscle or anterior left ventricular free wall, or both. When associated with serially diminishing amplitude of the R wave in lead V3R this is diagnostic of infarction. In the presence of right ventricular hypertrophy a Q wave in lead V3R may be due to the hypertrophy. The finding of a serially diminishing R wave in this lead, however, is evidence of infarction of the anterior right papillary muscles or anterior right ventricular free wall. Hence, with left ventricular hypertrophy or right ventricular hypertrophy a Q wave in lead V3R assumes diagnostic significance for infarction when accompanied by a diminishing R wave amplitude over the right precordial leads.
TL;DR: The value of signle measurements from the VCG or ECG in predicting LVP or gradient is limited but estimates can be improved by combining several into a multiple regression equation.
TL;DR: As the heart deteriorates and dies the relative and absolute amplitude of the SV complex recorded from direct leads increases remarkably, suggesting a growing preponderance of the contractile element of ventricular systole.
TL;DR: The electrocardiographic course of a 46-year-old recipient of a cardiac transplant in whom direct myocardial leads were implanted is outlined, and the use of a right atrial recording electrode is recommended for the diagnosis of complex arrhythmias.
Abstract: This paper outlines the electrocardiographic course of a 46-year-old recipient of a cardiac transplant in whom direct myocardial leads were implanted. There was one episode of decreased QRS voltage with an intraventricular conduction delay, suggestive of an acute immunologic rejection. On one occasion bradycardia occurred, and this was treated by ventricular pacing. There was also an episode of supraventricular tachycardia. Vagotonic maneuvers or agents would not have been appropriate treatment for this arrhythmia. In the presence of both donor and recipient P waves, the interpretation of some of the arrhythmias was difficult. Since the QRS voltage is important in diagnosing early rejection, great care was taken in accurately standardizing the electrocardiogram and in reproducibly placing electrocardiographic leads. The myocardial leads were found to reflect voltage changes more clearly than surface leads. The presence of myocardial wires also proved convenient for pacing. The use of a right atrial record...
TL;DR: In ninety-eight case with hypertension or aortic insufficiency and 60 normal persons the spatial ventricular gradient (G) and the direction of inscription of the QRS and T loops were determined, using the Frank lead system.
Journal Article•
TL;DR: This experimental study suggests that damage to the lateral subdivision of the right bundle branch, (i.e., so-called false tendons), may be an underlying factor in the production of IRBBB pattern.
Abstract: The genesis of IRBBB pattern was studied by incising subdivisions of the right bundle branch in 23 anesthetized dogs. The excised heart, perfused with Tyrode's solution using Langendorff's technique, was placed within a simplified model of the human torso. This procedure greatly improves vision, offering a completely unimpeded direct view of the right ventricular cavity during the incising procedure and provides a superior method for recording electro- and vectorcardiograms.The QRS duration was not significantly prolonged by incising any of the subdivisions. After incising the lateral subdivision, the QRS pattern showing a prominent R' wave in Lead V1 occurred in 35% of the cases; the QRS pattern showing rather deep or deep S waves in almost all the precordial leads occurred in 47%; and in 18% there were no characteristic pattern changes.The midportion of the basal region of the right ventricle was confirmed to be the region which exhibits a significant delay in activation after incising the lateral subdivision.This experimental study suggests that damage to the lateral subdivision of the right bundle branch, (i.e., so-called false tendons), may be an underlying factor in the production of IRBBB pattern.
TL;DR: The results suggest that the gradient concept of QRS-T area independent of activation order is applicable to electrocardiographic leads only when these are equally sensitive to activation and recovery patterns and that it is only applicable to single leads.
TL;DR: Electrocardiograms were recorded from turkeys, and analysis of orthogonal characteristics was performed by digital computation, and paths of ventricular depolarization in the turkey are presumed to be similar to those of ungulates and different from those of carnivores and primates.
TL;DR: In patients with the pre-excitation (Wolff-Parkinson-White) syndrome, tachyarrhythmias that present the appearance of ventricular tachycardia may be due to supraventricular tarryness with persisting W-P-W conduction, aberrant ventricular conduction or bundle-branch block.
TL;DR: It was considered that the sequential curves of the changes of the spatial magnitudes of QRS vectors, which had not been taken as to be important previously, had very important diagnostic informations for myocardial infarctions and that the spatial magnitude ECG was very useful for the diagnosis of old myocardials or latent myocardIAL injuries whose conventional ECG showed only equivocal changes.
Abstract: QRS waves of the spatial magnitude ECG of 70 normal young men and 127 cases of old myocardial infarctions were examined quantitatively. QRS waves of the normal spatial magnitude ECG showed definite patterns and were classified in 5 groups, namely simple triangular configurations (Type A), small notch at the initial (Type B), at the terminal (Type C) or at the both portions (Type D) of the main QRS waves and with large terminal notch (Type E). Among them Type D was considered as the basic pattern of the normal spatial magnitude ECG.QRS waves of the spatial magnitude ECG changed characteristically in old myocardial infarctions. These abnormal findings consisted of increase of the amplitude and duration of initial notch, slow ascent of ascending limb, prolongation of peak time, decrease of peak magnitude, splitting of QRS waves and increase of the amplitude and duration of terminal notch. These abnormalities were seen in 79.5% of whole cases of infarctions. Abnormalities of QRS waves of infarction type of the spatial magnitude ECG were observed in 67.9% of old myocardial infarctions, whose conventional ECG became less prominent so as not to satisfy the criteria of abnormal Q wave described by Massie et al. with the advancement of recovery process. It was considered that the sequential curves of the changes of the spatial magnitudes of QRS vectors, which had not been taken as to be important previously, had very important diagnostic informations for myocardial infarctions and that the spatial magnitude ECG was very useful for the diagnosis of old myocardial infarctions or latent myocardial injuries whose conventional ECG showed only equivocal changes.
TL;DR: It is concluded that the vectorcardiogram may offer additional information permitting separation of patients with or without heart disease whose scalar ECG's show T-wave inversion in the right precordial leads.