Chou's Electrocardiography in Clinical Practice: Adult and by Surawicz B., Knilans T.

By Surawicz B., Knilans T.

Competently interpret cutting-edge complete variety of ECG findings

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20. Calatayud JB, Abad JM, Khol NB, et al: P wave changes in chronic obstructive pulmonary disease. Am Heart J 79:444, 1970. 21. Ikeda K, Kubota K, Takahashi K, et al: P-wave changes in obstructive and restrictive lung disease. J Electrocardiol 18:233, 1985. 22. Harkavy J, Romanoff A: Electrocardiographic changes in bronchial asthma and their significance. Am Heart J 23:692, 1942. 23. Cutforth RH, Oram S: The electrocardiogram in pulmonary embolism. Br Heart J 20:41, 1958. 24. Irisawa H, Seyama I: The configuration of the P wave during mild exercise.

The maps obtained in these studies revealed an extensively distributed system of atrial pacemakers, mostly along the crista terminalis. 5 cm long, located along the junction between the superior vena cava and the right atrium, that extends posteriorly to the inferior limbus of the inferior vena cava. , it was multicentric). The important discovery of the multicentric origin of the P wave within a widely distributed area of the right atrium does not change the explanation of normal P wave morphology.

In lead V1 a small positive deflection is followed by a deep, wide negative deflection. Lead V2 shows a relatively slow slope of the line connecting the positive peak with the negative nadir, reflecting the slow interatrial conduction characteristic of left atrial enlargement. See text discussion. 37 38 SECTION I  Adult Electrocardiography Figure 2–11 Pattern of left atrial enlargement in a 33-year-old man with severe dilated cardiomyopathy (left ventricular ejection fraction 15 percent). Enlargement of all four chambers was evident in the echocardiogram, but the ECG shows only left atrial enlargement, probably because the QRS voltage is diminished by massive obesity.

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