An analysis of causes of right axis deviation based partly on endocardial potentials of the hypertrophied right ventricle

Kossmann, Charles E.; Berger, Adolph R.; Brumlik, Joseph V.; Briller, Stanley A.

doi:10.1016/0002-8703(48)90108-2

Cited by 56 publications

(8 citation statements)

References 19 publications

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“…The excellent animal experiments by Boden and Neukirch4 that followed were used as a basis for extrapolation to human electrocardiograms by literally generations of writers without demonstration of these rotations in human subjects, although the extent of rotations implied was considerable. Several authors even postulated that clockwise rotation could be so extreme that parts of the left ventricle would be subjacent to electrode V1 17,22,23 Schwedel, in 1948, using posteroanterior radiograms of the chest, concluded that rotations around the longitudinal axis of the heart actually are quite limited in degree, usually less than 15',24 which is in good agreement with the findings of Grant'5 and of our own study. In animal experiments.…”

Section: Methodssupporting

confidence: 86%

Relationship between the Electrocardiogram and the Position of the Heart as Determined by Biplane Angiocardiography

1961

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Anatomic orientation of the heart was determined in 53 patients by selective, biplane angiocardiography, and was compared with the mean electric axis and the location of the transition zone from conventional electrocardiograms. No significant correlation could be demonstrated between (a) the anatomic axis and the electric axis in the frontal plane, or (b) between the electric axis and rotation of the heart about its longitudinal axis, or (c) the location of the interventricular septum and the transition zone of the precordial leads. The electric variations are greater than can possibly be explained by known rotations of the heart about any anatomic axis. The degrees of rotation about the heart's longitudinal axis assumed in the concept of "electrical positions" is beyond the range found in normal or hypertrophied hearts. It is concluded that the electric positions of the heart should be abandoned in favor of direct description in three dimensions of the orientation of the mean electromotive force of the heart. Normal limits should be defined in percentiles or standard deviations.

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Section: Methodssupporting

confidence: 86%

Relationship between the Electrocardiogram and the Position of the Heart as Determined by Biplane Angiocardiography

1961

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“…This may be the result of posterior rotation of the left ventricle which thus casts its electrical shadow at the right shoulder36 or of late electrical activation of the base of the outer wall of the right ventricle which may be in relation to the right shoulder. 38 The intrinsic deflection was inscribed later over the right than the left ventricle in 5 cases. In 2 of these patients (Cases 2 and 3) the diagnosis of right ventricular hypertrophy and in 3 (Cases 1, 4, and 6) on the basis of a secondary R wave (R'), the diagnosis of incomplete right bundle branch block seemed justified.…”

Section: Electrocardiographic Findingsmentioning

confidence: 96%

Studies of Congenital Heart Disease

et al. 1950

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Congenital pulmonic stenosis is indicated by cardiac catheterization by the finding of a higher systolic pressure in the right ventricle than in the pulmonary artery. Eight cases of uncomplicated pulmonic stenosis are studied. The findings on history, physical examination, x-ray and fluoroscopy, and electrocardiogram have been analyzed and the variations in circulatory dynamics encountered in these individuals are described in detail.IT IS generally considered that congenital pulmonic stenosis unaccompanied by other cardiac defects is rare. Recently, Greene and coworkers1 have made a complete review of the literature and have collected 68 cases. Their article and the book of Brown2 contain excellent discussions of this disorder.Cardiac catheterization3 has made possible an accurate recognition of pulmonic stenosis by the finding of a higher systolic pressure in the right ventricle than in the pulmonary artery.4 Pollack, Taylor, Odel, and Burchell5 have recently published a report of 3 cases recognized by this technic, 4 more were reported by Greene and associates', and this paper deals with 8 more cases. METHODSEach patient remained in the hospital for at least four days. A history, physical examination, routine laboratory tests, electrocardiogram, x-ray examination, and fluoroscopy of the heart were carried out. Heart sound tracings were obtained in all cases. On the third day, venous catheterization was performed and the diagnostic routine described elsewhere4 was performed.The circulatory dynamics of 5 of the patients were studied at rest and also under conditions of split. The pulmonic second sound and mitral first sound were of normal intensity. In the third left intercostal space there was a Grade 4, rough, medium-pitched, systolic murmur, stopping just before the second sound. There was an accompanying thrill but no diastolic murmur. The systolic murmur was widely transmitted in diminished intensity over the precordium and faintly over the back. The lungs were clear, abdominal examination normal, radial and femoral pulses were strong, veins were not distended, and no edema could be discerned. TheHinton test 'was negative and urinalysis was normal.The hematocrit was 49 per cent, the hemoglobin 16.5 Gm., the white blood cell count and differential normal, and the routine blood chemistries were normal. X-ray and fluoroscopy revealed a heart of normal size. The pulmonary artery was enlarged and pulsating. The pulmonary vascular markings were within normal limits. The electrocardiogram showed incomplete right bundle branch block.Case 2. R. L. (P.B.B.H. #s6A875) was a 26 year old man in whom a heart murmur had been detected in childhood. He had never had symptoms of rheumatic fever, tuberculosis, or cardiac failure. He had always been fond of sports and was an enthusiastic skier. He had never noticed any decrease in exercise tolerance. Four months before admission, he contracted bacteriologically proven subacute bacterial endocarditis which was treated with penicillin in another city and pronounced cured. Becau...

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“…This point has been made previously. 5 The S wave in Leads V1 and V2 may show a notch on the descending limb simultaneous with the peak of the R wave in leads from the left side of the precordium. Under such circumstances the nadir is simultaneous with the nadir of S in Leads V4 or V5 or occurs at a time which is somewhere between the time of R and S in the left-sided leads.…”

Section: The Large Positive Deflection At Thementioning

confidence: 99%

Intracardiac and Intravascular Potentials Resulting from Electrical Activity of the Normal Human Heart

et al. 1950

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Electrical records were made from the interior of the right heart and attached vessels in 14 normal subjects. Technics differed somewhat from those previously reported in that simultaneously recording string galvanometers were used exclusively, and tracings were made whenever the catheterelectrode was moved within the heart. Previously unreported large positive QRS deflections were found in records from the lower part of the right atrium, from the pulmonary artery, and in two instances from within the right ventricle itself close to the base. The possible anatomical origin of these is discussed.

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An analysis of causes of right axis deviation based partly on endocardial potentials of the hypertrophied right ventricle

Cited by 56 publications

References 19 publications

Relationship between the Electrocardiogram and the Position of the Heart as Determined by Biplane Angiocardiography

Relationship between the Electrocardiogram and the Position of the Heart as Determined by Biplane Angiocardiography

Studies of Congenital Heart Disease

Intracardiac and Intravascular Potentials Resulting from Electrical Activity of the Normal Human Heart

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