524 Section IV • The Cardiovascular System

A—NORMAL SINUS RHYTHM B—FIRST-DEGREE BLOCK

R-R interval

Long PR
PR interval
interval

C—SECOND-DEGREE BLOCK: MOBITZ TYPE I D—SECOND-DEGREE BLOCK: MOBITZ TYPE II

P P P P P P P P P

PR Long Longer No R PR PR No R No R PR
PR
PR PR interval

E—BUNDLE BRANCH BLOCKS F—THIRD-DEGREE BLOCK

Right bundle branch block Left bundle branch block

P (superimposed)
P
P P
P P

Wide QRS R-R R-R

Wide QRS
G—DELTA WAVE (WOLFF-PARKINSON-WHITE SYNDROME) H—ATRIAL FIBRILLATION

Irregular R-R intervals

Delta
wave

Shortened PR No detectable P waves

I—VENTRICULAR FIBRILLATION Ventricular tachycardia

Ventricular fibrillation

Sinus rhythm

Figure 21-14 Pathological ECGs. In E, right bundle branch block is visible in the V1 or V2 precordial leads;
left bundle branch block is visible in the V5 or V6 leads. (Data from Chernoff HM: Workbook in Clinical Elec-
trocardiography. New York, Medcom, 1972.)

result of a local depolarization or may be due to pathological
changes in functional anatomy. Normal cardiac tissue can
conduct impulses in both directions (Fig. 21-15A). However,
after an asymmetric anatomical lesion develops, many more
healthy cells may remain on one side of the lesion than on
the other. When conduction proceeds in the direction from
the many healthy cells to the few healthy cells, the current
from the many may be sufficient to excite the few (right to
left in Fig. 21-15B). On the other hand, when conduction
proceeds in the opposite direction, the few healthy cells