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Table of Contents
Cover
Title Page
Copyright Page
Preface by Prof. Antoni Bayés de Luna
Preface by Drs Miquel Fiol‐Sala, Antoni Bayés‐Genís, and Adriá n
Baranchuk
Foreword by Dr Marcelo V. Elizari
Foreword by Dr Pedro Brugada
Recommended Reading
Part 1: Introductory Aspects
Chapter 1: The Electrical Activity of the Heart
Basic concepts
How can we record the electrical activity of the heart?
What is the surface ECG?
What is vectorcardiography? (See Chapter 25 for more
extensive information)
ECG–VCG correlation
Why do we record ECG curves and not VCG loops?
Why do we use ECG–VCG correlations to understand ECG
patterns?
References
Chapter 2: The History of Electrocardiography
References
Chapter 3: Utility and Limitations of the Surface ECG
Introduction
Utility
 Limitations
The future of electrocardiography
References
Part 2: The Normal ECG
Chapter 4: The Anatomical Basis of the ECG
The anatomical basis
The heart walls: perfusion and innervation (Cerqueira
2002; Fiol‐Sala et al. 2020)
The specific conduction system: perfusion and
innervation
Ultrastructural characteristics of cardiac cells
References
Chapter 5: The Electrophysiological Basis of the ECG
Types of cardiac cells: slow and fast response cells
(Hoffman and Cranefield 1960)
Transmembrane diastolic potential (DP)
Transmembrane action potential
Properties of cardiac cells
Cardiac activation
From cellular electrogram to the human ECG (Wilson et
al. 1935; Cabrera 1958; Sodi‐Pallares et al. 1964;
Macfarlane and Veitch Lawrie 1989; Wagner 2001; Bayés
de Luna and Baranchuk, 2017)
References
Chapter 6: The ECG Recording: Leads, Devices, and
Techniques
Leads
Hemifield concept
Correlation between the vectorcardiographic loop and
electrocardiographic morphology
Recording devices
 Recording techniques
References
Chapter 7: Characteristics of the Normal Electrocardiogram:
Normal ECGWaves and Intervals
A systematic and sequential approach to ECG
interpretation
Heart rhythm
Heart rate
PR interval and PR segment (Table 7.2; and Figures 7.1
and 7.8)
QT interval (Figure 7.8) (Malik and Camm 2004; Bayés de
Luna 2019; Goldenberg et al. 2008; Anttonen et al. 2009)
(see also Chapters 19, 21, and 24)
QRS complex
ST segment and T and U waves
T wave
U wave
Abnormalities of repolarization
Calculation of the electrical axis
 QRS at +60° (Figure 7.20)
Rotations of the heart
Electrocardiographic variations with age
Other ECG variants
References
Chapter 8: Diagnostic Criteria
Sensitivity
Specificity
Predictive values
Bayes’ theorem
References
Part 3: Abnormal ECG Patterns
Chapter 9: Atrial Abnormalities
Introduction
New concepts on P wave
Atrial enlargement
Atrial blocks
References
Chapter 10: Ventricular Enlargement
Concept: preliminary considerations
Critical review of the electrocardiographic concepts of
systolic and diastolic overload
New concepts
Right ventricular enlargement: hypertrophy and dilation
Left ventricular enlargement: hypertrophy and dilation
Biventricular hypertrophy
References
Chapter 11: Ventricular Blocks
Definition of terms
Anatomic considerations (see also Chapter 4)
Electrophysiological considerations
Right bundle branch block (Table 11.1)
Left bundle branch block (Tables 11.3 and 11.4)
Left divisional blocks
Combined blocks
Delayed diffuse intraventricular QRS activation
References
Chapter 12: Ventricular Pre‐excitation
Concept and types of pre‐excitation
WPW‐type pre‐excitation (type 1)
 Arrhythmias and WPW–type pre‐excitation: Wolff–
Parkinson–White syndrome (Figure 12.9)
Atypical pre‐excitation
Short PR interval pre‐excitation (Lown et al. 1957)
(Figures 12.14–12.16)
References
Chapter 13: Ischemia and Necrosis
Concept
Experimental mechanisms of ischemia
Changes of repolarization: T wave
Changes of repolarization: ST segment
Other changes of repolarization
Changes in QRS
References
Part 4: Arrhythmias
Chapter 14: Mechanisms, Classification, and Clinical Aspects
of Arrhythmias
Concept
Classification
Clinical significance and symptoms
ECG diagnosis of arrhythmias: preliminary
considerations
Mechanisms responsible for active cardiac arrhythmias
Active arrhythmias with fixed coupling interval
Abnormal generation of stimulus
Reentry
Other mechanisms
Active arrhythmias with variable coupling interval: the
parasystole
Mechanism responsible for passive arrhythmias
 Heart block
Aberrant conduction
Concealed conduction
References
Chapter 15: Active Supraventricular Arrhythmias
Premature supraventricular complexes
Sinus tachycardia (Tables 15.2 and 15.3)
Junctional reentrant (reciprocating) tachycardia
Atrioventricular junctional tachycardia due to ectopic
focus
Chaotic atrial tachycardia
Atrial fibrillation
Atrial flutter
References
Chapter 16: Active Ventricular Arrhythmias
Premature ventricular complexes
Ventricular tachycardias
Ventricular flutter
Ventricular fibrillation
References
Chapter 17: Passive Arrhythmias
Escape complex and escape rhythm
Sinus bradycardia due to sinus automaticity depression
(Figures 17.7 and 17.8)
Sinoatrial block
Atrioventricular block
The pacemaker electrocardiography (Garson 1990;
Kasumoto and Goldschlager 1996; Hesselson 2003;
Jastrzebski et al. 2014, 2019; ECG University V2 2019)
(Figures 17.16–17.28)
 References
Chapter 18: Diagnosis of Arrhythmias in Clinical Practice: A
Step‐by‐Step Approach
Determining the presence of a dominant rhythm
Atrial wave analysis
QRS complex analysis
Atrioventricular relationship analysis
Premature complex analysis
Pause analysis
Delayed complex analysis
Analysis of the P wave, the QRS complexes, and the ST‐T
of variable morphology (Figures 18.6–18.9 and Table
18.1)
Repetitive arrhythmia analysis: bigeminal rhythm
Differential diagnosis between several arrhythmias in
special situations
References
Part 5: The Clinical Usefulness of Electrocardiography
Chapter 19: The Diagnostic Value of Electrocardiographic
Abnormalities
Introduction
Abnormal PR interval
Abnormal QT interval
Abnormal QRS complex
Repolarization abnormalities: from innocent to very
serious findings
References
Chapter 20: The ECG in Different Clinical Set of Ischemic Heart
Disease
Introduction
 ECG changes due to decreased blood flow not related to
atherothrombosis (Table 20.1)
ECG changes due to ischemia caused by increased
demand (see Table 20.1)
References
Chapter 21: Inherited Heart Diseases
Introduction
Cardiomyopathies
Specific conduction system involvement
References
Chapter 22: The ECG in Other Heart Diseases
Valvular heart diseases
Mitral valve disease: ECG changes
Aortic valve disease: ECG changes
Myocarditis and cardiomyopathies
Rheumatic fever
Cor pulmonale
Congenital heart diseases
Mirror image dextrocardia
Arterial hypertension
References
Chapter 23: The ECG in Other Diseases and Different
Situations
Cerebrovascular accidents
Endocrine diseases
Respiratory diseases
Other diseases (see Chapter 22)
Athletes (Figures 23.8–23.11) (Corrado et al. 2010);
Uberoi et al. 2011)
Drug administration
 Alcoholism (Figures 23.16–23.18)
Ionic disorders
Hypothermia
Pregnancy and puerperium
Anesthesia and surgery
Arrhythmias in children
References
Chapter 24: Other ECG Patterns of Risk
Introduction
Severe sinus bradycardia
Advanced interatrial block with left atrial retrograde
conduction (Figures 24.3–24.5)
Intraventricular conduction disturbances
High‐risk combined intraventricular blocks
Classic masquerading bifascicular block (see Chapter 11)
Masquerading RBBB pattern in the presence of advanced
LBBB pattern
RBBB with alternating block in the two sub‐divisions of
the left bundle
Advanced atrioventricular block
The presence of ventricular arrhythmias in chronic heart
disease patients
Acquired long QT (see Chapters 7 and 19)
Electrical alternans (see Table 18.1 and Figure 18.9)
New ECG patterns of risk for sudden death
Risk of serious arrhythmias and sudden death in patients
with normal or nearly normal ECG
References
Chapter 25: Limitations of the Conventional ECG
Introduction
 Interpretation of the surface ECG in light of the patient’s
clinical setting
The abnormal ECG in the absence of heart disease and
patients with normal ECG and advance heart disease
(Bayés de Luna et al. 2020a)
Additional value of other techniques
Holter ECG monitoring and related techniques
Intracavitary ECG and electrophysiologic studies
Wave amplification and filtering techniques
Other ECG leads
Body surface potential mapping
Analysis of late potentials using signal averaging
electrocardiogram (SAEGG)
Tilt table test
Imaging techniques
Genetic techniques
References
Chapter 26: The Electrocardiology of the Twenty‐First
Century
Do we need to teach electrocardiology nowadays?
References
Index
Supplemental Images
End User License Agreement

List of Tables
Chapter 5
Table 5.1 Differences between rapid response and slow
response cardiac cells
Chapter 7
 Table 7.1 Calculation of heart rate according to the RR interval
Table 7.2 P wave height and duration in normal adults
Table 7.3 QTc prolongation in different age groups, based on
the Bazett form...
Table 7.4 Q wave voltage in millimeters in different leads and
at different ...
Table 7.5 R wave amplitudes in millimeters in different leads
and at different a...
Table 7.6 S wave amplitudes in millimeters in different leads
and at differe...
Table 7.7 T wave amplitudes in millimeters in different leads
and at differe...
Chapter 8
Table 8.1 Calculation of sensitivity (SE), specificity (SP),
positive and ne...
Table 8.2 Calculation of sensitivity (SE), specificity (SP),
positive and ne...
Table 8.3 Calculation of sensitivity (SE), specificity (SP),
positive and ne...
Chapter 9
Table 9.1 Right atrial enlargement. ECG criteria with high
specificity and l...
Table 9.2 Left atrial enlargement. ECG criteria based on P
wave changes with...
Table 9.3 ECG classification of interatrial blocks (IAB)
Chapter 10
Table 10.1 ECG criteria for right ventricular enlargement.
Table 10.2 Electrocardiographic criteria for right ventricular
enlargement i...
 Table 10.3 Presence of prominent R or r′ in V1: differential
diagnosis.
Table 10.4 ECG criteria for left ventricular hypertrophy
according to ECG an...
Table 10.5 Romhilt–Estes score. There is left ventricular
enlargement if 5 o...
Table 10.6 Diagnostic value of ECG criteria of left ventricular
enlargement ...
Table 10.7 Diagnostic characteristics of traditional ECG
criteria for detect...
Table 10.8 Association of ECG correlates of LVH with incident
total CVD even...
Chapter 11
Table 11.1 Right bundle branch block (delayed right
ventricular activation).
Table 11.2 ECG features of advanced proximal RBBB.
Table 11.3 Left bundle branch block (delayed left ventricular
activation)
Table 11.4 ECG features of advanced left branch bundle block.
Table 11.5 ECG diagnostic criteria for advanced
superoanterior hemiblock.
Table 11.6 ECG diagnostic criteria for advanced
inferoposterior hemiblock.
Chapter 12
Table 12.1 Pre‐excitation types: (1) WPW‐type pre‐excitation;
(2) atypical p...
Chapter 13
Table 13.1 ECG manifestations of acute myocardial ischaemia
(in the absence ...
 Table 13.2 Causes of taller‐than‐normal T wave (aside from
ischemic heart di...
Table 13.3 Causes of negative or flattened T waves (aside from
ischemic hear...
Table 13.4 Most frequent causes of ST segment elevation
(apart from ischemic...
Table 13.5 Most frequent causes of ST segment depression
(apart from ischemi...
Table 13.6 Characteristics of the “necrosis Q wave” or its
equivalenta.
Table 13.7 QRS ECG changes associated with prior myocardial
infarction.
Table 13.8 Proportions of agreement between patterns and
contrast‐enhanced c...
Table 13.9 Pathologic Q wave not secondary to myocardial
infarction.
Table 13.10 Sensitivity, specificity, and predictive values of
various ECG c...
Chapter 14
Table 14.1 Classification of arrhythmias according to their
electrocardiogra...
Table 14.2 Mechanisms involved in the main supraventricular
and ventricular...
Chapter 15
Table 15.1 ECG evidence indicative of the presence of ectopy
or aberrancy wh...
Table 15.2 Supraventricular active rhythms
Table 15.3 Classification of supraventricular tachyarrhythmias
according to ...
 Table 15.4 Clinical, electrophysiological, and pharmacological
differences b...
Table 15.5 Characteristics of atrial activity in monomorphic
supraventricula...
Table 15.6 ECG characteristics of the different types of
paroxysmal supraven...
Table 15.7 Differential diagnosis between incessant AV
junctional reentrant ...
Chapter 16
Table 16.1 Lown’s classification of premature ventricular
complexes (PVCs) a...
Table 16.2 Ventricular tachycardias
Table 16.3 Idiopathic ventricular tachycardias with QRS >120
ms: ECG morphol...
Table 16.4 Differential diagnosis between ventricular
tachycardia and wide Q...
Chapter 17
Table 17.1 Pacemakers: three‐ and five‐letter identification
codes
Table 17.2 Characteristics of the main types of pacemakers
currently used
Chapter 18
Table 18.1 Most frequent causes of QRS–T alternans
Chapter 19
Table 19.1 Predisposing factors for QT interval prolongation
Table 19.2 Drugs associated with QT prolongation and
potential arrhythmogeni...
Table 19.3 Differential diagnosis between pericarditis, early
repolarization...
Chapter 20
Table 20.1 Classification of ECG changes in clinical settings
due to myocard...
Table 20.2 Summary of ECG, clinical, angiographic, and
pathologic findings i...
Table 20.3 ECG patterns in ST elevation myocardial infarction
(occluded/near...
Table 20.4 ECG patterns in non‐ST elevation myocardial
infarction (50% of AC...
Table 20.5 Myocardial infarction without Q wave or equivalent
Chapter 21
Table 21.1 Inherited heart diseases with risk of sudden death
Table 21.2 ECG alterations in hypertrophic cardiomyopathy
(Figures 21.1–21.4...
Table 21.3 ARVC: Summary of revised task force criteria
(Marcuset al. 2010)...
Table 21.4 QTc prolongation in different age groups, based on
the Bazett for...
Table 21.5 ECG alterations in congenital long QT syndrome
Table 21.6 Long QT syndrome: diagnostic criteria
Table 21.7 Short QT syndrome: diagnostic criteria
Table 21.8 Diagnostic criteria of the Brugada syndrome
Table 21.9 ECG alterations in the Brugada syndrome
Table 21.10 ECG patterns of Brugada syndrome in V1–V2
Table 21.11 Most frequent conditions that can lead to
Brugada‐like pattern ...
Chapter 22
Table 22.1 Comparison of different ECG criteria for the
diagnosis of left ve...
 Chapter 23
Table 23.1 Cardiac abnormalities in 161 elite athletes with
arrhythmias
Chapter 24
Table 24.1 Predisposing factors for QT interval prolongation
Table 24.2 Drugs associated with QT prolongation and
potential arrhythmogeni...
Table 24.3 J wave syndromes: similarities and differences
Chapter 25
Table 25.1 Classical clinical usefulness of vectorcardiography
(see text)
Table 25.2 Bruce protocol for exercise (treadmill) ECG test
Table 25.3 Main indications for exercise testing
Table 25.4 Contraindications for exercise testing
Table 25.5 Exercise ECG: pathological responses
Table 25.6 Classic ECG criteria for positive stress test
Table 25.7 False positive and False negative ECG tests
Table 25.8 Usefulness of Holter monitoring
Table 25.9 Utility of intracavitary electrophysiologic studies
Chapter 26
Table 26.1 Areas to be studied in the future.
Table 26.2 The most remarkable advances on ECG technology.

List of Illustrations
Chapter 1
Figure 1.1 Depolarization (A) and repolarization (B) of the
dipole in an iso...
 Figure 1.2 The origin of P, QRS, and T deflections (A, B and C).
When van el...
Figure 1.3 Four locations of a vector and their projection in
frontal (FP) a...
Figure 1.4 The origin of P, QRS, and T loops (A, B and C). The
vectorcardiog...
Figure 1.5 The concept of the hemifield. We see how a
morphology may be +− o...
Figure 1.6 Correlation of a vectorcardiographic loop with an
electrocardiogr...
Chapter 2
Figure 2.1 Dr AD Waller recorded many ECG tracings using his
dog Jimmy, resu...
Figure 2.2 (A) Lippmann's capillary electrometer consisted of
a mercury rese...
Figure 2.3 Dr Willem Einthoven in his laboratory early in his
career (A) and...
Figure 2.4 (A) The first manufactured ECG machine. (B) The
second model (tab...
Figure 2.5 Dr Willem Einthoven, left, with Sir Thomas Lewis,
right
Figure 2.6 Twelve pioneers of electrocardiology (see text).
Figure 2.7 From left to right: Louis Wolff, Sir John Parkinson,
and Paul Dud...
Figure 2.8 Brugada brothers. Pere in the middle with Josep
and Ramon at his ...
Chapter 4
Figure 4.1 Cardiovascular magnetic resonance imaging (CMR).
(A) Transections...
 Figure 4.2 Sagittal–oblique view in a normal body build
subject (A) (“G shap...
Figure 4.3 Magnetic resonance imaging. (A) Thoracic
horizontal axial plane a...
Figure 4.4 (A) Segments into which the left ventricle is divided
according t...
Figure 4.5 Images of the segments in which the left ventricle is
divided acc...
Figure 4.6 According to the anatomical variants of coronary
circulation, the...
Figure 4.7 Right lateral views 1, 2 and 3 of the specific
preferential condu...
Figure 4.8 Structure of the AV junction extending further than
the AV node (...
Figure 4.9 (A) Diagram of the intraventricular conduction
system, starting a...
Figure 4.10 (A) Microphotography of a sarcomere where actin
and myosin filam...
Figure 4.11 (A) Molecular composition of the cellular
membrane, comprising a...
Figure 4.12 (A) P cells. (B) Purkinje cells. (C) Purkinje cells
show many in...
Chapter 5
Figure 5.1 Transmembrane diastolic or resting potential (DP)
and transmembra...
Figure 5.2 Ionic current passing through the cellular
membrane (CM) in a con...
Figure 5.3 The most relevant ionic currents in automatic (A)
and contractile...
Figure 5.4 (A) The predominant negative charges inside the
cell are due to t...
Figure 5.5 Sinus node AP (A) transmitted to the AV junction
(B), the ventric...
Figure 5.6 A vector is the magnitude expression of the
difference in potenti...
Figure 5.7 Membrane response curve. The dV/dt response
depends on the transm...
Figure 5.8 Diagram of the electro‐ionic changes occurring
during cellular de...
Figure 5.9 Diagram showing how the cellular electrogram
curve (A + B) is pro...
Figure 5.10 Cellular excitability phases and refractory periods
in cells whe...
Figure 5.11 Diagram of the morphology of the AP of the
different specific co...
Figure 5.12 Stimulus conduction of regenerative‐type
(contractile cells–myoc...
Figure 5.13 Location of refractory periods at AV level, the
supernormal exci...
Figure 5.14 (A‐1 and B‐1) Normal AV conduction. (A‐2)
Premature atrial compl...
Figure 5.15 Lewis diagrams show how an impulse passes
through the sinoatrial...
Figure 5.16 (A) Isochronic atrial activation lines ( (B) Left,
right, an...
Figure 5.17 (A) Atrial resting phase. (B and C) Depolarization
sequence. (D)...
Figure 5.18 (A) The three approximate initiation points of
ventricular depol...
Figure 5.19 Depolarization sequence of the ventricular wall
according to the...
 Figure 5.20 The intermediate heart: the QRS loop and the QRS
morphologies in...
Figure 5.21 The vertical heart: the QRS loop and the QRS
morphologies in dif...
Figure 5.22 The horizontal heart: the QRS loop and the QRS
morphologies in d...
Figure 5.23 Projection of the spatial P, QRS, and T loops on the
frontal and...
Figure 5.24 Above: Cellular depolarization in ischemic cells
results in a po...
Figure 5.25 Diagram of the depolarization (QRS) and
repolarization (T) morph...
Figure 5.26 Sequence of cardiac activation: an analogy using
dominoes. The f...
Figure 5.27 (A) The APs of endocardium and epicardium are
shown. The latter,...
Figure 5.28 (A) Cellular depolarization and repolarization
dipoles with the ...
Figure 5.29 At both the cellular and the ventricular level, the
sum of the A...
Chapter 6
Figure 6.1 For a better understanding of a landscape, building,
or statue, i...
Figure 6.2 Human silhouette with the wires placed for the
three classic fron...
Figure 6.3 (A) Lead I records thedifferences in potential
between the left a...
Figure 6.4 (A) Einthoven’s triangle. (B) The same
superimposed on a human to...
Figure 6.5 Sketch of the hypothetical human body
corresponding to Einthoven’...
Figure 6.6 Burger’s scalene triangle, which represents the
electrical field ...
Figure 6.7 Bailey’s triaxial system (see text).
Figure 6.8 The VR, VL, and VF frontal leads. (A) Wilson’s
system; (B) Goldbe...
Figure 6.9 Any vector projected on aVR, aVL, or aVF produces
a projection th...
Figure 6.10 Bailey’s hexaxial system (see text).
Figure 6.11 ECG lead angles and associated lead
nomenclature. (A) Hexaxial l...
Figure 6.12 System of precordial leads (see text).
Figure 6.13 (A) Sites where the exploring electrodes are
placed in precordia...
Figure 6.14 Positive and negative hemifields of the six FP
leads and the V2 ...
Figure 6.15 Relationship between the magnitude and
direction of a vector and...
Figure 6.16 According to the direction of loop rotation, an
isodiphasic defl...
Figure 6.17 (A) Frontal plane: Relationship between the
morphology of I, II,...
Figure 6.18 ECG recording from aVR and I. Correlation with
depolarization an...
Figure 6.19 (A‐1–A‐3) Conventional ECG recording (see text).
(A‐4) Small dev...
Figure 6.20 (A) Verification of proper calibration. (B) 1,
Normal tracing; 2...
Figure 6.21 (A) An ECG typical of a patient with mirror image
dextrocardia a...
 Figure 6.22 On the left, a patient with myocardial infarction of
the anteroa...
Figure 6.23 (A) Healthy 35‐year‐old patient, with palpitations.
Holter recor...
Figure 6.24 Forty‐year‐old patient with ECG morphology
typical for early rep...
Chapter 7
Figure 7.1 (A) Temporal relationship between the different
ECG waves and nom...
Figure 7.2 (A and B) Normal activation of the heart, with
Lewis diagram. (C)...
Figure 7.3 From A to E we can see the more frequently P wave
índices, with t...
Figure 7.4 P wave morphologies in the different leads, as
determined by the ...
Figure 7.5 Procedure for measuring height and width of the P
wave.
Figure 7.6 (A) A typical example of sympathetic overdrive.
ECG of a 22‐year‐...
Figure 7.7 According to loop rotation (counterclockwise in the
FP and HP in ...
Figure 7.8 Measurement of heart rate, PR interval, and QT
interval. Heart ra...
Figure 7.9 Method for measuring QT interval. The normal QT
is usually less t...
Figure 7.10 Projection of the QRS loop on the FP and HP in an
intermediate h...
Figure 7.11 Different QRS morphologies in the six frontal
plane leads, as de...
Figure 7.12 (A) Drawing showing the location of the J point.
(B) The J point...
Figure 7.13 Different morphologies of atypical ST segment
and T wave in the ...
Figure 7.14 Typical ECG of early repolarization of benign type.
See the asce...
Figure 7.15 Drawing of ECG pattern of early repolarization
seen especially i...
Figure 7.16 See the diagnostic differential features of ECG
patterns of (A) ...
Figure 7.17 (A) Normal resting ECG. (B) A normal ECG
response to exercise. A...
Figure 7.18 T loop and its projection on FP and HP. Observe
the correspondin...
Figure 7.19 Healthy 70‐year‐old male (my father). Observe the
prominent U wa...
Figure 7.20 Calculation of the  QRS: When this is situated at
+60°, the proj...
Figure 7.21 QRS morphologies at different  QRS situations.
Figure 7.22 Morphologies of I, II, and III with  QRS at +90°.
Figure 7.23 Morphologies of I, II, and III with  QRS at 0°.
Figure 7.24 (A) When  QRS shifts to the right, QRS starts
becoming negative ...
Figure 7.25 Morphology of the QRS in the six frontal plane
leads for differe...
Figure 7.26 ECG of a 50‐year‐old male without evident heart
disease and with...
Figure 7.27 Procedure for calculating the electrical axis of the
first and s...
Figure 7.28 Above: Â QRS direction in the vertical and
horizontal heart. Belo...
Figure 7.29 Healthy, 16‐year‐old, very asthenic male with
vertical heart wit...
Figure 7.30 Healthy 26‐year‐old male with vertical and
dextrorotated heart....
Figure 7.31 Very obese 40‐year‐old female with horizontal
heart without levo...
Figure 7.32 Obese 35‐year‐old woman with horizontal and
slightly levorotated...
Figure 7.33 Above: Diagram to explain dextrorotation and
levorotation. Below...
Figure 7.34 A 21‐year‐old asthenic male, without heart
disease, with a dextr...
Figure 7.35 Healthy 40‐year‐old male with levorotated heart
in horizontal pl...
Figure 7.36 When cardiac rotation on the transversal axis
exists, the apex i...
Figure 7.37 (A) QRS loop and ECG morphologies in a case with
the heart dexto...
Figure 7.38 Changes in the direction of the QRS loop on the
horizontal plane...
Figure 7.39 Infant preterm born. Observe the rS pattern in V1
(see text).
Figure 7.40 A normal 2‐year‐old child. Observe how the rSr′
morphology in V1...
Figure 7.41 Infant, post‐term born. Observe the ECG at birth
(A), at one wee...
Figure 7.42 ECG typical of a healthy 2‐year‐old child (my
daughter Miriam). ...
Figure 7.43 Changes of T wave axis from newborn to
adulthood.
 Figure 7.44 Difference between  QRS and ÂT on the
horizontal plane in infant...
Figure 7.45 This ECG of a 90‐year‐old male is typical of the age
with low vo...
Figure 7.46 Examples of the 4 types of atrial activity: (A)
normal P wave (P...
Figure 7.47 ECG of healthy 17‐year‐old male. Observe the
modification produc...
Figure 7.48 A 42‐year‐old man, healthy, with evident T wave
changes during e...
Chapter 9
Figure 9.1 Above: diagram of atrial depolarization in a normal
P wave (A), r...
Figure 9.2 Loops of the P congenitale (A) and P pulmonale (B)
waves with the...
Figure 9.3 Examples of P wave morphology and loops in the
following cases: (...
Figure 9.4 ECG and VCG of a one‐year‐old girl with Ebstein’s
disease. Note t...
Figure 9.5 A 60‐year‐old woman with mitro‐tricuspid valve
disease who presen...
Figure 9.6 The more anterior location of the right ventricle
that can be see...
Figure 9.7 A 52‐year‐old woman with double mitral and
double tricuspid lesio...
Figure 9.8 A patient with chronic cor pulmonale and an acute
respiratory fai...
Figure 9.9 A 62‐year‐old woman with double mitral and
double tricuspid lesio...
Figure 9.10 (A) A 45‐year‐old patient with subacute cor
pulmonale. Note the ...
Figure 9.11 P loop of left atrial enlargement and the
morphology in various ...
Figure 9.12 (A) P wave morphology in V1 and P loop in the
case of left atria...
Figure 9.13 Above: An example of pulmonary edema in the
acute phase of myoca...
Figure 9.14 Diagram contrasting normal and abnormal
negative components of t...
Figure 9.15 Example of P wave and loop morphology in bi‐
atrial enlargement (...
Figure 9.16 (A) Adapted from experimental Bachmann’s
bundle block (Waldo et ...
Figure 9.17 Two cases of nearly total (A) and total (B)
clockwise rotation o...
Figure 9.18 Diagram of atrial conduction under normal
circumstances (A), par...
Figure 9.19 Examples of the three types of atrial activity: (A)
normal P wav...
Figure 9.20 Typical ECG of advanced interatrial block (P ± in
II, III, and a...
Figure 9.21 Above: P wave ± morphology in II and III typical of
advanced int...
Figure 9.22 Virtual anatomic rendering of the LA in the other
patient with t...
Figure 9.23 A: Typical A‐IAB. B: Atypical A‐IAB by duration. C:
Type I atypic...
Figure 9.24 A and B: Normal P waves. In panel B, there is a
biphasic (±) patt...
Figure 9.25 A. P wave in a case of A‐IAB atypical type III by
morphology (1)....
 Figure 9.26 A case of 73‐year‐old man that has an atypical A‐
IAB due to dura...
Figure 9.27 (A) Surface ECG of a 77‐year‐old man with
hypertrophic cardiomyo...
Figure 9.28 A patient with aberrant atrial conduction
ectopically induced by...
Figure 9.29 We present the case of an 82‐year‐old man. Over
the years, his E...
Figure 9.30 P waves with different morphologies that have to
be differentiat...
Figure 9.31 Intra‐auricular dissociation: unilateral auricular
fibrillation ...
Figure 9.32 Simultaneous recording of low right atrium (LRA)
and inferior ve...
Figure 9.33 A 55‐year‐old patient with extensive acute
anteroseptal and diap...
Figure 9.34 (A) Typical example of sympathetic overdrive.
ECG of a 22‐year‐o...
Figure 9.35 A case of recurrent pericarditis. Note the PR
elevation in VR an...
Figure 9.36 Pathophysiological events relating atrial
fibrillation (AF) and ...
Figure 9.37 ECGs showing increasing HR for all‐cause
mortality in a multivar...
Chapter 10
Figure 10.1 Right ventricular enlargement (RVE) counteracts
the usually domi...
Figure 10.2 Top. Parting from a normal loop in the horizontal
plane. Progres...
Figure 10.3 Diagram of the QRS loops in the frontal plane (FP)
and horizonta...
Figure 10.4 Right ventricular enlargement (RVE) is
fundamentally seen in thr...
Figure 10.5 Two cases of severe right ventricular enlargement
(RVE), one wit...
Figure 10.6 Typical morphology of ostium primum‐type atrial
septal defect (A...
Figure 10.7 Typical morphology of ostium secundum‐type
atrial septal defect ...
Figure 10.8 An 8‐year‐old patient with important pulmonary
valve stenosis wi...
Figure 10.9 A 3‐year‐old patient with typical tetralogy of
Fallot. The ECG c...
Figure 10.10 A 7‐year‐old patient with moderate Fallot’s
tetralogy and RS wi...
Figure 10.11 (A) ECG of an 8‐year‐old patient with severe
pulmonary stenosis...
Figure 10.12 A 65‐year‐old patient with important chronic
obstructive pulmon...
Figure 10.13 SI, SII, SIII morphology in a normal case (A) and
in chronic ob...
Figure 10.14 A 60‐year‐old patient with chronic cor
pulmonale. Because of re...
Figure 10.15 (A) A 59‐year‐old patient with pulmonary
embolism and typical M...
Figure 10.16 (A) Pre‐operative ECG of a 58‐year‐old female
with no heart dis...
Figure 10.17 Patterns of left ventricular geometry in
hypertensive patients....
Figure 10.18 (A) Under normal conditions, the dominant
forces of ventricular...
Figure 10.19 Diagram of the QRS and T loops in the frontal
plane (FP) and ho...
Figure 10.20 Typical ECG of a 22‐year‐old male with
important, although not ...
Figure 10.21 ECG of a 47‐year‐old male, typical of severe,
long‐standing aor...
Figure 10.22 ECG and VCG in a patient with severe aortic valve
disease. Ther...
Figure 10.23 ECG and VCG in a patient with severe aortic valve
disease. Ther...
Figure 10.24 Typical but infrequent ECG of obstructive
hypertrophic cardiomy...
Figure 10.25 ECG and VCG of an asymptomatic patient who
had been diagnosed w...
Figure 10.26 Four typical examples of morphology evolution.
(A and B) are tw...
Figure 10.27 (A) ECG if a healthy, lean, adolescent and (B) if a
patient wit...
Figure 10.28 Four examples of atypical morphology of ST/T
according to the c...
Figure 10.29 Three‐dimensional bar graph showing
sensitivity of the ECG crit...
Figure 10.30 (A) Patient with mitral and aortic valve disease
with atrial fi...
Figure 10.31 In cases with left ventricular dilation, a narrow,
very posteri...
Figure 10.32 A 56‐year‐old male with hypertensive heart
disease. ECGs before...
Figure 10.33 Patient with mitral–aortic–tricuspid valve
disease and ECG sign...
 Figure 10.34 Example of bi‐atrial and biventricular
enlargement. A 35‐year‐o...
Figure 10.35 An example of biventricular enlargement (see
text). Patient age...
Chapter 11
Figure 11.1 Anatomic distribution of the intraventricular
conduction system ...
Figure 11.2 Different pathologic aspects of the middle fibers of
the left br...
Figure 11.3 To classify bifascicular and trifascicular block, we
assume that...
Figure 11.4 Frontal (FP) and horizontal (HP) plane loops in a
normal patient...
Figure 11.5 Left: QRS and T vectors and loops in advanced
(third‐degree) RBB...
Figure 11.6 The sequential appearance of progressive ECG–
VCG patterns of exp...
Figure 11.7 Diagrams of the formation of the dipole and vector
of depolariza...
Figure 11.8 ECG of a healthy 75‐year‐old woman with no
heart disease. For mo...
Figure 11.9 (A) Normal HV and V‐right ventricular apex (RVA).
(B) In periphe...
Figure 11.10 ECG of a 6‐year‐old girl with Ebstein’s disease.
Observe the hi...
Figure 11.11 Typical ECG pattern of a patient with
arrhythmogenic right vent...
Figure 11.12 (A) Preoperative ECG in an 8‐year‐old with
Fallot’s tetralogy. ...
Figure 11.13 (A) Both the frontal plane and the horizontal
plane are typical...
Figure 11.14 Diagram of ventricular depolarization in global
but partial (fi...
Figure 11.15 Three examples of first‐degree RBBB
morphology (QRS <0.12 sec) ...
Figure 11.16 aVR, V1, and V6 morphologies in a normal case
and in third‐ and...
Figure 11.17 A very lean 15‐year‐old patient without heart
disease. The rSr′...
Figure 11.18 V1. Continuous recording. A 55‐year‐old patient
with first‐degr...
Figure 11.19 Left: Diagram of the morphologies that appear in
anterosuperior...
Figure 11.20 (A) Diagram of the normal spatial velocity ECG.
(B–E) Examples ...
Figure 11.21 Comparison between a typical S1, S2, S3
morphology (normal vari...
Figure 11.22 Left: QRS vectors and loops in advanced LBBB
(third‐degree). Ri...
Figure 11.23 Diagram of formation of dipole and the
depolarization and repol...
Figure 11.24 (A) Normal activation of left ventricle starts
almost simultane...
Figure 11.25 Advanced LBBB in a patient with no apparent
heart disease. QRS ...
Figure 11.26 Advanced LBBB in a patient with no apparent
heart disease. The ...
Figure 11.27 ECG of a patient with congestive heart failure
and a morphology...
Figure 11.28 Patient with hyperkalemia (K = 7.5 mEq/l) and
LBBB pattern with...
Figure 11.29 (A) Diagram of how the association of a delay
activation more i...
Figure 11.30 (A) ECG of a patient with idiopathic dilated
cardiomyopathy wit...
Figure 11.31 Patient with dilated cardiomyopathy and
congestive heart failur...
Figure 11.32 ECG of a patient without heart failure and very
advanced left i...
Figure 11.33 Diagram of ventricular depolarization in first‐
degree LBBB. If ...
Figure 11.34 Two examples of partial LBBB. (A) A 55‐year‐old
patient with mi...
Figure 11.35 Intermittent LBBB. The third and sixth
complexes manifest a LBB...
Figure 11.36 Diagram of the activation in superoanterior
hemiblock. On the l...
Figure 11.37 ECG–VCG of a patient with typical isolated
superoanterior hemib...
Figure 11.38 Evolution in time in a case of superoanterior
hemiblock (SAH). ...
Figure 11.39 Patient in subacute phase of coronary syndrome.
Left (A): The m...
Figure 11.40 Typical example of SAH + LVH in a 55‐year‐old
patient with seve...
Figure 11.41 ECG of a 60‐year‐old patient with chronic
obstructive pulmonary...
Figure 11.42 Diagram of activation in inferoposterior
hemiblock. On the left...
Figure 11.43 (A) ECG of a 55‐year‐old patient with arterial
hypertension and...
 Figure 11.44 (A) ECG from an ischemic heart disease patient
who, during an a...
Figure 11.45 This drawing shows that the incision at the site
of the middle ...
Figure 11.46 ECG from a 22‐year‐old man without structural
heart disease. (A...
Figure 11.47 Two cases with very similar prominent R wave in
V1–V2. (A) Case...
Figure 11.48 Typical bilateral block. (A) LBBB with left  QRS
deviation patt...
Figure 11.49 Different possibilities of bifascicular block when
assuming tha...
Figure 11.50 A 70‐year‐old patient with no apparent heart
disease with a typ...
Figure 11.51 Two examples of classical bifascicular masked
block, one (A) wi...
Figure 11.52 Different ECGs in the same patient presenting
with intermittent...
Figure 11.53 In the presence of masked block, the
disappearance of the S wav...
Figure 11.54 A 76‐year‐old patient with ischemic coronary
heart disease and ...
Figure 11.55 A patient with RBBB + IPH and inferior
myocardial infarction. T...
Figure 11.56 Typical example of trifascicular block. (A) RBBB
+ SAH. (B) The...
Chapter 12
Figure 12.1 Right lateral view of the accessory pathways.
Figure 12.2 Left top panel: Diagram of the P–QRS relationship
in normal case...
 Figure 12.3 WPW‐type pre‐excitation morphologies according
to the different ...
Figure 12.4 (A) ECG–VCG of a patient with WPW type II (Ha:
amplified horizon...
Figure 12.5 A WPW patient with the accessory pathway
located in the inferose...
Figure 12.6 Algorithm used to localize the accessory pathway
in one of the f...
Figure 12.7 Two examples of WPW type I pre‐excitation. (A)
Important pre‐exc...
Figure 12.8 Two cases of WPW patient with the accessory
pathway located in t...
Figure 12.9 Atrial fibrillation episode (A) and
supraventricular paroxysmal ...
Figure 12.10 Intermittent pre‐excitation. In the first three
complexes, the ...
Figure 12.11 Intermittent type IV pre‐excitation: the pattern is
similar to ...
Figure 12.12 “Concertina” effect. The five first complexes are
identical and...
Figure 12.13 Conduction occurs via both the normal and the
accessory pathway...
Figure 12.14 Scheme of a heart with a right accessory AV
pathway, which lead...
Figure 12.15 Example of typical short PR interval pre‐
excitation syndrome (0...
Figure 12.16 (A) A hisiogram showing a typical case of short
PR syndrome. Th...
Chapter 13
Figure 13.1 Ischemic cascade. The figure shows the sequence
of events in asy...
Figure 13.2 (A) Recordings in the case of experimental
occlusion of left ant...
Figure 13.3 (A) Transmembrane action potential (AP): control
(1) and after w...
Figure 13.4 The different morphological features that appear
after coronary ...
Figure 13.5 Observe how different degrees of ischemia that
appear sequential...
Figure 13.6 Explanation of how the sum of the
transmembrane action potential...
Figure 13.7 (A) Subepicardial experimental ischemia.
Subendocardial repolari...
Figure 13.8 Cross‐section of the left ventricular wall in
diastole and systo...
Figure 13.9 The typical pattern of ischemic heart disease can
be explained b...
Figure 13.10 A normal variant tall T wave. B to E
morphologies of taller tha...
Figure 13.11 (A) ECG with a quite negative T wave in V1–V2 to
V5, with exten...
Figure 13.12 ECG of a 55‐year‐old man without chest pain and
with non‐ST seg...
Figure 13.13 ECG with a typical pattern of chronic negative T
wave in the le...
Figure 13.14 Symmetric negative T wave (see leads I and V5)
in a patient wit...
Figure 13.15 T wave morphologies in conditions other than
ischemic heart dis...
Figure 13.16 T wave morphologies in conditions other than
ischemic heart dis...
Figure 13.17 A patient with chronic constrictive pericarditis.
The T wave is...
Figure 13.18 (A) ECG of a patient with chronic ischemic heart
disease. (B) E...
Figure 13.19 Local DC extracellular ECGs from the left
ventricular subepicar...
Figure 13.20 The electrode located in the epicardium of
anterior cardiac wal...
Figure 13.21 Note the relationship between the value of the
transmembrane di...
Figure 13.22 How the respective patterns of subendocardial
(B) and subepicar...
Figure 13.23 (A) In significant experimental subendocardial
ischemia (1) (is...
Figure 13.24 Observe how an amplified ECG (4×) of lead V1
allows the proper ...
Figure 13.25 Evolution of non‐Q‐wave myocardial infarction
with important ST...
Figure 13.26 Various types of subendocardial ischemia
patterns may appear in...
Figure 13.27 Changes of the ST segment in a patient with
exercise angina. (A...
Figure 13.28 (A) In the case of diffuse subendocardial
circumferential injur...
Figure 13.29 (A) Normal control ECG of a patient with chronic
ischemic heart...
Figure 13.30 Top panel. This ECG was recorded during an
episode of chest pai...
Figure 13.31 Patient with subocclusion of the LMT. The figure
shows the sequ...
Figure 13.32 A flow chart drawing of the ECG changes in case
of Q‐wave anter...
Figure 13.33 Different types of tissues (normal, ischemic,
injured, and necr...
Figure 13.34 Acute infarction of anteroseptal zone with ST
segment elevation...
Figure 13.35 In an acute coronary syndrome with ST segment
elevation in V1–V...
Figure 13.36 In an acute coronary syndrome with ST segment
elevation in II, ...
Figure 13.37 In the case of high septal involvement due to left
anterior des...
Figure 13.38 Algorithm to precisely locate the left anterior
descending (LAD...
Figure 13.39 Algorithm to predict the culprit artery (right
coronary artery ...
Figure 13.40 ECG and coronarography of a patient with ST
elevation myocardia...
Figure 13.41 ST segment elevation acute coronary syndrome
(STE‐ACS) due to l...
Figure 13.42 ST segment elevation acute coronary syndrome
(STE‐ACS) due to l...
Figure 13.43 ST segment elevation acute coronary syndrome
(STE‐ACS) due to o...
Figure 13.44 ST segment elevation acute coronary syndrome
(STE‐ACS) due to l...
Figure 13.45 ST segment elevation acute coronary syndrome
(STE‐ACS) due to o...
Figure 13.46 ST segment elevation acute coronary syndrome
(STE‐ACS) due to i...
Figure 13.47 ST segment elevation acute coronary syndrome
(STE‐ACS) due to r...
Figure 13.48 Typical case of ST segment elevation acute
coronary syndrome (S...
Figure 13.49 ST segment elevation acute coronary syndrome
(STE‐ACS) due to o...
Figure 13.50 ST segment elevation acute coronary syndrome
(STE‐ACS) due to o...
Figure 13.51 ST segment elevation acute coronary syndrome
(STE‐ACS) due to o...
Figure 13.52 ST segment elevation acute coronary syndrome
(STE‐ACS) due to p...
Figure 13.53 (A) Acute phase of evolving Q wave myocardial
infarction of the...
Figure 13.54 (A) Acute myocardial infarction (MI) of the
anteroapical zone d...
Figure 13.55 (A) Acute phase of an infarction in a patient with
complete lef...
Figure 13.56 Patient with pacemaker and acute ST segment
elevation acute cor...
Figure 13.57 The ECG of a patient with rapid atrial fibrillation
and right b...
Figure 13.58 A 62‐year‐old patient with hypertension
presenting with a non‐S...
Figure 13.59 (A) The most frequent cases of ST segment
elevation apart from ...
Figure 13.60 Non‐ischemic ST segment depression. (A) ST
segment depression s...
Figure 13.61 (A) Normal ventricular depolarization, being
very rapid in the ...
Figure 13.62 (A) Under normal conditions, the overall QRS
vector (R) is made...
Figure 13.63 (A) Comparison between normal activation and
the activation in ...
Figure 13.64 (A) Comparison between normal activation and
activation in the ...
Figure 13.65 Evolution of a patient with acute myocardial
infarction (MI) of...
Figure 13.66 Correlations between the different types of MI
with their infar...
Figure 13.67 Example of large septal myocardial infarction
(type A‐1): ECG c...
Figure 13.68 Example of apical‐anterior myocardial infarction
(Q wave beyond...
Figure 13.69 Example of extensive anterior myocardial
infarction (type A‐3) ...
Figure 13.70 Example of mid‐anterior myocardial infarction
(type A‐4) (QS in...
Figure 13.71 Example of lateral myocardial infarction (MI)
with RS in V1 (ty...
Figure 13.72 Example of inferior myocardial infarction (MI)
with Q in II, II...
Figure 13.73 Example of inferolateral myocardial infarction
(MI) (Q in II, I...
Figure 13.74 (A, B) Example of apical‐anterior infarction with
inferior invo...
Figure 13.75 The three typical patterns of R in V1 in lateral
myocardial inf...
Figure 13.76 (A,B) Direction of necrosis vector in the case of
myocardial in...
Figure 13.77 Left: The involved area in the case of inferior,
posterior, and...
Figure 13.78 On the left a patient with myocardial infarction
of the anteroa...
Figure 13.79 If the necrosis affects the areas of late ventricular
depolariz...
Figure 13.80 The ECG of a patient that has suffered two
myocardial infarctio...
Figure 13.81 (Above) Patient with acute myocarditis and ECG
with signs of RB...
Figure 13.82 ECG–VCG correlation in the case of isolated right
bundle branch...
Figure 13.83 Patient with complete right bundle branch block
(RBBB) and myoc...
Figure 13.84 (A) Patient with complete right bundle branch
block (RBBB) in a...
Figure 13.85 (A, B) Ventricular activation in the case of left
bundle branch...
Figure 13.86 Example of the usefulness of vectorcardiography
(VCG) to diagno...
Figure 13.87 ECG–VCG of complete left bundle branch block
(LBBB) with signs ...
Figure 13.88 The ECG of a patient with complete left bundle
branch block (LB...
Figure 13.89 Inferior infarction associated with
superoanterior hemiblock (S...
Figure 13.90 Inferior infarction associated with an
inferoposterior hemibloc...
Figure 13.91 Mid‐anterior infarction associated with
superoanterior hemibloc...
 Figure 13.92 Extensive anterior infarction including mid‐
anterior wall assoc...
Figure 13.93 Superoanterior hemiblock (SAH) may mask a
small inferior infarc...
Figure 13.94 (A) Normal habitus. In the presence of small
septal infarction ...
Figure 13.95 Inferoposterior hemiblock (IPH) may mask small
mid‐anterior inf...
Figure 13.96 (A) Normal habitus. In the presence of small
septal infarction ...
Figure 13.97 Vectorcardiography (VCG) loops in the case of
inferior myocardi...
Figure 13.98 ECG–VCG example of inferior myocardial
infarction (MI) + supero...
Figure 13.99 ECG–VCG example of inferior myocardial
infarction (MI) without ...
Figure 13.100 Above: ECG of a patient with an intermittent
Wolff–Parkinson–W...
Figure 13.101 Four sets of leads with basal ECG (left) and
after pacemaker i...
Figure 13.102 (A) Acute anterior myocardial infarction plus
complete right b...
Figure 13.103 A 72‐year‐old man with previous apical‐
anterior myocardial inf...
Chapter 14
Figure 14.1 Note the correct procedure for carotid sinus
massage (CSM). The ...
Figure 14.2 Several examples of Lewis (ladder) diagrams
including: (A) the a...
Figure 14.3 (A) (1) Normal atrioventricular (AV) conduction,
(2) premature a...
Figure 14.4 Placement of atrial and ventricular waves within
the atrial and ...
Figure 14.5 (A) Ventricular extrasystole; (B) atrial
extrasystole; (C) ventr...
Figure 14.6 Sinus node transmembrane action potential (TAP)
(A) transmitted ...
Figure 14.7 Factors influencing the increase of automaticity
(broken lines)....
Figure 14.8 (A) Sinus node transmembrane action potential
(AP) curve. (B) At...
Figure 14.9 The presence of early (A–C) and late (D and E)
post‐potentials i...
Figure 14.10 Examples of circuits involved in classical
reentrant atrial and...
Figure 14.11 The three mechanisms dealing with the onset
and perpetuation of...
Figure 14.12 (A and B) Circuits explaining the presence of
common flutter wi...
Figure 14.13 (A) Example of reentrant arrhythmias with
circuit involving the...
Figure 14.14 Above: Example of fast–slow tachycardia with
the involvement of...
Figure 14.15 (A) Classical reentry (anatomical obstacle) (see
Figure 14.10)....
Figure 14.16 Apart from the reentrant mechanisms, there are
other mechanisms...
Figure 14.17 Left: (A, B and C) Diagrams showing the gap
phenomenon. (A) The...
Figure 14.18 The parasystolic mechanism is generally
explained by an entry b...
 Figure 14.19 (A) First‐degree sinoatrial block. The sinoatrial
conduction is...
Figure 14.20 (A) First‐degree AV block. The PR interval is
always prolonged ...
Figure 14.21 (A, B, C, D) Diagrams showing how the
combination of a precedin...
Figure 14.22 The first atrial extrasystole is conducted with
minimal aberran...
Figure 14.23 Sustained aberrancy during different complexes
at the beginning...
Figure 14.24 Atrial fibrillation (AF) patient with one wide
premature QRS co...
Figure 14.25 A patient with atrial fibrillation (AF) showing
wide QRS comple...
Figure 14.26 Comparison between the aberrancy related with
cycle shortening ...
Figure 14.27 Example of a phase 4 left bundle branch block.
Note the left bu...
Figure 14.28 Intermittent aberrancy without apparent
changes in heart rate....
Figure 14.29 Interpolated ventricular extrasystole. The
following P wave is ...
Figure 14.30 V2 recording showing the different
morphologies of “f” waves (a...
Figure 14.31 (A) Taken from an atrial fibrillation (AF) patient
with general...
Chapter 15
Figure 15.1 Sinus rhythm alternating with paroxysmal atrial
fibrillation (AF...
Figure 15.2 Examples of supraventricular premature
complexes: (A) isolated; ...
Figure 15.3 (A) A healthy 8‐year‐old girl with atrial trigeminy,
at times no...
Figure 15.4 Sinus tachycardia in a 32‐year‐old man at
different moments duri...
Figure 15.5 Above: Tachycardia at 110 bpm with barely visible
atrial activit...
Figure 15.6 Sudden onset of supraventricular tachycardia at a
rate of 110 bp...
Figure 15.7 Upper tracing: A 20‐year‐old patient with dilated
cardiomyopathy...
Figure 15.8 The P wave polarity is clearly indicative of the
ectopic origin ...
Figure 15.9 A digitalis‐intoxicated patient with atrial
tachycardia due to a...
Figure 15.10 (A) Most frequent locations of atrial tachycardias
of focal ori...
Figure 15.11 (A) ECG of a patient with no heart disease and
episodes of paro...
Figure 15.12 (A) Example of junctional paroxysmal
tachycardia with left acce...
Figure 15.13 Location of P′ waves in paroxysmal
supraventricular tachycardia...
Figure 15.14 (A) aVF and V1 in a patient with heart failure
and fixed ventri...
Figure 15.15 Holter continuous recording. Incessant
junctional reentrant tac...
Figure 15.16 A 28‐year‐old patient without heart disease and
a normal ECG (A...
Figure 15.17 Example of a fast junctional ectopic focus
tachycardia (180 per...
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The Project Gutenberg eBook of Indians of the
Enchanted Desert
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Title: Indians of the Enchanted Desert

Author: Leo Crane

Release date: July 2, 2022 [eBook #68445]

Language: English

Original publication: United States: Little, Brown, and Company,

1925

Credits: Jeroen Hellingman and the Online Distributed Proofreading

Team at https://www.pgdp.net/ for Project Gutenberg (This
file was produced from images generously made available
by The Internet Archive/American Libraries.)

*** START OF THE PROJECT GUTENBERG EBOOK INDIANS OF

THE ENCHANTED DESERT ***
[Contents]

[Contents]

INDIANS OF THE ENCHANTED DESERT

[Contents]
Photo. by W. C. Wilson
ANNOUNCING THE SNAKE DANCE

Priest at sunset removing kiva signal

[Contents]
 INDIANS OF THE
ENCHANTED DESERT

BY
LEO CRANE

WITH ILLUSTRATIONS
BOSTON
LITTLE, BROWN, AND COMPANY
1925
[Contents]

Copyright, 1925,
By Little, Brown, and Company.

All rights reserved

Published September, 1925

First Impression September, 1925

The Atlantic Monthly Press

Publications
are published by
Little, Brown, and Company
in association with
The Atlantic Monthly Company

Printed in the United States of America

[Contents]

TO

those people of the Enchanted Desert who

called me “Chief,”—Indians, employees,
 missioners, traders,—whose confidence,
loyalty, and devotion made my work among
the Hopi and Navajo tribes possible of
success; and to humbler friends, my faithful
horses, Dandy and Barney Murphy, Prince
and Frank, that went with me so many
weary miles, and were shot, by my order, to
save them from the miseries of
Governmental economy, this book is
dedicated. [vii]

[Contents]
 CONTENTS

PAGE
I Nolens Volens 3
II Across the Plains 11
III Into “Indian Country” 22
IV Old Trails and Desert Fare 30
V Desert Life and Literature 44
VI A Northern Wonderland 54
VII The First Ball of the Season 65
VIII Old Oraibi 78
IX The Making and Breaking of Chiefs 94
X The Provinces of the “Mohoce or Mohoqui” 101
XI The Law of the Realm 113
XII Comments and Complaints 122
XIII A Desert Vendée 142
XIV Soldiers, Indians, and Schools 157
XV An Echo of the Dawn-Men 181
XVI Fiddles and Drums 191
XVII Service Tradition 210
XVIII Buttons and Bonds 224
XIX Our Friends, the Tourists 240
XX The Great Snake-Ceremony [viii] 260
XXI Desert Belascos 275
XXII On the Heels of Adventure 287
XXIII The Red Bootleggers 297
XXIV Held for Ransom 312
XXV Wanted at Court 325
XXVI Hopi Annals 336
XXVII L’Envoi 361
[ix]

[Contents]
 ILLUSTRATIONS

Announcing the Snake Dance Frontispiece

Walpi, the Pueblo of the Clouds 12

The Valley and Its Headlands

A Navajo Flock and Its Shepherds 16

Cañon de Chelly, Seen from the Rim

Crossing the Desert below Chimney Butte 58

The Oraibi Wash in Flood-Time

Navajo on Their Way to a Dance 70

A Navajo Hogan and Its Blanket Loom

Outfit of a Well-Digger, the Desert “Water-Witch” 84

Drying Bed of the Little Colorado River

The Hopi Ceremonial Corn-Planting 92

Hopi Gardens in a Spring-Fed Nook of the Desert

Hopi Indian Agency at Keams Cañon 106

Hopi Indian Hospital at Keams Cañon

A Busy Day at the Trading-Post, Keams Cañon 118

Ready for the 105-Mile Trek to the Railroad

Hostin Nez, Navajo Chief and Medicine Man 124

Judge Hooker Hongave of the Indian Court 132

Youkeoma, Antelope Priest and Prophet 162

A Mesa Road—Old Trail to Hotevilla 170
A Pretentious Home at Hotevilla

A Hopi Schoolgirl 178

A Hopi Youth Who Is Preparing for College

The Walpi Headland, Seen from the Orchards 196

The Walpi Stairway, A Rock-Ladder to the Sky 202 [x]

The Author, in the Enchanted Desert 230

Old Glory and the Bond Flag at the Agency

Albert Yava: Interpreter 234

Tom Pavatea: Hopi Merchant and Patriot

The Corn Rock, an Ancient Bartering-place 238

Opening the Walpi Snake Dance 250

Dramatic Entry of the Snake Priests

The Gatherer, Handling a Rattlesnake 266

A Patriarch of Snakes

The Chief Snake-Priest 272

The Enchanted Desert and the Moqui Buttes 282

In the Twin-Butte Country 294

Silversmith Jim: a Typical Navajo

Billa Chezzi: Chief of the Northern Navajo 316

Nelson Oyaping: Tewa Chief of Police

A Navajo Boy Who Has Never Been to Any School 322

A Hopi Range-Rider 336

Blue Cañon: A Study in Blue-and-White
A Hopi Shrine 338
A Hopi Weaver of Ceremonial Robes
A Katchina Dance

Hopi Mother in Gala Dress, with Her Child 340

Navajo Mother with Child in Cradle

A New Son of the Desert 344

Hopi Girls Arrayed for a Dance

Hopi Wedding Costume 352

A Hopi Beauty 358 [1]

[Contents]
 INDIANS OF THE ENCHANTED DESERT

[3]
I
 NOLENS VOLENS
It is well for a man to respect his own vocation,
whatever it is, and to think himself bound to
uphold it and to claim for it the respect it
deserves.—Charles Dickens

They were good fellows, cordial, modest, although somewhat shy in

manner, the sort that would have been more at home perhaps
among fewer men. They came out of the West, at infrequent
intervals, to visit the Chief, who in those days did not keep them
waiting. The course of business, filtering down through the red-taped
labyrinth, brought some of them to my desk and within my survey. I
wonder now what they thought of me, especially as I am about to
relate how I viewed them.

Imbued as I was then with the rare efficiency of bureaucracy, I

sympathized with their apparent helplessness in the transaction of
Departmental business. They were always wanting to do promptly
things that weren’t done. Aside from that, I found them interesting,
they being from what an Easterner would term the “hinterland,” had
he vision enough to know that his country has one. I thought they
would have tales to tell—a hope that never materialized.

When one came to know them better, as I sometimes did, they would
relate their problems in a constrained, half pathetic manner, as if,
seeking something and finding it not, they were confused. The idea
came to me that they were awed, if not actually bewildered, by their
uncommon [4]experiences in the big city. I did not dream that they
were struggling manfully, as indeed they could, to restrain a just
wrath; that their seeming pathos was a sort of crude pity, inspired by
the artificialities and cheap bluff that they saw around them. Their