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168
169
170
170
172

4
( 1-1)

1-1
(pulmonary circulation) (systemic circulation) (From
www.doctorgrasshopper.wordpress.com)

8
2
1. (systemic circulation)
(aorta)

2. (pulmonary circulation)
(pulmonary artery)

(
16)
(fetal circulation)

( 1-2) (umbilical
artery)
( )
(passive process) (active transport)
() (umbilical
vein) (portal vein)

(inferior vena cava) (ductus venosus)
( superior vana cava)
(foramen ovale)

(pulmonary artery)

9
(ductus arteriosus) (distal thoracic aorta)

(abdominal aorta)

1-2 (fetal circulation)

(prostaglandins) (bradykinin)
10

(autoregulation)

( 17)

(right atrium)
(right ventricle)

(left atrium) (left ventricle)

11
(sternum)

(pericardium)

(base) (apex)

(5th intercostal space)

(cytoskeleton) (fiber) (fibrous band)

(annulus fibrosus)
(fibrous trigone and tendon of the conus)

(bulbospiral fiber)
(sinospiral fiber) ( 1-3)
(atrial fiber)

(nodal or pacemaker cell) (sinoatrial
or S-A node) (atrioventricular or A-V node)
(conducting fiber) (internodal fiber)
(bundle of His and bundle branches) (Purkinje fiber)
( 1-4)

12

1-3 (cardiac cytoskeleton)

(From www.rci.rutgers.edu)
1-4
( )(From www.nature.com)

13
(aortic
valve) (pulmonary valve)

(semilunar)

(tricuspid valve)
(mitral valve)

(chordae tendineae)
(papillary muscle)

( 1-5) (semilunar
valves) (atrioventricular valves)

(coronary vascular system)
9
(autonomic nervous system)
(sympathetic nerve) (parasympathetic nerve) ( 16)
(sympathetic chain)
(cardiac ganglion)

(norepinephrine)

(1adrenergic receptor) (-adrenergic receptor)
(propranolol)

14

(acetylcholine) (muscarinic receptor)
(atropine)
1-5
(From www.cardiacsurgeryacademy.org)
(From www.emedicine.medscape.com)

( 1-1)

15

1-6 (From www. alexandria.healthlibrary.ca)

( 1-7) (endothelium)
(vascular smooth muscle) (adventitia) ( 10
11)
(norepinephrine)
( 17)

( 1-7)

16
1-7 (From www.colorado.edu)
1. (Windkessel vessel)
(
) " (Windkessel vessel)" (Windkessel
compression chamber)
(elastic fiber)

(cardiac output) (elastic energy)
( )

(elastic recoil)

17
2. (resistance vessel)
(terminal artery and arteriole)
(small lumen)

(total peripheral resistance)
(precapillary area)
(venule)
(filtration) (absorption)

( 14)
3. (sphincter vessel)
(precapillary sphincter)

4. (exchangable vessel)

(plasma oncotic pressure)
( 14)

(capillary
permeability) (histamine(
(nitric oxide)
5. (capacitance vessel)
(compliance)

(reservoir) 70%

18
(elasticity)

1-1

O2 CO2
1.

2.
Granulocytes
- Neutrophils (Polymorpho nuclear leukocytes)

- Eosinophils
- Basophils
Agranulocyte
- Lymphocytes
- Killer cells
- Monocytes
3.

(macrophage)

80%
(blood cell) (plasma)
90% (Na+, K+, Ca2+, Cl-,
etc) (waste product) (glucose, amino acid, and lipids)
(albumin) 5%
(extracellular fluid)
(hematocrit) 45%
(serum)
(clotting factor)

(organelle) 4
( 1-1)
(granulocytes) (neutrophil)

19
(eosinophil) (allergy)
(basophil) (serotonin)
(agranulocyte) (Band t-lymphocyte) (Kuffer cell)
(monocyte) (macrophage)
(phagocytosis)
(platelete)
(hemostasis)

( 12)
1. Barrett KE, Barman SM, Boitano S, Brooks H. Ganong's review of medical physiology, 23rd edition.
Boston, McGraw-Hill, 2010.
2. Berne RM, Sperelakis N, Geiger SR. Handbook of physiology. Section 2: the cardiovascular
system; volume I: the heart. American Physiological Society, Bethesda/Maryland, 1979.
3. Boron WF, Boulpaep EL. Medical physiology: a cellular and molecular approach, 2nd edition.
Philadelphia, Saunders, 2009.
4. Hall JE. Guyton and Hall textbook of medical physiology, 12th edition. Philadelphia, Saunders,
2011.
5. Koeppen RM, Stanton BA. Berne & Levy physiology, 6th edition. Philadelphia, Mosby, 2010.
6. Fozzard, H.A., E. Haber, R.B. Jennings, and A.M. Katz. The heart and cardiovascular system, 2nd
edition. New York, Raven Press, volume 1-2, 1991.
7. Rhoades RA, Bell DR. Medical physiology: principles for clinical medicine, 3rd edition. Philadelphia,
Lippincott Williams & Wilkins, 2009.
20
1. (Coulomb's law)
(F) q1 q2 r

kq1q2/r2
=
=
(9 x 109 -()2/()2)
1/ (dielectric constant)
2. (Gauss's law)
(P) ( 1 )
q r
P
kq/r2
(W) 1 (infinity)
q r
W
kq/r
W (electrical potential) 1
(potential difference)

21

-90 +30

(membrane potential difference) (membrane
potential)
(earth or ground)

3. (Ohm's law)
E
I R V

V = E = IR
I = dq/dt
dq/dt = (
)
Na+, K+ Cl-
(Faraday constant) 1
96,500 10
96,500 x 10 = 965,000
(1)

(2)

I
= -
dq/dt q
22
(3)

(cathode) (anion)
(anode)

ZF dM/dt
(valence electron)
Na+ = 1 Ca2+ = 2
(96,500 )

F
=
dM/dt =
4. (electrochemical energy)

H - TS
G
H
S
=
=
=
(Gibbs-free energy)
(enthalpy)
(entropy)
(absolute temperature , oK)

(1) (chemical energy C)
C
C
C* + RT ln C
23
(2) (electrical energy E)

(E)
C*
ZFE
Z
F
E
=
=
=
(3) (electrochemical energy )

C* + RT ln C + ZFE

"
"

(ATP)
(cotransport)
5. (Gibbs-Donnan equilibrium)
(semipermeable membrane)

G

( )
G

( ) 2-1
2-1 (A)
[Na+] (B) [Cl-] "J.

24
Willard Gibbs" .. 2417-2421 "Frederick R.
Donnan" .. 2454

A B
B A

Pr-
Na+
ClH2O
Na+
ClH2O
2-1 (semipermeable
membrane) Pr- Na+ Cl-

(v) Na+ Cl- A B
B A vAB = k[Na+ ]A[Cl-]A vBA = k
[Na+ ]B[Cl-]B k
[Na+]A[Cl-]A = [Na+]B [Cl-]B [Na+]A /[ Na+ ]B = [Cl-]B /[Cl-]A
6. (Nernst equation)
G

Na+ Cl-

25
0
0
EA-B
=
=
=
=
=
+ E
C + E
RT ln [Na+ ]A /[ Na+ ]B + ZFEA-B
-(RT/ZF) ln [Na+ ]A /[ Na+]B
-(RT/ZF) ln [Cl-]B /[Cl-]A
C
EA-B
-(RT/ZF) ln CA/CB
EA-B
( A B)
(equilibrium potential)
A B
C A, C B =

EA-B
A B C E
7. (Goldman or constant field equation)

(different
permeability) (Em)

Em
-(RT/ZF) ln (PK[K+] i + PNa[Na+ ] i + PCl[Cl-] o + ---)/(PK[K+] o

+ PNa[Na+] o + PCl[Cl-] i + ---)
PK, PNa, PCl = (permeability coefficient) K+, Na+ Cl-

i
=
(inside cells)
o
=
(outside cells)
26

Cl-
Em
=
-(RT/ZF) ln ([K+]i + PNa/PK[Na+]i)/([ K+]o + PNa/PK[Na+]o)
PK PNa
Em
-(RT/ZF) ln [K+]i/[ K+]o

(Ei) 2-1
K+
Cl- Na+ Ca2+ EK ECl
( 3)
ENa ECa
Na+ Ca2+

(Na and Ca conductance)
Na+ Ca2+
(active transport) K+
1.

(ground)
(bipolar recording)

27
(ground or indifferent electrode)
(unipolar recording) 2 ( 2-2)
2-1

( )
( )
()
Na+
145
15
9.7
+60
K+
4
150
0.03
-94
Cl
120
5
24.0
-83
2+
4
-4
Ca
2
2 x 10
+129
10 *
* 2
(Berne et al., 1979)
2-2 ()
() (E)
(1) (intracellular recording)

( )

28
(resting potential) (depolarization)
(action potential)
(2) (extracellular recording)

2-3 (patch clamp technique)

(From www.comprehensivephysiology.com)

29
2. (patch clamp technique)

(ion channel)
(voltage clamp technique)
20
(single channel)
(patch clamp technique) ( 2-3)
1
( cell line tissue slice)
(seal)

109

KCl

(whole-cell recording)

(outside-out patch)

(inside-out patch)

2-3

(gate kinetics)
( 2-4)

30
(opening time)
(burst)
2-4
(patch clamp technique)

(current-voltage relation) (linear
relation)
I = gVC
I = (channel current)
g = (channel conductance)
VC = (clampal voltage)
31

(chord conductance) (slope conductance)

(equilibrium potential)
-90

(driving force)
g(Ei -VC)
I
g
Ei
VC
=
=
=
=
(V =
IR)

(1) (open channel) (permeability)
(2) (conductance)
(3) (driving potential)
(current)
(ion channel)

( 2-5)

32

(fast sodium channel)

(cationic channel)

(resting) (activation)
(inactivation)
(single channel current)

( )
( 2-4)
2-5
(From www.daddyblog.wordpress.com)

(gate)
2
(activation gate)
(inactivation)

33
(gate kinetics)
(threshold)

(deactivation)
(open)
(close)
(stimuli)
1. (voltage-sensitive channel) /

(delayed outward rectifier
K+ channel)
2. (chemical-sensitive channel) /
( secondary messenger )

(ligand-sensitive channel) ( Ca+2, ATP, cAMP
) (messenger-sensitive channel)

3. (stretch-sensitive channel) /
(Ia afferent fiber)
(muscle spindle)

(ionic current)
(Na+ current)
(I = ZF dM/dt)

(I)
(g) (V)
(Ei)

34
I
g(Ei-V)
g I (Ei-V) Ei
V
V = Ei I (EiV) g I (Ei-V) g I

(IK1 channel)

(ATP)

(interaction)

(phosphorylate)

1. IK1 channel K1 channel

(inward rectifier K+ channel)
2. IK(Ach) channel KAch channel
3. INa channel Na+ channel
4. IK channel ( K+ channel) (delayed outward
rectifier K+ channel)

I IK channel
IK channel K+ channel K+ channel
IK channel
35

( 2-2)
( 3)
2-2

INa(fast)
Na+
INa(slow)
Na+
ICa(L)
Ca2+
Voltage (+)
ICa(T)
Ca2+
Voltage (-)
ITI
If
Na+ & K+
Na+ & K+
[Ca2+]i
Voltage
Voltage
Voltage

IK(s)
K+
IK(r)
K+
IK(ur)
K+

Phase 0 depolarization
Excitation-contraction cloupling
Transient depolarization From
hyperpolarization
After-depolarization
Prepotential of SA nand AV node
Early depolarization From
hyperpolarization
Voltage (slow)
Voltage (rapid)
Voltage
Phase 3 repolarization
Early phase 3 repolarization
IK(ACh,Ado)
K
K+
Voltage
Acetyl choline
IK(Na)
IK(ATP)
IK(Ca)
Ibo
K+
K+
K+
K+
[Na+]i
Cell ATP deficit
[Ca2+]i
Voltage & [Ca2+]i
Ito
ICl
K+
Cl-
Voltage
Voltage
Resting membrane potential

Parasympathetic nerve response
Ischemic response
Hyperpolarization
Ischemic reponse and repolarization
Repolarization
Rat ventricular repolarization
IK1
(ultra rapid)
Adenosine
36
(gate kinetics)

(Hodgkin and
Huxley) .. 2495

(peak current)
(
capacitance current )
(g) (Ei-VC)

(maximum current)

(probability)
Y X
(steady state activation curve)
(activation threshold) ( 2-6)
(1
0 )

(IK1 channel) (If channel)

( )

37
( 2-6)

(steady state inactivation curve)

2-6
( X) Y (opening probability)

38
( )

0.1-0.2
1

(physiological range)

(hyperkalemia)

(depolarizing block)

(reassemble)
(INa channel)
.. 2495

(m gate) 0.1-0.2 (depolarize)
-60
2-3

39
(h gate) 1
-60 -20
(repolarize)

2-7
(resting stage )
(activating and inactivating stage )
(activated and inactivated stage )

-20
( 2-7)
(deactivation)
( 2 )
( )
-20

(-10, -5, +10 mV )

40

(voltage dependent)
-20
(
) (
)

20 (pS)
(mean open time) 0.9-2.4
-65 -60
0.1-0.2 (maximum or peak current)
-35 -20 50% (h0.5)
-90 -74 1-2 -20
( decay J From
ensemble average)
(partial depolarization) -90 -70

(GS protein)

(cAMP-dependent protein kinase)

/ (ischemia and/or infarction)
(
)
(arrhythmias)
(electroplax)
.. 2521 (heavily
glycosylated membrane bound protein) 270 (kD)
230-270
260-270
35-45 1

41

2,000 4 (domand)
( 2-8) 6 (six membranespanning segments) 1 (a pore loop)
5 (S5) (S6)
(P loop) (mutation)

(S4)
5-8 (five to six positively charge residues) 3 (spaced at
three-amino acid intervals) (voltage sensor)

2-8
(From www. cardiovascres.oxfordjournals.org)

(tetrodotoxin, TTX) ( micromolar)

( nanomolar)

42
(-conotoxin)
(TTX-and -conotoxin-resistant
cardiac channels, TTX-sensitive and -conotoxin-resistant neuronal channels, and TTX- and conotoxin-sensitive skeletal muscle channels)
( lidocain) 501000
(affinity)

(ectopic pacemaker)
(saturation)

(ICa channel)
(membrane protein)

(Harald Reuter)
(.. 2516)

( d gate) ( f gate) (
10 ) -70 -20
(ICa(T) channel) (T) (tiny conductance) (transient
current) -50
-50 -20 ( +0 mV)
(ICa(L) channel)
(L) (long-lasting) -60

43

2-3
( )
( )
Active function

Calcium channel
blockers
Dihydropyridines
Ca2+
Ni2+
Isoproterenol
-30 mV
Voltage dependent (slow response)
-40 mV
Ca2+ dependent
Voltage dependent (slow response)

Channel phosphorylation
ATP dependent
-60 mV
Voltage dependent (fast response)
-90 -60 mV
Ca2+ independent
Voltage dependent (fast response)

Voltage below -60 mV

ATP independent

( 2-3)
(charge carrier)
(Ba2+)

(1
44
2 )

(< 1 )
(burst)

(mode)
(mode 0)
(mode 1)

(mode 2) (~ 20 )

(calcium
channel blocker) (ditrendipine) (verapamil)
Bay K-8644
Cd2+, La3+, Mn2+ Co2+
Ni2+ (tetramethrin)
Mg2+
(dehydration)

(T-tubule)

/
(A-V node) (A-V block)

45

(ICa(B)
channel) (B = Bovine )
(background current)
(selectivity)
(Cs+) 10
100 (~7 pS)

(Bay K-8644)
2-10 (B, N, L, T, P and Q)

(From www.cardiff.ac.uk)

( 2-10) (1 subunit)
212 (pore)
(protein kinase A) 175

46
(voltage sensor) (2 subunit) 140
(beta subunit) 54
(30 kD)
(27 kD)

(K+ channel)
6 ( 2-2)
(delayed outward rectifier K+ channel, IK channel)
(inward rectifier K+ channel, IK1 channel)
(acetylcholine-sensitive K+ channel, IK(Ach) channel)
(ATP-sensitive K+ channel, IK(ATP) channel) (Na+-sensitive K+
channel, IK(Na) channel) (transient outward channel, Ito channel)

1.

.. 2495
.. 2512 (Noble and Tsein)
-90

(IX1 channel) (IX2 channel)
-50 ( 2-13) -40
(reversed potential =
) -85 -50 -20

47

10-60 1 50

(peak)

3 (IK(s), slowly
activating delayed rectifier) (IK(r), rapidly activating delayed rectifier) (IK(ur),
ultrarapidly activating delayed rectifier)

(inward rectifier)
(lanthanum)
(class III antiarrhythmics) dofetidide, E-4031 sotalol
NE10064 NE-10133 10-13 3-5

(preprotential)

(Q-T interval) (arrhythmia)
2.

48
( [K+]00.062 Em EK)
10-100

(20-30
pS [K+]O = 140 mM )
223 1
-20
-140
-40 ( 2-14)
(
) (-80 mV)
(
) -120

-70 -40

-40
()
(monovalent and divalent cations)
Cs+, Mg2+ Ca2+

(Na+-K+ pump)

49
3.

2 (Ito(1) channel) (Ito(2)
channel)
(4-aminopyridine and flecainide)
20-27
(Cl- channel)

(epicardium)
(mid-cardium) (endocardium)

4.

(40 ps in symmetrical K+)

-40
-40

-80 -100
5 (~ 10
29 )
( 2-12) (GTP)
(pertussistoxin-sensitive G protein)
( subunits)

50

(adenosine)

(apparent dissociation constant)
5.

(glycolytic blockade)
0.1-1.0 ( [ATP]i
= 3-4 mM)
(70-100 ps in symmetrical K+)
(ADP)
(AMP)
(sulfonylurea) (tolbutamide)

(open state probability)

Mg2+
Na+

6.
270
10

- (Na+-K+ATPase)

51

1. (transient inward channel, ITI channel)
"inward 'creep'
current"
-
(Ouabain) - (or inward 'creep' currents induced by Na loading or in
response to an increase in amplitude of ICa)

(Ca-activated nonspecific channel current)
(neonatal rat ventricle)
0.5 35

2. (If (or Ih, former IK2)

( 3) Na+ K+

0.1 -112 0.05
-72 ( 2-15) 70
Na+ K+

( )
52
3. (ICl channel)
(400450 pS in symmetrical 140 mM [Cl-])

2-3

(development and differentiation)

(adenylate cyclase system) (phosphoinositol
turnover) (guanylate cyclase system) (tyrosine kinase)

/
( 2-16)

(phosphatase)

(
)

1. Anumonwo JM, Lopatin AN. Cardiac strong inward rectifier potassium channels. J Mol Cell Cardiol
48:45-54, 2010.
2. Berne R, Sperelakis N, Geiger SR. Handbook of physiology. Section 2: the cardiovascular system;
volume I: the heart. American Physiological Society, Bethesda/Maryland, 1979.
3. Cain SM, Snutch TP. Voltage-gated calcium channels and disease. Biofactors 37:197-205, 2011.

53
4. Kapa S, Venkatachalam KL, Asirvatham SJ. The autonomic nervous system in cardiac
electrophysiology: an elegant interaction and emerging concepts. Cardiol Rev 18:275-84, 2010.
6. Li GR, Dong MQ. Pharmacology of cardiac potassium channels. Adv Pharmacol 59:93-134, 2010.
7. Lipkind GM, Fozzard HA. Voltage-gated Na channel selectivity: the role of the conserved domain III
lysine residue. J Gen Physiol 131:523-9, 2008.
8. Marcus GM, Scheinman MM, Keung E. The year in clinical cardiac electrophysiology. J Am Coll
Cardiol. 58:1645-55, 2011.
9. Morin TJ, Kobertz WR. Tethering chemistry and K+ channels. J Biol Chem 283:25105-9, 2008.
10. Nagy N, Mrton Z, Kiss L, Varr A, Nnsi PP, Tth A. Role of Ca2+-sensitive K+ currents in
controlling ventricular repolarization: possible implications for future antiarrhytmic drug therapy.
Curr Med Chem 18:3622-39, 2011.
11. Niwa N, Nerbonne JM. Molecular determinants of cardiac transient outward potassium current (I(to))
expression and regulation. J Mol Cell Cardiol 48:12-25, 2010.
12. O'Leary ME, Hancox JC. Role of voltage-gated sodium, potassium and calcium channels in the
development of cocaine-associated cardiac arrhythmias. Br J Clin Pharmacol 69:427-42, 2010.
13. Rapposelli S. Novel adenosine 5'-triphosphate-sensitive potassium channel ligands: a patent
overview (2005-2010). Expert Opin Ther Pat 21:355-79, 2011.
14. Ravens U, Wettwer E. Ultra-rapid delayed rectifier channels: molecular basis and therapeutic
implications. Cardiovasc Res 89:776-85, 2011.
15. Sakmann B, Neher E. Single-channel recording. Plenum Press, New York/London, 1983.
16. Szentandrssy N, Nagy D, Ruzsnavszky F, Harmati G, Bnysz T, Magyar J, Szentmiklsi AJ,
Nnsi PP. Powerful technique to test selectivity of agents acting on cardiac ion channels: the action
potential voltage-clamp. Curr Med Chem 18:3737-56, 2011.
17. Verkerk AO, Tan HL. Sex-deparities in cardiac electrophysiology: L-type Ca2+ current and the Na+Ca2+ exchanger go hand in hand. J Physiol 589: 247-8, 2011.
18. Zipes, DP, Jalife J. Cardiac electrophysiology: From cell to bedside, 5th edition. Philadelphia, W.B.
Saunders, 2009.
54
3

(excitable
cell) 3 1
(ectopic pacemaker)
(
4)

(resting membrane
potential) (action potential) 2 ( 3-1)
1. (non-pacemaker potential)

2. (pacemaker potential)

1.
( )
4 (phases) ( 3-2)

55
(phase 0)
(peak) (upstroke potential or rapid
depolarization)
3-1

(From www.fisica.unav.es)
3-2 (ARP = absolute refractory period,

ERP = effective refractory period, RRP = relative refractory period)

56
(phase 1)

(overshoot potential)
(phase 2)
(plateau)
(threshold) -60

(phase 3)
(repolarization)
(phase 4)
3-3

(ERP = effective refractory period, RRP =
relative refractory period)

( 3-3)
(absolute refractory period)
(relative refractory period)
(overshoot

57
)
(tetanus)

(effective refractory period)
2. (ionic basis of resting

membrane potential)
-90
-80

Eion
= -
Eion =
[C] i ,[C] o =
61.5 log [C] i/[C] o 37 o.

(i) (o)

EK
= - 90 -100 ( )
ENa =
+40 +60 ( )
ECa =
+129
ECl = - 83

58

(1) 5
(
)

(2) 5

(prepotential)

(1)

(5 mM)

59
(
) ()

(hyperkalemia)
(2)

PNa:PK 0.01 ( 2)
PK

PNa
(3) (ionic pump) -80

-90 -90 -100

+40 +60
PNa +130

- (Na+-K+ ATPase)

(Ca2+ pump) (Na+-Ca2+ exchange)
(K+-Ca2+ exchange)

60

- -

5-10

3. (ionic basis of action potential)

(G =
0)

(depolarization) (threshold)
(action
potential) ( 3-4)
3.1
-80 -90
-60 -70
+25

(upstroke) (overshoot)

(ENa
61
= +40 +60 )

(gNa) (PNa gNa)
( 3-8)

-80

-60 (
2) -60
-80
-60
-60

3-4 (depolarizing current) (repolarizing current)

(From www.ccbm.jhu.edu)

62

(hyperkalemia)

(
2)
(dVm/dt,
maximum rate of rise) 100 200
500 1000

(fast INa channel) (fast
inward Na+ current) (fast component
of action potential)

-60

3.2

63

+40

3.3

(-60 ) (plateau)

3.3.1

-40

-40 ( -50 )

-25 (inactivation threshold)

3.3.2

(Na+-Ca2+ exchange) Na+:Ca2+
3:1

64

3.3.3

(isolated tissue)

(IK(Na) channal)

-

(Ca-triggering Ca release)
(excitation-contraction coupling)

(reentry phenomenon)

65

(slow component of action
potential)

3.4
-60

-

Na+:K+
3:2

(-60 )

66

(tetanus)

(tachycardia)
4.
4.1

(~ 5 mV) -

()

/

-

67

4.2

-

-

(hypernatremia)

(hyponatremia)

-

68

(Na+
Ca2+ )

(hypercalcemia) (threshold potential)
(hypocalcemia)

( 6)
4.3

4.4 (agonists)

(TEA)
( 2)

4.5
(ischemia)

69

(infarction)
-

1.
( 3-5) 4

( phase 4 depolarization, diastolic depolarization, diastotic prepotential, diastolic
potential, pacemaker potential, and prepotential)

(prepotential)
(maximum prepotential)
-70

(nodal cells)
(ectopic pacemaker)
(ectopic focus)

70
3-5 ()

2. (ionic basis of nodal potential)

..
2528 (PK)
PNa/PK

()

2.1

71

( )

70
IK:If
6:1

(membrane
resistance)
( V = IR) Cs+

(Ito)

(inward background currents)

- (leak
current)
(excitation)

72
2.2

-40

-60

-70
(
)

3-6

( )

73

3:1

2.3

-

3. (ionic basis of ectopic

pacemaker)

(diastolic depolarization) ( 3-6)

(inactivation)

(
)

74

(concentration gradient )
(latent pacemaker) (normal automaticity)

(abnormal automaticity) ( 5)
4. (overdrive suppression and

stimulation)
(overdrive)

(overdrive suppression)

-
Na+:K+ = 3:2

(overdrive stimulation)

Na+:Ca2+ = 3:1

5.
()

( 3-5 )
75
(1)

(2)

(3)

(4)

7.

(1) (intrinsic automaticity)

100 (intrinsic heart rate)
(2)

( 3-7)

76

3-7 ( ) ( )
()
(3)
3-8

77
( 3-6)

-

-

(4)

(5)

(6)

78
(antagonists)

( 3-8)
(7)
( ) (
)

3-8 ( )
( )
6.

70
100

79

(ectopic pacemaker)

(cardiac electrical conduction)

1.

(compact zone or nodal center) (periphery or
nodal border zone)

(axon)
(propagation of electrical signal or impulse)
2.

80
( V = IR)

(Ri)
(Rm)

( )

( ) ( Na+,
K+, Cl-)

3-9 () (1)
(2)

81

( 3-9)

(eddy current)

dVm
dqm/Cm
dVm =
(Im)
dqm =
( Imdt)
Cm
=
(membrane capacitance)

(electrotonic conduction)

37% (length constant) (Rm/Ri)1/2

40-50
(3-5 /) 8-12
(0.3-1.0 /)

82
( Im = Cm dVm/dt)

(low-resistance
junction or gap junction)

( intercalated disc)

(
) ( )
(fast component)
(slow component)
(bidirectional or
unidirectional blocks)

(1)
(2)
(3)
(4)
(5)
(6) ( )

83
3. (depolarization wave)

(crista terminalis)

(atrial
depolarization)

(bundle of His) (bundle
branches) 3 ( 3-10)
(interventricular septum)

(septal depolarization)

(anteroseptal
depolarization)

(A-V junction)

(major ventricular depolarization)
(posterobasal) (late
ventricular depolarization)

(
3-10)
( 1)

84
3-10
(

)

(atrial
depolarization)

(ventricular septal depolarization)

(major ventricular
depolarization)

(posterobasal or late ventricular
depolarization)
4.

3-5
. (refractory period) 165
7-11 .
110

(hypoxia)

85

(
)

5.

3
(AN or atrionodal region) (nodal region)
(NH region)

0.02

( -53 )
( 58 )

86

()
(A-V block)

6.

(1)

()

(adrenal medulla)

(2)
(
)

()


87

(hypercalcemia)

( 5)

Mg2+, Ni2+, Co2+, Cd2+, Mn2+, La3+ H+

(3)

(4)

( 5)
5. (repolarization wave)

(
) ( 3-11)

88

(
)

(QRS complex)
(T wave) (electrocardiogram)
( 4)

3-11
(
)
(atrial
depolarization)

(ventricular repolarization)
1. Aaronson PI, Ward JPT. The cardiovascular system at a glance, 3rd edition. Massachusetts: Blackwell,
2007.
3. Berne RM, Sperelakis N, Geiger SR. Handbook of physiology. Section 2: the cardiovascular system;
5. Efimov IR, Fedorov VV, Joung B, Lin SF. Mapping cardiac pacemaker circuits: methodological
puzzles of the sinoatrial node optical mapping. Circ Res106:255-71, 2010.

89
6. Fozzard, H.A., E. Haber, R.B. Jennings, and A.M. Katz. The heart and cardiovascular system, 2nd
edition. New York, Raven Press, volume 1-2, 1991.
7. Greger R, Windhorst U. Comprehensive human physiology: From cellular mechanisms to
integration. Springer, Berlin, 1996, volume 2.
2011.
9. Hatem SN, Coulombe A, Balse E. Specificities of atrial electrophysiology: Clues to a better
understanding of cardiac function and the mechanisms of arrhythmias. J Mol Cell Cardiol 48:90-5,
2010.
10. Kapa S, Venkatachalam KL, Asirvatham SJ. The autonomic nervous system in cardiac
electrophysiology: an elegant interaction and emerging concepts. Cardiol Rev18:275-84, 2010.
12. Li GR, Dong MQ. Pharmacology of cardiac potassium channels. Adv Pharmacol 59:93-134, 2010.
13. Marcus GM, Scheinman MM, Keung E. The year in clinical cardiac electrophysiology. J Am Coll
Cardiol58:1645-55, 2011.
14. Mohrman DE, Heller LJ. Cardiovascular physiology, 7th edition. New York, McGraw-Hill, 2010.
15. Morin TJ, Kobertz WR. Tethering chemistry and K+ channels. J Biol Chem 283:25105-9, 2008.
16. Niwa N, Nerbonne JM. Molecular determinants of cardiac transient outwardpotassium current (I(to))
expression and regulation. J Mol Cell Cardiol 48:12-25, 2010.
17. O'Leary ME, Hancox JC. Role of voltage-gated sodium, potassium and calcium channels in the
development of cocaine-associated cardiac arrhythmias. Br J Clin Pharmacol 69:427-42, 2010.
19. Szentandrssy N, Nagy D, Ruzsnavszky F, Harmati G, Bnysz T, Magyar J, Szentmiklsi AJ,
Nnsi PP. Powerful technique to test selectivity of agents acting on cardiac ion channels: the action
potential voltage-clamp. Curr Med Chem. 18:3737-56, 2011.
20. Zaza A. Control of the cardiac action potential: The role of repolarization dynamics. J Mol Cell
Cardiol 48:106-11, 2010.
21. Zhang Y, Mazgalev TN. Arrhythmias and vagus nerve stimulation. Heart Fail Rev16:147-61,
2011.Barrett KE, Barman SM, Boitano S, Brooks H. Ganong's review of medical physiology, 23rd
edition. Boston, McGraw-Hill, 2010.
Saunders, 2009.

90
4

2
4
( 4-1)
(
)

(
)
Ep
KQ cosine / d2
Ep
K
Q
d
=
=
=
=
=

(conductivity constant)
x (dipole moment)

d

1.
2.
3.
4.
(voltmeter)

91
(bipolar recording)

(isoelectric potential) (isoelectric line)

4-1 (the body as volume conductor)

(
)
(isoelectric line)
(ground)

(unipolar recording)

92
(indifferent electrode)
(reference electrode)
(ground)

(scalar)

1.
(V = IR)
2.

3.

4.

5.

(local current)

(volume conductor)

(electrocardiogram, ECG or EKG From the German
Elektrokardiogramm) (extracellular recording)

93

(electrogram)

(cardiac cycle)
(scalar ECG or ECG)

(vector ECG or vectocardiogram)

(polarcardiogram)

(dipole)

( 4-2)

94

4-2 ( )
()

(
)
(isoelectric line) ( 4-3)

95

(biphasic response)

4-3 ( ) (1)
(2) (3)
(4) (5)
()
( )
()

96

1.

1 5

97
25 1 0.04
10
1

(oscilloscope)

2. (bipolar limb leads)

(bipolar limb lead or standard lead)
(frontal plane) .. 2446
(Willem Einthoven) 3
( 4-4) (RA) (LA) (LL)
(RL)

(ground) 3 ( 4-5)
(1) I (lead I)
(2) II (lead II)
(3) III (lead III)
(Kirchhoff rule)
II = I + III I - II + III = 0

(scalar)
(vector)
(Einthoven triangle) ( 4-4)
( )
98
4-4 ( )
(earth or ground) I, II III

I

1-2
( )
2 ( )

( junctional potential)
(cardiac electrical axis)

(frontral plane)

99
3. (unipolar leads)
(Frank Norman Wilson, 18901952) .. 2475
(exploring electrode)
( 5 )
(RA) (LA) (LL) (indifferent or
reference electrode or Wilson's central terminal)
(RA) (LA) (LL)
(Kirchhoff's law requires that IRA + ILA +ILL = 0)

(RL)

5
(augmented and non-augmented
unipolar limb leads) (unipolar chest leads)
(unipolar esophageal leads) (unipolar intracardiac leads)
3.1 (unipolar limb or extremitry leads)

() 3
(1) VR
(2) VL
(3) VF

100
4-8 (A)
(B) (CT = central terminal or reference electrode of each lead, R =
right arm, L = left arm, F = left leg) (From www.bem.fi/book)

50%
(unipolar augmented limb leads or Goldberger's leads) ( 4-5)
(unipolar non-augmented limb leads)

3
(1) aVR ()
()
(2) aVL ()
()
(3)
aVF ()
()

101

3/2

3.2 (unipolar chest or precordial leads)

(horizontal plane)

(V)
(ventricle) I, II, III, IV V IV

( 4-6, 4-10)
(1) V1 4 5 (4th intercostal space)
(sternum)
(2) V2 4 5
(3) V3 4 5
V2 V4
(4) V4 5 6 (5th intercostal space)
(left midclavicular line)
(5) V5 5 6
(anterior axillary line) V4 V6
(6) V6 5 6
(midaxillary line)
(7) V7 5 6
(posterior axillary line)
102
(8) V8 5 6
(posterior scapular line)
(9) V9 5 6
(spine)
(10) V3R-9R V3 V9
V2R V1 V1R V2
(11) 3V1-9 V1-9
3V1 3V9 V1 V9
V1
3 (3rd intercostal space)
2V1-9
2 (2nd intercostal space)
4-6 (A)
(B)
(C)

103
(12) 3V3R-9R V3R-9R V1
3 3V1-9
(13) VE (ensiform cartilage)
6 V1 V6
3.3 (monitor leads)

V1 ( 4-11)

V1 "modified CL1"

4-7 "modified CL1" V1 (+)

(-) (G)
3.4 (unipolar esophageal leads)
(sagittal plane)
(catheter)
E

104
E50 50 .
( 4-8)
4-8
(A = atrium, V = ventricle) (From www.cardiocommand.com)
(1) E15-25
(2) E25-35

(atrioventricular groove)
(3) E45-50

(fluoroscopy)

(atrial fibrillation)
3.5 (unipolar intracardiac leads)

105

(arrhythmia)

4.
12
I, II, III, aVR, aVL, aVF V1-6 5
(RA) (LA) (RL) (LL) (C)
I, II, III, aVR, aVL, aVF V1-6 ( 4-12) V1-6
(C)
V1, V2, V3, V4, V5 V6

(heart rate
variability)
106
4-8 (From www.ispub.com)

(wave)

I, II, III, VR, VL, VF,
aVR, aVL aVF

(1) II = I + III
(2) I = VL - VR LA - RA = I
(3) II = VF - VR LL - RA = II
(4) III = VF - VL LL - LA = III
3/2

(5) I = 2/3 (aVL - aVR)
(6) II = 2/3 (aVF - aVR)
(7) III = 2/3 (aVF - aVL)
VR + VL + VF = 0 RA + LA + LL = 0
(8) aVR + aVL + aVF = 0
(9) VR = -(I + II)/3
(10) VL = (I - III)/3
(11) VF = (II + III)/3
(12) aVR = -(I + II)/2
(13) aVL = (I - III)/2
(14) aVF = (II + III)/2
(strength)

58%
87%

(15) aVR = -(I + II)(0.87)/2
(16) aVL = (I - III)(0.87)/2

107
(17)
(18)
(19)
(20)
aVF
I
II
III
= (II + III)(0.87)/2
= 2/3 (aVL - aVR)(100/87)
= 2/3 (aVF - aVR)(100/87)
= 2/3 (aVF - aVL)(100/87)
1.

2.

3. 1 1 .

4. (ground)
5.

6.
(RA + LA + LL = 0)

7.

(ST segment depression)
(hyperventilation)
108
8.

(lead axes)

(dipole)

( )
1. (frontal plane)
I, II
III
( 4-10)

I 0 -180 aVF
+90 -90 (+270 )
4-14

(isopotential)

(upward deflection)

(downward deflection)

() ()

109
4-10

( )
2. (horizontal plane)

( 4-6C)

(
)

3. (sagittal plane)

110

1.
(scalar
electrocardiogram)
(
)

4-17 ( ) 5 .
5 .
1.
1.1 (P wave)
(atrial depolarization or activation)
1.2 (Ta Pt wave)
(atrial repolarization)
(second-degree A-V
block) (atrial flutter)
(atrial fibrillation)
1.3 (QRS complex)
(ventricular depolarization) (
4-18)
1.3.1 (Q wave) II,
aVF V6 (septal depolarization)
1.3.2 (R wave)
II, aVF V6 (major
ventricular depolarization) R wave r wave
1.3.3 (S wave) II, aVF, V6
(late ventricular depolarization of posterobasal
portion of left ventricle, pulmonary conus, and uppermost portion of interventricular septum)
S wave s wave
111
4-11
(isoelectric line)

1.3.4 (T wave)
(ventricular repolarization)
1.3.5 (U wave)

2.
2.1 (RR interval)
60 (60/RR interval)

()
60
2.2 (PP interval)

2.3 (Pwave interval or duration)
( )

112
2.4 (PR interval)

(PQ
interval)
0.12-0.20
0.035 130

0.125-0.19
2.5 (QRS interval or duration)
0.1
V2 V3 0.11
2.6 (ventricular activation time or VAT)

0.03 V1 V2 0.05
V5 V6
2.7 (QT interval)

(electrical systole)

(QTc interval)
( 4-1) 60
0.42 0.43
2.8 (QU interval)

2.9 (ST interval) (ST segment)
113
4-1
Logarithmic formulae for correction of QT interval (Log-linear)
Bazetts formula: QT / (RR)0.5
[Observed QT interval divided by root of RR interval, in seconds]
Fridericias formula: QT / (RR)0.33
[Observed QT interval divided by cube root of RR interval, in seconds]
Baseline correction: QT / (RR)0.37
[Observed QT interval divided by RR interval, in seconds raised to the power of 0.37]
Linear formulae for correction of QT interval
Framingham formula: QT + 0.154 (1 RR)
Hodges formula: QT + 1.75 (HR 60)
3. (segments and junctions)

3.1 (PR segment)
(isoelectric
potential)
3.2 (J or RS-T junction)
3.3 (ST or RS-T segment)
-0.5
+2.0 (ST segment elevation)
+2.0 (ST segment depression) -0.5
( )
(vectocardiogram)
1.

114
x, y, z
(loop)
( 4-12) (spatial vectocardiogram)

( 4-20) 3 (P loop)
(QRS loop) (T loop)

4-12

(Frank system)
7 H, F, I, E, C, A M 4-13
4-12
( )
(frontal plane) () (loop) ()
()

115
(1) H
(2) F
(3) I, E, C, A M (4th intercostal
space)
I (right anterior axillary line) E
A (left anterior axillary line) ( 4-22) C 45
A E M

( 4-22)

( 423)
4-13 (Frank
system) ( x, y, z) (Px,y,z
x, y, z )

116
(1)
(right-to-left movement)
(2) (superior-inferior movement)
(3) (anteroposterior movement)

360
()
2.
3
2.1 (P loop)
(P vector)
(inferior) (anterior)
I, II, III, aVF V4-6 (upright deflection)
aVR aVL (downward deflection) V1-2
( 4-14)
4-14 (frontal plane)

(horizontal plane)
117
2.2 (QRS loop)
(QRS vector)
( 4-15)
(initial septal vector) (major ventricular vector)
(late ventricular vector)

(horizontal plane)
(1)

I, II, III, aVL, aVF V4-6 aVR V1-2
(2)

I, II, III, aVF V4-6 aVR, aVL V1-2
(3)

I, II, III, aVF V4-6 (R wave) aVR
V1 aVL
3. (T loop) ( 4-16)

0-40

118
I, II, III, aVF V4-6
aVR, aVL V1-2

(horizontal plane)
4-17
() ()

(
)

119
3.

( 4-17 )

( )
4.

120

(
)

(Im)
=
dqm/dt qm
Im
Cm dVm/dt
qm
Vm
Cm
=
=
=

(membrane capacitance)
CmVm
Im
(capacitor)
( )

( 4-18) (aVm/dt
)

(dVm/dt)

121

4-18

(1)
(2)
(3)
(terminal
repolarization)
(4)

(5)

122

(35 ) (55 ) (40-50 )
(80-100 )

(cellular electrophysiology)

(injury current) ( 5)
(hypothermia)

()
(Quinidine)

123

1.
2. ()
3.
4.
5.
6.
7.
8.

(cardiac electrical axis)

1.

(rotation)
(deviation)
1.1 (frontal plane axis) (vertical axis)
(horizontal axis) (intermediate axis) (semivertical axis)
(semihorizontal axis)
1.2 (horizontal plane axis) (cockwise
rotation) (countercockwise rotation)

124
2.

I, II III
2.1
(1) I, II III
() ()
+1.5 . I
(2)
= -0.2 . = -0.3 . I
(3)
I +1.5 - 0.2 - 0.3 =
+1.0 .
(4) II III
(1) (3) II = +2.5 . III = 0.5 .
(5) ( 4-19) () I
1.0 . ( ) II
II 1.5 . III III
0.5 . 2
()

I
aVF 90 I (0 )
aVF (+90 ) ( 420) I aVF (1) (3)

13 %
aVF 87 % -30
+110 +110
(right axis deviation) -30
125
(superior or left axis deviation)
( 4-3)
2.2

( )
()

V5 V6

(left ventricular complex) V2
V2
( 4-21)
4-19

126
4-20 Lead I Lead aVF

1.

95 - 98% 2 5%

(normal variants) (
)

(hyperventilatation)

4-4

127
4-21

(counterclockwise rotation)
(clockwise rotation)

4-4
1. Abnormally tall P wave (P wave height is affected by heart rate, sympathetic tone, and position of the
heart relative to the diaphragm)
2. Notched P waves of normal duration.
3. Abnormal Q waves (affected by body build, position of the heart relation to the diaphragm, chest cage
abnormalities such as kyphoscoliosis, and pulmonary conditions such as pneumothorax).
4. Tall right precordial R waves (prominent anterior forces).
5. Prominent precordial voltage (affected by ventricular muscle mass, distance of recording electrodes
From cardiac muscle, and bodybuild).
6. Intraventricular conduction delay, notched QRS complexes, and bundle branch block patterns.
7. AV nodal conduction delay and block (affected by vagal tone).
8. Early repolarization.
9. Isolated T wave inversions.
128
2. (ST segment elevation)

3. (ST segment elevation with inversed T

wave)

4. (hyperventilation)

(sinus
tachycardia)
II, III, aVF (V4-6)
( )

5. (food intake)

6. (deep respiration)

(vertical axis)

129
(horizontal axis) (

( 6)

(respiratory-cardiac arrhythmia)

( 4-22)

( 6)

4-22
130

1. (atrial and ventricular hypertrophy)
2. (myocardial ischemia and infarction)

3. (arrhythmia)

4. (pericarditis)
5. (systemic diseases)
6. (digitalis) (quinidine)
7.

1.

2.

3.

4.
(1) (dipole hypothesis)
(2)
(3) I, II III
(4) (human torso)
(5)

100%

131
5.
6.

7.

1.

2.
II V1
3.

4.
5.

(QRS T angle)
6.

7.
(1)
(2)
(3)
(4)
(5)

132
1. Aaronson PI, Ward JPT. The cardiovascular system at a glance, 3rd edition. Massachusetts:
Blackwell, 2007.
5. Fuster V, Walsh RA, Harrington RA. Hurst's the heart, 13th edition. New York: McGraw-Hill, 2011.
6. Goldschlager N, Goldman MJ. Principles of clinical electrocardiography, 13th edition. Connecticus:
Appleton & Lange, 1989.
2011.
8. Josephson ME. Clinical cardiac electrophysiology: techniques and interpretations, 4th edition.
Philadelphia, Lippincott Williams & Wilkins, 2008.
10. Macfarlane PW, Lawrie TDV. Comprehensive electrocardiology. New York, Pergamon Press, 1989,
volume 1-3.
12. Phibbs BP. Advanced ECG: boards and beyond, 2nd edition. Philadelphia: W.D. Saunders, 2006.
13. Goldberger AL. Clinical electrocardiography: a simplified approach, 7th edition. Missouri, Elsevier
Mosby, 2006.
14. Wagner GS. Marriott's practical electrocardiography, 11th edition. Philadelphia, Lippincott Williams
& Wilkins, 2008.
16. Rimmerman CM, Jain AK. Interactive electrocardiography, 2nd edition. Philadelphia, Lippincott
Williams & Wilkins, 2008.
17. Thaler MS. The only EKG book you'll ever need, 6th edition. Philadelphia, Lippincott Williams &
Wilkins, 2010.
Saunders, 2009.

133
(arrhythmias)

(cardiac cycle)

1. (abnormal impulse generation)

(automatic rhythm) (triggered rhythm)
1.1

(latent pacemaker)
(injury
current)
(normal automaticity)
134
5-1
I. Abnormal impulse generation
A. Automatic rhythm
II. Abnormal impulse conduction

A. Conduction block
S-A node and latent pacemakers

1. Normal automaticity
Usually activated by hypokalemia,
hyperpolarization, autonomic nerve
activity, injury current, and hormones
2. Abnormal automaticity
Abnormally activated by severe
hypopolarization (above 60 mV) and
related factors
A-V node and conducting fibers

1. A-V blocks
First, second, completed degree A-V
blocks
Usually caused by parasympathetic nerve
overactivity and related drugs
2. Bundle branch blocks
Commonly caused by ischemia and
hyperkalemia
B. Triggerd rhythm (latent or ectopic
B. Unidirectional conduction block and

reentry
pacemakers)
1. Early afterdepolarization
Usually induced by prolonged action
potential duration
Phase 3 activation of same cells
2. Delayed afterdepolarization
Usually induced by hypercalcemia,
partial depolarization, increased action
potential amplitude, and prolong action
potential duration
Phase 4 activation of same cells
1. Circus movement
Unidirectional block of some Purkinje
fibers within a groups
Circular reactivation of an affected
group
2. Reflection
Delayed electrical conduction of some
conducting areas
Reactivation of the early depolarized
cells by the post affected cell action
potential
III. Abnormal impulse generation and
conduction
135

(
)

( )
(conduction block)
(
)
(
)

( -60 )

(abnormal automaticity)

1.2

(trigger)
(afterdepolarization)
(triggered rhythm) ( 5-1)
(1) (early afterdepolarization)

136

( )
5-1 (trigger rhythm)

() ()
(2) (delayed afterdepolarization)

(Cainduced cyclic-Ca release)

137

(calcium-activated channel) /

(premature beat)

/
(-80 -70 )
2. (abnormal impulse conduction)

/ (
)

(bidirectional block)
(unidirectional block)

(reentry phenomenon) 2
(1) (circus movement)
( 5-2)
(bundle)

138
( )

5-2 ()
(circus movement)

( )

(2) (reflection)

(delayed conduction)

139
( 5-3)

5-3 (electrical reflection)

()
( )

2.3 (abnormal impulse generation and

conduction)

140

(ventricular escape) 30-40
(idioventricular tachycardia)

(overdrive suppression) ( 3)
(atrial flutter)

(ectopic focus)
(sinus arrhythmia)

(sinus rhythm) 60-100
100
(sinus tachycardia)
60
(sinus bradycardia)
( 5-4)

(injury current)

141

(sinus arrest) (cardiac arrest)

(artificial pacemaker)
5-4 ()
() ()
(premature beat)

142

(compensatory pause)
(extrasystole)

(parasystole)
1
5-5 () ()

( 5-5)
(premature atrial contraction)

(premature ventricular contraction)

143

(ectopic tachycardia)

(ectopic atrial tachycardia or atrial tachycardia)
(ectopic ventricular tachycardia or ventricular tachycardia)

(paroxysmal atrial tachycardia)
(paroxysmal ventricular tachycardia)

( 5-6)


144
(junctional nodal
tachycardia)

(supraventricular tachycardia)

5-6 (atrial tachycardia)

(notch) ( 5-7)
150 250

145
(flutter and fibrillation)

250

(atrial flutter)
( 5-8)

(flutter wave)

5-7 (ventricular tachycardia)
5-8 (atrial flutter)

146
5-9 (atrial fibrillation)

(atrial fibrillation) ( 5-9)

( 5 )

(ventricular flutter)

250 (ventricular fibrillation)

( 5-10)

147

5
5

(cardioversion)
(external pacemaker)
5-10 (ventricular flutter) ()

(ventricular fibrillation) ()

148
(pararrhythmias)

1. (parasystole or parasystolic rhythm)

(atrial bigeminy) (ventricular bigeminy)

( 5-11)
5-11 (pararrhythmias)
(atrial bigeminy) () (ventricular bigeminy) ()
2. (AV dissociation)

149

( 5-12)

5-12 (pararrhythmias)
(atrioventicular dissociation)

(atrioventricular or AV block)

( )
()
( 5-13)
0.21 (first-degree AV
block)
(2 : 1 AV block)
(second-degree AV block, constant
type)

(Wenckebach phenomenon or Mobitz
type I block)
(second-degree AV block, Wenckebach type)

(third-degree or complete AV block;
150
3:1 AV block) 3:1

5-13 (AV blocks)
151
(bundle-branch blocks)

( 5-14)

1. (left posterior fascicle)

2. (left anterior fascicle)

5-15
3. (right bundle branch)
4. (left septal fiber)
(left bundle branch) (anterior and posterior fascicles)

(intraventricular
conduction defects)
(right bundle-branch block)
(wide splitting of second-heart sound)
(paradoxic splitting of second-heart sound)
(left bundle-branch block)

152

5-15 (right bundlebranch block)

II, aVF V4-6 (right bundle

branch block)
( 5-15)

153

(horizontal axis)

I, aVL V4-6

III V2-3

I, II V4-6
aVR V1-2

0.12
5-16 (left bundlebranch block)

(left bundle-branch block)

I, aVL V5-6 ( 5-16)
(myocardial infarction)

154

I, aVL
V5-6 V1-4
0-30
III aVF
0.12

I V5-6
V1-3 III, aVL aVF
5-17
block)
(left anterior fascicular

(septal block)
(left posterior or anterior fascicular blocks) ( 5-17, 5-18)

(> 0.12 )
(complete bundle branch block)

155
(incomplete bundle branch block)

5-18 (left posterior fascicular

block)
(cardiac hypertrophy or hypertrophic heart)

(ischemia)
(infarction)
(acute or chronic myocardial infarction)

(preload) (afterload) (contractility)

156

1. (atrial hypertrophy)
0.11
2.5 (Ta wave) (PR segment
depression)

1.1 (left atrial hypertrophy)

(mitral stenosis) (left ventricular hypertrophy)
(systemic hypertension)

I II V1 (biphasic wave)
(downward component) I
V1 (delayed depolarization)
( 5-19)
5-19 (Left atrial hypertrophy is diagnosed when P

waves are wider than 3 mm in older children and adults and wider than 2 mm in younger children; From
www.pedcard.raush.edu)
157
1.2 (right atrial hypertrophy)
(tricuspid stenosis) (pulmonary diseases)
(interatrial septal defect) (venous congestion)
2.5
II, III aVF ( 5-20)
5-20 (Right atrial hypertrophy is diagnosed when the

P waves (in any lead, although best seen in lead II) is > 3 mm tall in older children and adults and > 2 mm
in younger children. From www.pedcard.raush.edu)
2. (ventricular hypertrophy)

(left ventricular hypertrophy)
(pulmonary hypertension) (venous
congestion) (right ventricular hypertrophy)
(1) ( )

(2) 0.12

158
(3) /

(4)

(5)

(echocardiography)
5-21 (left ventricular hypertrophy)

V4-6 V1-2

2.1
(cardiomyopathy)
(physiologic hypertrophy)
0-30

159
aVL V4-6
( 5-21) (minimal criteria) aVL
11 V5-6 27 V1 V5-6
35
2.2
(chronic obstructive pulmonary disease) (pulmonary hypertension)

II, III, aVF V1-3 0.03
V5-6 ( 5-22) V1
V3R 0.03 (> +110 )
5-22 (right ventricular hypertrophy)

qR wave qS wave

(right axis deviation)
2.3

(> +90 )
( 5-23)

160
5-23

(From www.cardiophile.org)

(hypokalemia, K+] o < 3
)
(AV block)
( )
V4-6 ( 5-24)

(hyperkalemia, [K+]o > 5.5 )

II, aVF V4-6 9
(bizarre) (sine wave)

II, aVF V4-6

161
II, III, aVF V1-6
( 3)
( 5-24)

(ventricular tachycardia) (ventricular fibrillation)

5-24 ( )
(lead II; From www.unboundmedicine.com)
(hypercalcemia) 12 ./.

(J wave) (QT segment
) ( 5-25 )

162
5-25 (hypocalcemia) ()
(hypercalcemia)
()

(Top
From
www.medscape.com, bottom From www.lifeinthefastlane.com)
(hypocalcemia)

( 5-25 )

163
(myocardial ischemia)

()

(injury current)

(angina pectoris)

(endocardium)

(midcardium)

(epicardium) ( 5-26) (TP segment)

164
(
)

5-26

(
) (T )
()
(non-transmural ischemia) (transmural ischemia)

165

(transmural myocardial ischemia)
(ST segment alternans)

(acute vasospasm)

( 5-27)
II,
III, aVF V2-6

5-27

II V2-6
(myocardial infarction)
(necrosis)

(atherosclerosis) (thrombosis)

(acute myocardial infarction)

166

(electrically silent)

(1)

(2)
(3)
(4)
5-28

(From www.nottingham.ac.th)
(transmural myocardial infarction)
( 5-28)
( 0.04 ) ( 25% of R wave)

167

5-29 (From
www.rcsed.ac.uk)

(anterior wall) ( 5-29)
V2-6 (inferior wall) II aVF ( III) (lateral wall) I, aVL V6
(posterior wall) ( 5-30) V1-2 V2-4R V1-3

1 2-3
(giant T wave)

168
( )

(nontransmural myocardial
infarction)

5-30 (From
www.clinicalcorrelations.org)
(pericarditis)

(epicardial injury current) (concave)
(convex) ( 5-31)
( aVR V1)

169
(pericarditis with effusion)

(electrical alternans) ( 5-32)

(mechanical or pulsus alternans)
(systolic pressure)

5-31 (acute pericarditis) (From

www.heartpearls.com)
(myocarditis)
(inflammation)
( parvovirus B19, HIV, Polio virus)
( Trypanosoma cruzi)

170

5-32 (electrical alternans)

(From www.cardiacedu.com)
(hyperthyroidism)
(thyroid hormone)

1. Aaronson PI, Ward JPT. The cardiovascular system at a glance, 3rd edition. Massachusetts: Blackwell,
2007.

171
5. Fuster V, Walsh RA, Harrington RA. Hurst's the heart, 13th edition. New York: McGraw-Hill, 2011.
6. Goldschlager N, Goldman MJ. Principles of clinical electrocardiography, 13th edition. Connecticus:
Appleton & Lange, 1989.
2011.
8. Josephson ME. Clinical cardiac electrophysiology: techniques and interpretations, 4th edition.
Philadelphia, Lippincott Williams & Wilkins, 2008.
10. Macfarlane PW, Lawrie TDV. Comprehensive electrocardiology. New York, Pergamon Press, 1989,
volume 1-3.
12. Phibbs BP. Advanced ECG: boards and beyond, 2nd edition. Philadelphia: W.D. Saunders, 2006.
13. Goldberger AL. Clinical electrocardiography: a simplified approach, 7th edition. Missouri, Elsevier
Mosby, 2006.
14. Wagner GS. Marriott's practical electrocardiography, 11th edition. Philadelphia, Lippincott Williams
& Wilkins, 2008.
16. Rimmerman CM, Jain AK. Interactive electrocardiography, 2nd edition. Philadelphia, Lippincott
Williams & Wilkins, 2008.
17. Thaler MS. The only EKG book you'll ever need, 6th edition. Philadelphia, Lippincott Williams &
Wilkins, 2010.
Saunders, 2009.
172

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1

1-2 (fetal circulation)

1-3 (cardiac cytoskeleton)

1-6 (From www. alexandria.healthlibrary.ca)

1-7 (From www.colorado.edu)

- Neutrophils (Polymorpho nuclear leukocytes)

(2) (electrical energy E)

(3) (electrochemical energy )

7. (Goldman or constant field equation)

-(RT/ZF) ln (PK[K+] i + PNa[Na+ ] i + PCl[Cl-] o + ---)/(PK[K+] o

PK, PNa, PCl = (permeability coefficient) K+, Na+ Cl-

-(RT/ZF) ln [K+]i/[ K+]o

(Berne et al., 1979)

2-3 (patch clamp technique)

1. IK1 channel K1 channel

Resting membrane potential

Voltage below -60 mV

2-10 (B, N, L, T, P and Q)

2. (If (or Ih, former IK2)

3-2 (ARP = absolute refractory period,

2. (ionic basis of resting

61.5 log [C] i/[C] o 37 o.

(3) (ionic pump) -80

3. (ionic basis of action potential)

3-4 (depolarizing current) (repolarizing current)

2. (ionic basis of nodal potential)

3. (ionic basis of ectopic

4. (overdrive suppression and

(cardiac electrical conduction)

(ventricular septal depolarization)

Mg2+, Ni2+, Co2+, Cd2+, Mn2+, La3+ H+

4-1 (the body as volume conductor)

2. (bipolar limb leads)

(cardiac electrical axis)

3.2 (unipolar chest or precordial leads)

4-7 "modified CL1" V1 (+)

3. (segments and junctions)

(2) (superior-inferior movement)

(3) (anteroposterior movement)

4-14 (frontal plane)

4-15 (frontal plane)

4-16 (frontal plane)

(cardiac electrical axis)

4-20 Lead I Lead aVF

3. (ST segment elevation with inversed T

1. (abnormal impulse generation)

II. Abnormal impulse conduction

S-A node and latent pacemakers

A-V node and conducting fibers

B. Triggerd rhythm (latent or ectopic

B. Unidirectional conduction block and

5-1 (trigger rhythm)

2. (abnormal impulse conduction)

5-3 (electrical reflection)

2.3 (abnormal impulse generation and

5-6 (atrial tachycardia)

(flutter and fibrillation)

5-7 (ventricular tachycardia)

5-8 (atrial flutter)

5-9 (atrial fibrillation)

5-10 (ventricular flutter) ()

5-13 (AV blocks)

5-15 (right bundlebranch block)