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Con
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1 Ca
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B

a
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l
e.........................................
Co
ron
a
ryS
inu
s
...........................................
Th
eG
r
e
a
tV
e
s
s
e
l
s
.........................................
H

e
a
r
tW
a
l
l..............................................
C
i
r
cu
l
a
to
ryFun
c
t
iono
fth
eH
e
a
r
t..............................
Co
ron
a
ryA
r
t

e
r
i
e
s
.........................................
S
t
a
r
l
ing
’
sL
awo
fth
eH
e
a
r
t.................................
P
r
e
lo
adandA
f
t
e
r

lo
ad.....................................
C
a
rd
i
a
cOu
tpu
t
...........................................
B
loodP
r
e
s
su
r
e
...........................................
E
l
e
c
t
rophy
s
io
logy..........................................
Und

e
r
s
t
and
ingD
epo
l
a
r
i
z
a
t
ionandR
epo
l
a
r
i
z
a
t
ion...............
Ab
so
lu
t
eandR
e

l
a
t
i
v
eR
e
f
r
a
c
to
ryP
e
r
iod
s
......................
Th
eCondu
c
t
ionSy
s
t
emR
e
l
a
t

edtoth
eE
l
e
c
t
ro
c
a
rd
iog
r
am
.........
Summ
a
ryo
fK
e
yPo
in
t
s
......................................
Qu
i
z.....................................................

1
1

1
1
2
3
3
3
3
3
4
4
4
5
6
6
7
8
9
10
12
12
13
14

2 ECGIn
t
e
rp
r
e
ta

t
ion
........................................
B
a
ckg
round...............................................
ECGP
ap
e
r
................................................
B
a
s
i
cCh
e
ck
s..............................................
A
r
t
e
f
a
c
t..................................................
C
a

l
ib
r
a
t
ion................................................

17
17
18
19
19
19
x
i
i
i


x
i
v

Con
t
en
t
s

RW

a
v
eP
rog
r
e
s
s
ion
/L
e
adaVR................................
D
e
t
e
rm
in
eth
eRhy
thm
.......................................
S
inu
sA
r
rhy
thm
i
a

...........................................
R
a
t
eC
a
l
cu
l
a
t
ion
............................................
Au
tom
a
t
edR
a
t
eD
e
t
e
rm
in
a
t
ion
..............................

Th
e1
,500 M
e
thod........................................
Th
e300 M
e
thod
..........................................
Th
eS
equ
en
t
i
a
lM
e
thod....................................
Th
e30Squ
a
r
eM
e
thod
.....................................
Con
v

e
r
t
ingT
im
eB
e
tw
e
enS
e
cond
sand M
i
l
l
i
s
e
cond
s
.............
Th
eECG W
a
v
e
fo
rm
.........................................

PW
a
v
e
.................................................
T
aW
a
v
e................................................
PQ
/PRIn
t
e
rv
a
l
...........................................
QRSComp
l
e
x...........................................
QW
a
v
e
.................................................
RW
a
v

e
.................................................
QRSAx
i
s
...............................................
TW
a
v
e
.................................................
UW
a
v
e
.................................................
STS
e
gm
en
t.............................................
QTIn
t
e
rv
a
l
..............................................
TPIn
t

e
rv
a
l..............................................
RRIn
t
e
rv
a
l
..............................................
WhyDoth
eW
a
v
e
fo
rm
sLookD
i
f
f
e
r
en
tinD
i
f
f
e

r
en
tL
e
ad
s
?.........
No
rm
a
lS
inu
sRhy
thm.......................................
Summ
a
ryo
fK
e
yPo
in
t
s
......................................
Qu
i
z.....................................................

22
23

25
25
25
27
27
28
28
29
30
31
32
33
33
35
35
35
35
35
37
38
39
39
40
40
41
42

3 Ca
l
cu

la
t
ingE
l
e
c
t
r
i
ca
lAx
i
s
..................................
B
a
ckg
round...............................................
HowI
sTh
i
sU
s
e
fu
l
?........................................
No
rm
a

lAx
i
s
...............................................
Ax
i
sD
e
v
i
a
t
ion
.............................................
C
a
t
e
go
r
i
e
so
fAx
i
sD
e
v
i
a

t
ion
..................................
C
a
l
cu
l
a
t
ingth
eC
a
rd
i
a
cAx
i
s
..................................
E
in
tho
v
en
’
sL
aw
..........................................
B

ipo
l
a
randUn
ipo
l
a
rL
e
ad
s
...................................
M
e
thod1...............................................
M
e
thod2...............................................
M
e
thod3...............................................
Summ
a
ryo
fK
e
yPo
in
t
s

......................................
Qu
i
z.....................................................

45
45
45
45
46
47
48
48
49
53
55
57
59
59


Con
t
en
t
s

xv

4 Chamb

e
rAbno
rma
l
i
t
i
e
s
.................................... 61
B
a
ckg
round............................................... 61
A
t
r
i
a
lAbno
rm
a
l
i
ty
.......................................... 61
Abno
rm
a
l

i
tyo
rEn
l
a
r
g
em
en
t
?................................. 62
R
igh
tA
t
r
i
a
lAbno
rm
a
l
i
ty
..................................... 63
L
e
f
tA
t

r
i
a
lAbno
rm
a
l
i
ty
...................................... 64
B
i
l
a
t
e
r
a
lA
t
r
i
a
lAbno
rm
a
l
i
ty.................................. 65
L

e
f
tV
en
t
r
i
cu
l
a
rHyp
e
r
t
rophy
.................................. 65
A
th
l
e
t
e
’
sH
e
a
r
t
/Phy
s

io
log
i
c
a
lLVH........................... 65
In
t
r
in
s
i
co
idD
efl
e
c
t
ion
/V
en
t
r
i
cu
l
a
rA
c
t

i
v
a
t
ion
T
im
e(VAT
)............................................. 66
V
en
t
r
i
cu
l
a
rHyp
e
r
t
rophyEv
a
lu
a
t
ion M
e
thod
s

................... 67
L
e
f
tV
en
t
r
i
cu
l
a
rHyp
e
r
t
rophyEv
a
lu
a
t
ion...................... 68
R
igh
tV
en
t
r
i
cu

l
a
rHyp
e
r
t
rophy................................ 68
R
igh
tV
en
t
r
i
cu
l
a
rHyp
e
r
t
rophyEv
a
lu
a
t
ion..................... 69
B
i
v

en
t
r
i
cu
l
a
rHyp
e
r
t
rophy
.................................. 70
C
a
rd
iomyop
a
th
i
e
s.......................................... 70
D
i
l
a
t
edC
a
rd

iomyop
a
thy(DCM
)
............................. 70
Hyp
e
r
t
roph
i
cC
a
rd
iomyop
a
thy(HOCM
/HCM
)................. 71
T
ak
o
t
suboC
a
rd
iomyop
a
thy
................................. 72

A
r
rhy
thmog
en
i
cR
igh
tV
en
t
r
i
cu
l
a
rDy
sp
l
a
s
i
a
/
C
a
rd
iomyop
a
thy(ARVD

/C
)................................ 73
H
e
a
r
tF
a
i
lu
r
e.............................................. 74
C
a
rd
i
a
cR
e
syn
ch
ron
i
z
a
t
ionTh
e
r
ap

y(CRT
)
..................... 75
Summ
a
ryo
fK
e
yPo
in
t
s
...................................... 76
Qu
i
z..................................................... 78
5 Condu
c
t
ionB
lo
ck
sandCa
rd
ia
cP
a
c
ing
....................... 81

B
a
ckg
round............................................... 81
Bund
l
eB
r
an
chB
lo
ck
s
....................................... 81
R
igh
tBund
l
eB
r
an
chB
lo
ck
s
................................ 81
L
e
f
tBund

l
eB
r
an
chB
lo
ck
s................................. 83
R
a
t
eD
ep
end
en
t
/T
r
an
s
i
en
tBund
l
eB
r
an
chB
lo
ck

s
................ 84
F
e
a
tu
r
e
sandC
r
i
t
e
r
i
afo
rId
en
t
i
fy
ingL
e
f
t
andR
igh
tBund
l
eB

r
an
chB
lo
ck
s
............................. 85
W
i
l
l
i
am Mo
r
row
/W
i
l
l
i
am M
a
r
row
............................ 85
H
em
ib
lo
ck

s............................................. 85
T
r
i
f
a
s
c
i
cu
l
a
rB
lo
ck
........................................ 86
A
t
r
io
v
en
t
r
i
cu
l
a
rNod
a

lB
lo
ck
s
................................. 86
1
s
tD
e
g
r
e
eAVB
lo
ck...................................... 87
2ndD
e
g
r
e
eAVB
lo
ck..................................... 87
3
rdD
e
g
r
e
eAVB

lo
ck
...................................... 90
3
rdD
e
g
r
e
eAVB
lo
ckandA
t
r
i
a
lF
ib
r
i
l
l
a
t
ion
.................... 91


xv
i

Con
t
en
t
s

S
ino
a
t
r
i
a
lB
lo
ck
............................................
1
s
tD
e
g
r
e
eSAB
lo
ck......................................
2ndD
e

g
r
e
eSAB
lo
ck.....................................
3
rdD
e
g
r
e
eSAB
lo
ck
......................................
S
i
ckS
inu
sSynd
rom
e
......................................
C
a
rd
i
a
cP

a
c
ing
.............................................
Und
e
r
s
t
and
ingP
a
c
ingCod
e
s
................................
S
ing
l
eCh
amb
e
rP
a
c
em
ak
e
r

s................................
Du
a
lCh
amb
e
rP
a
c
em
ak
e
r
s.................................
B
i
v
en
t
r
i
cu
l
a
rP
a
c
em
ak
e

r
s
...................................
P
a
c
em
ak
e
r
sandth
eECG
...................................
P
a
c
em
ak
e
rP
rob
l
em
sV
i
s
ib
l
eonth
eECG......................

Summ
a
ryo
fK
e
yPo
in
t
s
......................................
Qu
i
z.....................................................

92
92
92
93
94
95
96
98
99
100
100
101
101
103

6 A

r
rh
y
thm
ia
s
..............................................
B
a
ckg
round...............................................
P
r
em
a
tu
r
eB
e
a
t
s
............................................
P
r
em
a
tu
r
eB

e
a
tO
r
ig
in
.....................................
Comp
en
s
a
to
ryandNon
comp
en
s
a
to
ryP
au
s
e
s..................
B
ig
em
in
yandT
r
ig

em
in
y
...................................
Sup
r
a
v
en
t
r
i
cu
l
a
rT
a
chy
c
a
rd
i
a
..................................
V
ag
a
lM
an
euv

e
r
s.........................................
A
t
r
i
a
lF
ib
r
i
l
l
a
t
ion
...........................................
A
t
r
i
a
lF
lu
t
t
e
r
...............................................

A
t
r
i
a
lT
a
chy
c
a
rd
i
a..........................................
Mu
l
t
i
fo
c
a
lA
t
r
i
a
lT
a
chy
c
a

rd
i
a...............................
S
inu
sT
a
chy
c
a
rd
i
a..........................................
S
inu
sA
r
rhy
thm
i
a
...........................................
Jun
c
t
ion
a
lT
a
chy

c
a
rd
i
a
.......................................
R
e
en
t
ry
.................................................
P
r
e
e
x
c
i
t
a
t
ion
..............................................
W
o
l
f
f
-P

a
rk
in
son
-Wh
i
t
eSynd
rom
e(WPW
)
.....................
O
r
thod
rom
i
candAn
t
id
rom
i
c
................................
W
o
l
f
f
-P

a
rk
in
son
-Wh
i
t
eSynd
rom
eandA
t
r
i
a
lF
ib
r
i
l
l
a
t
ion.........
Lown
-G
anong
-L
e
v
in

eSynd
rom
e(LGL
)
.......................
C
a
rd
io
v
e
r
s
ion
............................................
E
l
e
c
t
rophy
s
io
logyS
tud
i
e
s(EPS
)
.............................

Ab
l
a
t
ion................................................
V
en
t
r
i
cu
l
a
rT
a
chy
c
a
rd
i
a(VT
).................................
Fu
s
ionB
e
a
t
s
.............................................

C
ap
tu
r
eB
e
a
t
s
............................................
AVD
i
s
so
c
i
a
t
ion
..........................................
Rhy
thmR
e
gu
l
a
r
i
ty
........................................

Con
co
rd
an
c
e............................................
C
a
rd
i
a
cAx
i
s
.............................................

107
107
107
108
109
109
110
111
111
116
117
118
119
120

120
120
122
123
124
125
126
127
127
129
130
131
132
132
132
132
133


Con
t
en
t
s

xv
i
i

C

a
rd
i
a
cA
r
r
e
s
tRhy
thm
s
......................................
Pu
l
s
e
l
e
s
sVT
.............................................
V
en
t
r
i
cu
l
a

rF
lu
t
t
e
r........................................
V
en
t
r
i
cu
l
a
rF
ib
r
i
l
l
a
t
ion
.....................................
A
sy
s
to
l
e................................................

Pu
l
s
e
l
e
s
sE
l
e
c
t
r
i
c
a
lA
c
t
i
v
i
ty
.................................
Summ
a
ryo
fK
e
yPo

in
t
s
......................................
Qu
i
z.....................................................

135
136
136
136
137
137
138
138

7 A
cu
t
eCo
r
ona
rySynd
r
om
e
s
.................................
B

a
ckg
round...............................................
A
th
e
ro
s
c
l
e
ro
s
i
s
.............................................
Ang
in
a...................................................
S
t
ab
l
eAng
in
a
............................................
Un
s
t

ab
l
eAng
in
a
..........................................
P
r
in
zm
e
t
a
l
’
sAng
in
a
.......................................
D
ig
i
t
a
l
i
sE
f
f
e

c
t
...........................................
Myo
c
a
rd
i
a
lIn
f
a
r
c
t
ion.......................................
Doo
rtoN
e
ed
l
eo
rB
a
l
loonT
im
e.............................
STE
l

e
v
a
t
ion
.............................................
JW
a
v
e
s
.................................................
STEM
I.................................................
V
en
t
r
i
cu
l
a
rAn
eu
ry
sm.....................................
T
omb
s
ton

ing
.............................................
R
e
c
ip
ro
c
a
lCh
ang
e
s
.......................................
M
IR
e
g
ion
s
/T
e
r
r
i
to
r
i
e
s

.....................................
Po
s
t
e
r
io
randR
igh
tV
en
t
r
i
cu
l
a
rM
I...........................
LBBBandCh
e
s
tP
a
in.....................................
NSTEM
I
................................................
C
a

rd
i
a
cB
iom
a
rk
e
r
s
.......................................
T
r
e
a
tm
en
tfo
r Myo
c
a
rd
i
a
lIn
f
a
r
c
t

ion
..........................
Summ
a
ryo
fK
e
yPo
in
t
s
......................................
Qu
i
z.....................................................

141
141
144
145
146
146
146
148
149
150
151
152
153
155

155
156
156
158
161
161
161
162
165
167

8 G
en
e
t
i
cCa
rd
ia
cCond
i
t
ion
s
................................. 171
B
a
ckg
round............................................... 171
B

rug
ad
aSynd
rom
e
.......................................... 173
T
r
e
a
tm
en
t
............................................... 175
L
e
v
’
sD
i
s
e
a
s
e
.............................................. 176
Du
ch
enn
e Mu

s
cu
l
a
rDy
s
t
rophy
................................ 176
LongQTSynd
rom
e
s........................................ 177
Rom
ano
-W
a
rdSynd
rom
e
................................... 178
J
e
rv
e
l
landL
ang
e
-N

i
e
l
s
enSynd
rom
e......................... 178
A
r
rhy
thmog
en
i
cR
igh
tV
en
t
r
i
cu
l
a
rDy
sp
l
a
s
i
a

/
C
a
rd
iomyop
a
thy(ARVD
/C
).................................. 179
Summ
a
ryo
fK
e
yPo
in
t
s
...................................... 179
Qu
i
z..................................................... 179


xv
i
i
i

Con

t
en
t
s

9 Th
eP
ed
ia
t
r
i
cECG
.........................................
B
a
ckg
round...............................................
S
t
ag
e
so
f Myo
c
a
rd
i
a
lD

e
v
e
lopm
en
t
.............................
P
a
t
en
tF
o
r
am
enOv
a
l
e.......................................
P
a
t
en
tDu
c
tu
sA
r
t
e

r
io
su
s(PDA
)...............................
T
e
t
r
a
logyo
fF
a
l
lo
t..........................................
A
t
r
i
a
lS
ep
t
a
lD
e
f
e
c

t(ASD
)...................................
V
en
t
r
i
cu
l
a
rS
ep
t
a
lD
e
f
e
c
t(VSD
)
...............................
Co
a
r
c
t
a
t
iono

fAo
r
t
a........................................
Eb
s
t
e
in
’
sAnom
a
ly
..........................................
T
r
an
spo
s
i
t
iono
fth
eG
r
e
a
tA
r
t

e
r
i
e
s.............................
D
e
x
t
ro
c
a
rd
i
a
...............................................
I
so
l
a
t
edD
e
x
t
ro
c
a
rd
i

a
/D
e
x
t
ro
c
a
rd
i
ao
fEmb
ryon
i
cA
r
r
e
s
t
..........
D
e
x
t
ro
c
a
rd
i

aS
i
tu
sIn
v
e
r
su
s
.................................
T
e
chn
i
c
a
lD
e
x
t
ro
c
a
rd
i
a....................................
Cong
en
i
t

a
lA
c
c
e
s
so
ryP
a
thw
ay
s...............................
No
rm
a
lCh
i
ldECGV
a
lu
e
s
....................................
Ax
i
s...................................................
In
t
e
rv

a
l
s
/STS
e
gm
en
t
......................................
Summ
a
ryo
fK
e
yPo
in
t
s
......................................
Qu
i
z.....................................................

181
181
181
185
185
186
188

189
189
190
190
191
192
192
192
193
193
194
196
197
197

Ind
ex
........
................................................ 199


Chap
t
e
r1

Ca
rd
ia
cAna

tomyandE
l
e
c
t
r
oph
y
s
io
logy

K
eyw
o
rd
s An
a
tomy• Phy
s
io
logy• E
l
e
c
t
rophy
s
io
logy• A

c
t
ion po
t
en
t
i
a
l•
D
epo
l
a
r
i
z
a
t
ion• R
epo
l
a
r
i
z
a
t
ion• C
a
rd

i
a
cou
tpu
t• B
loodp
r
e
s
su
r
e• C
i
r
cu
l
a
to
ry
sy
s
t
em

Ba
ckg
r
ound
Th
ehum

anh
e
a
r
ti
sano
r
g
anth
a
th
a
sbo
th m
e
ch
an
i
c
a
lande
l
e
c
t
r
i
c
a
lcompon

en
t
s
.
Bo
thknow
l
edg
eo
fb
a
s
i
cc
a
rd
i
a
can
a
tomyandphy
s
io
logy
,a
sw
e
l
la
se

l
e
c
t
rophy
s
i
o
logyi
sn
e
c
e
s
s
a
rytofu
l
lyund
e
r
s
t
andth
eb
a
s
i
c
so

fth
ee
l
e
c
t
ro
c
a
rd
iog
r
am(ECG
)
.
Und
e
r
s
t
and
ingandaw
a
r
en
e
s
so
fth
e

s
ee
l
em
en
t
sinth
eno
rm
a
lh
e
a
r
ti
se
s
s
en
t
i
a
l
b
e
fo
r
eb
u
i

ld
ingamo
r
ecomp
l
e
t
ep
i
c
tu
r
eo
fth
ep
a
tho
log
i
c
a
lh
e
a
r
t
.
W
ew
i

l
ls
t
a
r
tw
i
thano
v
e
rv
i
ewo
fth
eb
a
s
i
can
a
tomyandphy
s
io
logyo
fth
eh
e
a
r
t

b
e
fo
r
elook
ing mo
r
esp
e
c
ific
a
l
lya
tth
ee
l
e
c
t
rophy
s
io
log
i
c
a
lcompon
en
t

so
fth
e
h
e
a
r
t
’
sfun
c
t
ion
.F
in
a
l
lyw
ew
i
l
llooka
thowth
em
e
ch
an
i
c
a

lande
l
e
c
t
r
i
c
a
lsy
s
t
em
s
o
fth
eh
e
a
r
tin
t
e
r
a
c
tw
i
the
a

cho
th
e
rinah
e
a
l
thyind
i
v
idu
a
l
.

Ana
tomyo
fth
eH
ea
r
t
F
igu
r
e
1
.1d
i
sp

l
ay
s
th
em
a
inan
a
tom
i
c
a
lf
e
a
tu
r
e
so
f
th
ehum
anh
e
a
r
t
.Ab
r
i

e
fd
e
s
c
r
ip
t
iono
fsom
eo
fth
ep
r
im
a
ryan
a
tom
i
c
a
lf
e
a
tu
r
e
sfo
l

lo
w
s
.

Chamb
e
r
s
Th
eh
e
a
r
tcon
s
i
s
t
so
ffou
rch
amb
e
r
s
,tw
osm
a
l

lch
amb
e
r
slo
c
a
t
edsup
e
r
io
r
ly
,c
a
l
l
ed
th
el
e
f
tandr
igh
ta
t
r
iumandtw
ol

a
r
g
e
rch
amb
e
r
slo
c
a
t
edin
f
e
r
io
r
lyc
a
l
l
edth
el
e
f
t
andr
igh
tv

en
t
r
i
c
l
e
.Th
el
e
f
tv
en
t
r
i
c
l
ei
sl
a
r
g
e
rth
anth
er
igh
ta
si

th
a
stopumpb
lood
toth
em
a
jo
r
i
tyo
fth
ebody
,wh
e
r
e
a
sth
er
igh
tv
en
t
r
i
c
l
epump
sb

loodin
toth
elung
s
.
Th
ea
t
r
i
aandv
en
t
r
i
c
l
e
sa
r
es
ep
a
r
a
t
edf
romon
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th

e
rby
th
e
in
t
e
r
a
t
r
i
a
ls
ep
tumand
th
ein
t
e
rv
en
t
r
i
cu
l
a
rs
ep

tumr
e
sp
e
c
t
i
v
e
ly
.
©Sp
r
ing
e
r
-V
e
r
l
agLondon2015
A
.D
a
v
i
e
s
,A
.S

co
t
t
,S
ta
r
t
ingtoR
eadECG
s
:AComp
r
eh
en
s
i
v
eGu
id
e
,DO
I10
.1007
/978
-1
-4471
-4965
-1_1
toTh
eo

r
yandP
r
a
c
t
i
c
e

1


2

1 C
a
rd
i
a
cAn
a
tom
yandE
l
e
c
t
roph
y

s
i
o
l
o
gy
B
rach
iocepha
l
ica
r
te
ry

Le
f
tcommonca
ro
t
ida
r
te
ry
Le
f
tsubc
la
v
iana

r
te
ry
Ao
r
ta
Pu
lmona
rya
r
te
ry

Pu
lmona
ryve
ins

Pu
lmona
ryve
ins

Supe
r
io
r
venaca
va
Fossao

va
l
is

Le
f
ta
t
r
ium

R
igh
ta
t
r
ium

M
i
t
ra
lva
lve
Cho
rdae
T
end
ineae

Co
rona
ry
s
inus

Ao
r
t
icva
lve

T
r
icusp
id
va
lve

Pap
i
l
la
ry
musc
le

In
fe
r

io
r
venaca
va

Le
f
tven
t
r
ic
le
Pu
lmona
ryva
lve
Myoca
rd
ium

R
igh
tven
t
r
ic
le
T
rabecu
laeca

rneae

In
t
ra
ven
t
r
icu
la
rsep
tum

F
ig
.1
.1 B
a
s
i
can
a
tomyo
fth
eh
e
a
r
t

V
a
l
v
e
s
Th
eh
e
a
r
ta
l
soh
a
sfou
rv
a
lv
e
s
.Th
et
r
i
cu
sp
idand m
i
t

r
a
lv
a
lv
e
s
,knowna
sth
ea
t
r
io
v
en
t
r
i
cu
l
a
rv
a
lv
e
sa
sth
e
ys
i

tb
e
tw
e
enth
ea
t
r
i
aandv
en
t
r
i
c
l
e
sa
l
low
inga
c
c
e
s
sfo
r
b
loodtop
a

s
sf
romth
ea
t
r
i
atoth
ev
en
t
r
i
c
l
e
s
.Th
eo
th
e
rtw
ov
a
lv
e
sa
r
eth
eao

r
t
i
cand
pu
lmon
a
ryv
a
lv
e
s
,anda
r
er
e
f
e
r
r
ed
toa
s
th
es
em
i
lun
a
rv

a
lv
e
swh
i
ch
l
e
ad
to
th
eao
r
t
a
andth
epu
lmon
a
rya
r
t
e
ry
.Th
ep
r
in
c
ip

l
epu
rpo
s
eo
fth
ev
a
lv
e
si
stop
r
e
v
en
tr
e
gu
r
g
i
t
a
t
iono
fb
loodf
romth
ev

en
t
r
i
c
l
e
sb
a
ckin
toth
ea
t
r
i
a
.Th
ev
a
lv
e
sop
en wh
enth
e
p
r
e
s
su

r
einth
ech
amb
e
rfi
l
l
edw
i
thb
loode
x
c
e
ed
sth
ep
r
e
s
su
r
einth
ea
r
e
ap
a
s

tth
e
v
a
lv
e
.F
o
re
x
amp
l
e wh
enth
ep
r
e
s
su
r
einth
er
igh
ta
t
r
iume
x
c
e

ed
sth
ep
r
e
s
su
r
ein
th
er
igh
tv
en
t
r
i
c
l
e
,th
ev
a
lv
eop
en
sandth
eb
loodp
a

s
s
e
sf
roma
t
r
iumtov
en
t
r
i
c
l
e
.
Th
ev
a
lv
e
sh
a
v
efl
ap
sth
a
ta
r

esom
e
t
im
e
sr
e
f
e
r
r
edtoa
sl
e
afl
e
t
so
rcu
sp
s
.Th
e
t
r
i
cu
sp
idv
a

lv
eh
a
sth
r
e
esu
chfl
ap
so
rcu
sp
s
.Th
em
i
t
r
a
lv
a
lv
ei
sa
l
sor
e
f
e
r

r
edtoa
s
th
eb
i
cu
sp
idv
a
lv
eandh
a
stw
ocu
sp
s
.


An
a
tom
yo
fth
eH
e
a
r
t

3

Cho
rda
eT
end
in
ea
e
Th
echo
rd
a
et
end
in
e
a
ea
r
efib
rou
st
endonl
ik
eco
rd
sth
a

tconn
e
c
ttoth
et
r
i
cu
sp
id
v
a
lv
einth
er
igh
tv
en
t
r
i
c
l
eandth
em
i
t
r
a
lv

a
lv
einth
el
e
f
tv
en
t
r
i
c
l
e
. Wh
enth
ev
a
lv
e
s
c
lo
s
eth
echo
rd
a
et
end

in
e
a
ep
r
e
v
en
tth
ecu
sp
sf
romsw
ing
ingupw
a
rd
sin
toth
ea
t
r
i
a
l
c
a
v
i
ty

.

F
o
s
saO
va
l
i
s
Th
efo
s
s
ao
v
a
l
i
si
sth
er
em
a
in
so
f wh
a
tw
a

son
c
eaho
l
e(
fo
r
am
en
)th
a
te
x
i
s
t
ed
b
e
tw
e
enth
el
e
f
ta
t
r
iumandth
er

igh
ta
t
r
ium
,lo
c
a
t
edinth
ea
t
r
i
a
ls
ep
tum
.Th
i
sho
l
e
a
l
low
sb
loodtobyp
a
s

sth
elung
sinad
e
v
e
lop
ingf
e
tu
swh
enf
e
t
a
loxyg
ensupp
lyi
s
p
ro
v
id
edv
i
ath
ep
l
a
c

en
t
a
,a
sth
ef
e
t
a
llung
sa
r
eund
e
v
e
lop
ed
.

T
rab
e
cu
la
eCa
rn
ea
e
Th

et
r
ab
e
cu
l
a
ec
a
rn
e
a
ea
r
e mu
s
cu
l
a
rco
lumn
so
fi
r
r
e
gu
l
a
rsh

ap
eth
a
te
x
i
s
tinbo
th
v
en
t
r
i
c
l
e
s
.Inth
el
e
f
tv
en
t
r
i
c
l
eth

e
ya
r
esmoo
thandfin
ewh
encomp
a
r
edtotho
s
ein
th
er
igh
tv
en
t
r
i
c
l
e
.I
ti
sb
e
l
i
e

v
edth
a
tth
efun
c
t
iono
fth
et
r
ab
e
cu
l
a
ec
a
rn
e
a
ei
sto
p
r
e
v
en
tsu
c

t
ionth
a
tcou
ldimp
a
i
rth
epump
inga
c
t
iono
fth
ev
en
t
r
i
c
l
e
sth
a
tcou
ld
o
th
e
rw

i
s
eo
c
cu
r
i
f
th
ev
en
t
r
i
c
l
e
sw
e
r
esmoo
th
. Wh
en
th
e
t
r
ab
e

cu
l
a
ec
a
rn
e
a
econ
t
r
a
c
t
th
e
yin
tu
rnpu
l
lonth
echo
rd
a
et
end
in
e
a
e

.

P
ap
i
l
la
r
y Mu
s
c
l
e
A
typ
eo
f
t
r
ab
e
cu
l
a
ec
a
rn
e
a
e

th
a
ta
r
econn
e
c
t
ed
tov
en
t
r
i
cu
l
a
rsu
r
f
a
c
ea
ton
eendand
a
tth
eo
th
e

rtoth
echo
rd
a
et
end
in
e
a
e
.

Co
rona
r
yS
inu
s
Th
eco
ron
a
rys
inu
sa
l
low
sth
ec
a

rd
i
a
cv
e
in
sc
a
r
ry
ingd
eoxyg
en
a
t
edb
loodtod
r
a
in
in
toth
er
igh
ta
t
r
ium
.

4

1 C
a
rd
i
a
cAn
a
tom
yandE
l
e
c
t
roph
y
s
i
o
l
o
gy

Th
eG
r
ea
tV

e
s
s
e
l
s
In
co
rpo
r
a
t
eth
ev
en
ac
a
v
a
,pu
lmon
a
rya
r
t
e
ry
/v
e
in

sandth
eao
r
t
a
.Inth
er
e
s
to
fth
e
bodyoxyg
en
a
t
edb
loodi
sfoundina
r
t
e
r
i
e
sandd
eoxyg
en
a
t

edb
loodinth
ev
e
in
s
.
Th
i
sg
en
e
r
a
lru
l
edo
e
sno
tapp
lytoth
eh
e
a
r
t
, wh
i
chsom
e

t
im
e
sc
au
s
e
scon
fu
s
ion
.
Th
epu
lmon
a
rya
r
t
e
ryc
a
r
r
i
e
sd
eoxyg
en
a

t
edb
loodin
toth
elung
sandth
epu
lmon
a
ry
v
e
in
sc
a
r
ryth
er
e
su
l
t
ingoxyg
en
a
t
edb
loodin
toth
el

e
f
ta
t
r
ium
.Th
eao
r
t
at
r
i
fu
r
c
a
t
e
s
in
toth
r
e
eo
th
e
rb
r
an

ch
e
s
;b
r
a
ch
io
c
eph
a
l
i
c
,l
e
f
tcommonc
a
ro
t
idandl
e
f
tsub
c
l
a
v
i

an
a
r
t
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ig
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5

F
ig
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r
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linCh
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.


6

1 C
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fe
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va

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ig
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ch
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cd
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ag

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ig
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