Interpreting Electrocardiograms Using Basic Principles and Vector Concepts is the latest addition to a series on fundamental and clinical cardiology, edited by Samuel Z. Goldhaber. The book reflects work done by Dr. Hurst during a lifetime of devotion to patient care, teaching, and writing about cardiovascular disease, including electrocardiographic interpretation. His interest in vector electrocardiography developed early in his career, during his relationship with Drs. Robert Grant and Harvey Estes in the department of cardiology at Emory University.
This book explains the concepts that were originally described and popularized by Grant and Estes in Spatial Vector Electrocardiography in 1951. The volume is divided into 8 parts. Hurst's Part I, “How People Learn,” describes what he believes to be the key components of the learning process.
Part II, “Historical Benchmarks and the Naming of the Waves,” is a tribute to the men who developed the basics of electrocardiographic tracings. Hurst has always emphasized the importance of the historical aspects of cardiology.
The 3rd part describes the basic principles of electrocardiography. It is divided into 8 chapters that contain information essential to electrocardiographic interpretation. The 2 introductory chapters of this part describe the use of vectors to represent cardiac electrical forces and the electrical activity of myocytes. The next 4 chapters deal with the body as a conductor for the electrical activity of the heart, the anatomy of the heart chambers and conduction system, the process of depolarization and repolarization, and the electrocardiographic leads (including the contributions of Einthoven, Bayley, Goldberger, and Wilson). Part III ends with a chapter on how to measure cardiac electrical forces.
Parts IV and V are brief discussions (a chapter each) about the use of the electrocardiogram as a diagnostic tool and the normal measurements of the different waves and intervals. Part V includes charts and figures of normal recordings. These figures display the correlation between QRS and T wave spatial vector directions in the frontal plane and their antero-posterior orientation.
Part VI, the largest in the book, describes the most common electrocardiographic abnormalities and shows the vector relationships and their correlations with tracings. These chapters include the following topics: ventricular hypertrophy, myocardial infarction, abnormalities of the conduction system, pericarditis, pulmonary embolism, chronic obstructive lung disease, digitalis effects, and electrolyte disturbances. At the end of the book, Hurst briefly mentions other electrocardiographic abnormalities, which include preexcitation, postexcitation, the Brugada syndrome, and the long QT syndrome.
A couple of drawbacks deserve mention. Some of the important figures are difficult to read and interpret because too much information is crammed into the space allowed. Additionally, the book costs $165, which puts it out of reach for many medical students and residents. Nevertheless, it is well written and informative and will be useful to students of medicine at all levels who wish to understand electrocardiography using vector concepts.