Clinical electrocardiography . Fig. 22.—Electrocardiogram in Derivation II. Phasic variation with breathing. present, but a phasic variation in the amplitude of the R waveoccurs corresponding to the respiratory cycle. This also is a vaguseffect and is the paradox of Riegels pulse (pulsus paradoxus) ofadhesive pericarditis. PREMATURE CONTRACTIONS (EXTRASYSTOLES) Premature contractions or extrasystoles constitute one of themost common arhythmias of adult life. They often occur inperfectly normal hearts and in hearts with organic disease. Thearhythmia must not be considered indicative of heart di
Clinical electrocardiography . Fig. 22.—Electrocardiogram in Derivation II. Phasic variation with breathing. present, but a phasic variation in the amplitude of the R waveoccurs corresponding to the respiratory cycle. This also is a vaguseffect and is the paradox of Riegels pulse (pulsus paradoxus) ofadhesive pericarditis. PREMATURE CONTRACTIONS (EXTRASYSTOLES) Premature contractions or extrasystoles constitute one of themost common arhythmias of adult life. They often occur inperfectly normal hearts and in hearts with organic disease. Thearhythmia must not be considered indicative of heart disease,but simply the expression of increased cardiac irritability, whichmay result from functional or organic causes. CARDIAC ARHYTHMIAS 57 Etiology.—The frequency of premature contractions in per-sons with nervous instability and without demonstrable evidenceof organic heart disease definitely establishes a neurogenic overindulgence in tea, coffee, and tobacco in some personsincreases cardiac irritability suffi
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