ELECTROCARDIO

GRAM
 ELECTROCARDIOGRAM
 The electrocardiogram (ECG) is a graphic
recording of the electrical potentials produced
by the cardiac tissue.
 Electrical impulse formation occurs within the
conduction system of the heart.
 Excitation of the muscle fibers throughout the
myocardium results in cardiac contraction.
 The ECG is recorded by applying electrodes to
various locations on the body surface and
connecting them to a recording apparatus.
 ELECTROCARDIOGRAM
 Clinical Value of the ECG
 Atrial and ventricular hypertrophy
 Myocardial ischemia and infarction

 Pericarditis

 Systemic diseases that affect the heart

 Determination of the effect of cardiac drugs

 Disturbances in electrolyte balance

 Evaluation of function of cardiac pacemakers

 ELECTROCARDIOGRAM
 Value of ECG in the following clinical
conditions
 Prediction of sudden cardiac death
 Prediction of ischemic pre-conditioning

 Prediction of adverse states in AMI, post-MI and

silent ischemia cases
 Progression/regression of LV mass
RECORDING AND MONITORING
AN ECG
 Lead Configurations
 Bipolar Leads
 Two electrodes placed at 2 different sites
 Register the difference in potential between these 2
leads
 Unipolar leads
 Measure the absolute electrical potential at one site
 Requires a reference site

 Reference site formed by the limb leads

 12 LEAD ECG
 Chest Leads
 Limb Leads

RA Red Right arm

LA Yellow Left arm
LL Green Left leg
RL Black Right leg
V1 Red 4th ICS
RPSB
V2 Yellow 4th ICS LPSB
V3 Green Midway between
V2 and V4
V4 Brown 5th ICS LMCL
V5 Black LAAL Lateral &
horizontal to V4
V6 Violet LMAL Lateral &
horizontal to V4
ELECTROPHYSIOLOGY OF THE
HEART
 Four Electrophysiologic Events Involved in
the Genesis of the ECG
 Impulse formation
 Transmission of the impulse

 Depolarization

 Repolarization
 LAYERS OF THE HEART WALL
 Epicardium
 Coronary arteries are
found in this layer
 Myocardium
 Responsible for
contraction of the heart
 Endocardium
 Lines the inside of the
myocardium
 Covers the heart valves
CONDUCTION SYSTEM OF THE
HEART

SA Node

Atrial Muscle
AV Node

Bundle of His
Bundle Branches
Purkinje Fibers
Ventricular Muscle
 TERMINOLOGY
 Waveform
 Movement away from the baseline in
either a positive or negative direction
 Segment
 A line between wave forms
 Interval
 A waveform and a segment
 Complex
 Consists of several waveforms
ECG PAPER
 ELECTROGRAM
 Upward deflection - +

 Downward deflection - +

- +
 Diphasic deflection
 THE NORMAL
ELECTROCARDIOGRAM
 P wave
 Generated by activation of the atria
 PR segment
 Represents the duration of atrioventricular (AV)
conduction
 QRS complex
 Produced by activation of both ventricles
 ST-T wave
 Reflects ventricular recovery
 STANDARD 12 LEAD ECG
 The P wave
 Atrial activation
 Height < 0.2 mV (2 mm)

 Duration < 0.12 sec

 STANDARD 12 LEAD ECG
 P-R Interval
 Intraatrial, internodal, His purkinje conduction
 Duration 0.12 to 0.20 or 0.22 sec
 STANDARD 12 LEAD ECG
 The QRS Complex
 Ventricular activation
 Duration of 100 msec
 STANDARD 12 LEAD ECG
 The ST-segment
 Phase 2 of transmembrane potential
 Isoelectric in normal subjects
 STANDARD 12 LEAD ECG
 The T wave
 Upright after the age of 16
 Juvenile T wave
 STANDARD 12 LEAD ECG
 The U wave
 Surface reflection of negative after potential
 Repolarization of Purkinje fibers

 Ventricular relaxation
 STANDARD 12 LEAD ECG
 The QT Interval
 From beginning of QRS to end of T wave
 Reflects the duration of depolarization and
repolarization
 Bezett: Q-Tc Interval = Q-T/ R-R
ANALYZING A RHYTHM STRIP

 Rate
 Rhythm
 Axis
 P wave
 PR Interval
 QRS Complex
 T wave
 Q-T Interval
ANALYZING A RHYTHM STRIP
 What is the rate?
 To determine the ventricular rate,measure the
distance between 2 consecutive R-waves (R-R
interval)
 To determine the atrial rate, measure the distance
between 2 consecutive P-waves (P-P interval)
 What Is The Rate?
 Ventricular Rate
 Small squares (R-R Interval) / 1500
 Big squares (R-R Interval) / 300
ANALYZING A RHYTHM STRIP
 Is the rhythm regular or irregular?
 To determine if the ventricular rhythm is regular or
irregular, measure the distance between 2
consecutive R-R intervals and compare that distance
with the other R-r intervals.
 For atrial rhythm, measure the distance between 2
consecutive P-P intervals.
 Generally, a variation of up to 0.12 seconds (3 small
boxes) is acceptable. The slower the heart rate, the
more acceptable the variation.