CVR02 - ECG

13 February 2011 12:30

ECG Leads
Lead a COMBINATION of TWO wires and their ELECTRODES to make a COMPLETE CIRCUIT BETWEEN the BODY and the ELECTROCARDIOGRAPH

ECG LEADS 3 BIPOLAR leads 6 CHEST leads

Lead I - Lead II - Lead III

V1 - V6

Lead 1 RIGHT arm (-ve terminal)

LEFT arm (+ve terminal)

when right arm connected to chest is ELECTRONEGATIVE with respect to point where left arm connects electrocardiograph records POSITIVELY

Lead 2 RIGHT arm (-ve terminal)

Left LEG (+ve terminal)

when right arm is NEGATIVE with respect to left leg electrocardiograph records POSITIVELY

Lead 3 Left LEG (-ve terminal)

Left ARM (+ve terminal)

when left arm is NEGATIVE with respect to left leg electrocardiograph records POSITIVELY

2 UPPER APICES points at which the two arms connect electrically with the fluids around the heart

EINTHOVEN'S triangle LOWER APEX point at which the left leg connects with the fluids

Einthovens law states that

if the electrical potentials of any two of the three bipolar limb electrocardiographic leads are known at any given instant, the third one can be determined mathematically by simply summing the first two

Lead I + 0.5 mV Lead 2 + 1.2 mV Lead 3 + 0.7 mV

Lead 1 + Lead 3 = Lead 2 (+0.5) + (+0.7) = 1.2 )

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Chest Leads
Electrocardiograms are often recorded with one electrode placed on the anterior surface of the chest directly over the heart at one of the points shown in the figure.

+ve terminal of EC-graph - the electrode

-ve terminal of EC-graph - called 'indifferent electrode' - connected through equal electrical resistances to the right arm, left arm, and left leg all at the same time Usually 6 standard chest leads recorded, one at a time, sequentially along 6 points.

Known as leads V1 - V6. The heart surfaces are close to the chest wall, each chest lead records mainly the electrical potential of the cardiac musculature immediately beneath the electrode . relatively minute abnormalities in the ventricles, particularly in the anterior ventricular wall, can cause marked changes in the electrocardiograms recorded from individual chest leads.

V1 and V2 - QRS complex mainly negative chest electrode in these leads is nearer to the base of the heart than to the apex base of the heart is the direction of electronegativity during most of the ventricular depolarization V4, V5 and V6 - QRS complex mainly positive chest electrode in these leads is nearer the heart apex apex is the direction of electropositivity during most of depolarization

Augmented Unipolar Limb Leads

- 2 of the limbs are connected through electrical resistances to the negative terminal of the electrocardiograph - 3rd limb is connected to the positive terminal - when +ve terminal is on: RIGHT arm LEFT arm standard limb recording of aVR lead is inverted aVR lead
aVL lead

LEFT leg

aVF lead

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Vectorial Analysis of ECG

A vector is an arrow that points in the direction of the electrical potential generated by the current flow, with the arrowhead in the positive direction. length of the arrow is drawn proportional to the voltage of the potential Considerably more current flows downward from the base of the ventricles toward the apex than in the upward direction

Long BLACK ARROW

Instantaneous mean vector

summated vector of the generated potential at this particular instant summated current is considerable potential is large vector is long

Mean QRS vector - average direction of vector during spread of depolarization wave through ventricles in NORMAL heart - +59 degrees - This means that during most of the depolarization wave, the apex of the heart remains positive with respect to the base of the heart

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