The Electrocardiogram

Charles E. Wood, Ph.D.

Willem Einthoven receives Nobel Prize

The EKG is not only the oldest but, in fact, over 100 years after its introduction, continues as the most commonly used cardiovascular laboratory procedure.

Resting membrane potential

The Nernst Equation: EK= -61.5 log (Ki/Ko)

[K+]i=135 mEq/L

----

+ + + +

Cellular Action Potentials

Spread of the Action Potential

Instantaneous potentials developed on the surface of a cardiac muscle mass.

Figure 11-4.
Copyright 2000, WB Saunders Company, All Rights Reserved

Recording depolarization and repolarization waves

Zero voltage - Isoelectric point Resting stage - Polarized

Flow of current in the chest around partially depolarized ventricles.

Figure 11-5.
Copyright 2000, WB Saunders Company, All Rights Reserved

The Wave of Depolarization

ECG and Mechanics

Vector Algebraic Analysis

Vector Analysis, contd

Summary of Limb Leads

The Precordial (Chest) Leads

Vector Algebraic Analysis

Vector Analysis, contd

Current Flow Patterns

Sinoatrial Node

Atrioventricular Node

Time relationships between developed force and the changes in transmembrane potentials in a thin strip of ventricular muscle
Electrical event

Mechanical event

Time

ECG and Mechanics

Modulation of the Slow-Response (Nodal) Action Potentials

The Wave of Depolarization

Types of cardiac arrhythmias

Bradyarrhythmias Escape rhythms AV block Premature contractions Supraventricular tachyarrhythmias Ventricular tachyarrhythmias

Bradyarrhythmias

Sinus bradycardia Sinus pauses Escape rhythms

Junctional Idioventricular

Sinus rhythm

Sinus bradycardia (lead III).

Figure 13-2.
Copyright 2000, WB Saunders Company, All Rights Reserved

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Prolonged P-R interval caused by first degree heart block (lead II)

Figure 13-5.
Copyright 2000, WB Saunders Company, All Rights Reserved

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Mobitz type II AV block

Complete AV block

Sinus tachycardia (lead I)

Figure 13-1.
Copyright 2000, WB Saunders Company, All Rights Reserved

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Atrial tachycardia with 2:1 conduction

Ventricular preexcitation (WPW)

Tachycardia circuits in WolffParkinson-White syndrome