Electrocardiogram ma Electrophysiology of the heart Properties of cardiac muscle Automaticity - The heart begins its own electrical impulses

Excitability - respo nds to these impulses Conductivity - transmits impulses contractility - shrinks to depolarizing, refractoriness - after the depolarization remains absolutely re fractory, which produces some impulse response by disability in cardiac cells re spond to these stimuli. Step 1: Node SA fires Step 2: Impulse passes through the internodal bundles to reach the AV node Step 3: Start Delayed AV conduction atrial contraction Step 4: The impulse travels along the septum, the bundle of His Step 5: The momentum is distributed over the Purkinje fibers to ventricular musc le contraction atrial ends and begins the ventricular contraction The P wave represents the electrical impulse that causes contraction of the atri a. The complex (because it is composed of three waves: the Q, R and S) QRS repre sents the impulse of contraction of the ventricles and the T wave represents the electrical recovery of the ventricles when they return to home The ECG The ECG may be useful to determine: • the orientation of the anatomical heart, • the relative size of the various he art chambers; • a variety of rhythm and conduction • the extent, location and pr ogression of myocardial ischemic lesions; • The effects of changes in concentrat ions of electrolytes; • the influence of certain drugs (eg digitalis). The electrocardiogram is typically recorded in a special graph paper which is di vided into squares of 1 mm2. The ECG paper speed is usually 25 mm / sec., The lo west horizontal divisions (1mm) correspond to 0.04 Mon Vertically ECG graph meas ures the amplitude of a given wave or deflection (1mV = 10mm in the calibration standard) 12-lead ECG • • • recording the electrical activity in the heart from 12 different viewpoint s. Each branch provides a unique image of the electrical impulses transmitted fr om the heart to the body surface. 6 leads members or arising from the frontal pl ane of the electrodes placed on or adjacent to the four members: I, II, III, aVR , aVL and aVF. 6 leads to the chest, precordial or horizontal because they deriv e from six electrodes placed in specific areas on the precordium of the chest (h eart): V1, V2, V3, V4, V5 and V6. Each lead ECG has a specific spatial orientati on and polarities. Thus the ECG record based on the reception of electrical impu lses. This register is determined by the direction of the electrical potential g enerated by current flow • • • Concept of activation of the heart vector

A vector is a mathematical value expressed as an arrow that has a length, a dire ction and a direction. The vector length is proportional to the voltage potential. The direction vector is determined by the direction of the electrical potential generated by current flow (the arrow points towards the positive charges). • To have a three-dimensional view of the vector mean ventricular activation sho uld be considered projections of cardiac depolarization in the frontal plane and horizontal. • The frontal plane is represented by the limb leads and allows for the projection and determination of the forces that go up or down and to the ri ght or left. • The horizontal plane can be determined using the pre-cordial lead s and allows the determination of the forces that are directed laterally and ear lier / later Genesis of the Normal ECG During depolarization of a muscle cell, the external load changes positive to ne gative. An electrode placed next to a muscle cell depolarization recorded either as a positive deflection, either as a negative, depending on the location of th e electrode with respect to dipolar depolarization. A dipolar depolarization is a pair of moving charges with the positive charge to lead • Dipolar of depolarization that moves towards the electrode: there is a positiv e deflection on ECG + • Dipolar of depolarization that moves away from the electrode recording: there is a negative deflection on the ECG. + During the repolarization of the muscle cell, the negative charge around the out side to be positive. An electrode placed next to a muscle cell repolarization no tes, either as a positive deflection, either as a negative, depending on the loc ation of the electrode in relation to the dipole repolarization. A dipole repola rization is a pair of moving charges with a negative charge to lead the way (as opposed to dipolar depolarization. + P wave Represents the depolarization headset.€The normal atrial depolarization vector i s directed downwards and towards the left side of the person, reflecting the spr ead of depolarization from node to the atrial myocardium sinoauricular right and then to the left. QRS Represents the depolarization of muscle cells of the ventricles. This complex pr ocess can be divided into two sequential phases. The first phase is the depolari zation of the interventricular septum from left to right (a vector). The second phase results from the simultaneous depolarization of the main mass of the right and left ventricles, usually it is dominated by the left ventricle more massive , so that the vector 2 points left, and beyond. A derivation right pre-cordial note of that process biphasic depolarization with a small inflection followed by a greater deflection (S wave). Therefore a deriv ation left precordial V6 register as the same sequence with a small deflection f ollowed by an inflection relatively high (R wave). There is a gradual increase i

n R wave amplitude from V1 to V6 derivation. Between V3 and V4 is considered the transition zone since the R and S waves have equal amplitudes. The QRS axis may range from -30 º to +100 º. An axis more negative than -30 ° is designated as a n axis deviation to the left, while a more positive axis +100 ° is referred to a s axis deviation to the right. T wave Represents the end of repolarization of the ventricles and always follows the QRS complex. As the depolarization and repolarization processes are electrically opposing, th is agreement of the normal vectors of QRS and T wave indicates the repolarizatio n should proceed normally in the reverse direction of depolarization. The T wave is usually oriented in the same direction as the QRS complex. U wave The U wave is a small deflection or inflection depending on the orientation of t he T wave and that the next item. Its significance is unknown but may represent an additional repolarization of the ventricles. An abnormal increase in the ampl itude of the U wave is due most commonly to drugs. The U-wave inversion in preco rdial leads is abnormal and may be a subtle sign of ischaemia. Abnormal findings on ECG Arrhythmias AV blocks Left bundle branch block or right? Ventricular hypertrophy Myocardial infarction Electricity Amendment The QRS complex in myocardial Infarction of the anterior wall Posterior wall infarction and apical C-infarction apical small D-MI anterobasal E-posteroinferior infarction F-posteroseptal infarction G-posterolateral infarction ; H - Myocardial posterobasal END Prepared by: Fábio Gonçalves