MAKERERE UNIVERSITY

COLLEGE OF HEALTH SCIENCES (MakCHS)

DEPARTMENT OF PHYSIOLOGY
A REPORT ON THE PRACTICAL CARRIED OUT BY GROUP 9 ON
5TH FEBRUARY 2020 IN THE PHYSIOLOGY LABORATORY 3.
NAME REG NO. COURSE
1 SSEMAKALU GABRIEL 19/U/0791 BMAM
2 KISAKYE SAMUEL 19/U/0402 BDS
3 LUSAGALA ABUBAKER 19/U/19757/PS BPHA
4 NAMIRO AMELIA MARGARET 19/U/0334 BMAM
5 AUMA ESTHER LAURYNA 19/U/18884/PS BMAM
6 LUSIBA MARK COLLINS 19/U/12105/PS
7 NALUBEGA LAILA 19/U/12936/PS
8 BYAMUKAMA IBRAHIM 19/U/29158 BOPT
9 MGENI CHRISTIAN E. 19/X/20842/PS
10 NABUNYA BRENDAH 19/U/19878/PS
11 GULOBA ALI 19/U/19588/PS
12 NAMBALIRWA NOELINE 19/U/0862 BOPT
13 AGABA RONALD 19/U/9060/PS
14 UDULU AMINA 19/U/0344
15 KASONGOVU DANIEL 19/U/0802
16 MBONJO MBAHO ADOLPHE S. 19/X/29602/PS BDS
17 ABBAGI RACHEAL 19/U/9854/PS BOPT
18 EGADU SAMUEL 19/U/30094/PS BPHA
19 NAKATO LATIFAH 19/U/13342/PS BSB
20 SERUFUSA PHILLIP ZACK 19/U/21818 BSB
21 ISORET REBECCA 18/U/27133
22 JUAN MOUREEN 18/U/889
23
24
TITLE: ELECTROCARDIOGRAPHY (ECG)
ABSTRACT:
The experiment was carried out on a volunteer male subject where limb and chest leads were
connected to his body in specific areas, and an electrocardiograph was obtained from the ECG
machine by the volunteer ECG operator. It was found out that the volunteer’s heart was normal
with a normal heart rhythm at a rate of 66 beats/minute, which was calculated using R – R
interval on the electrocardiograph of standard lead II.

INTRODUCTION:
An Electrocardiograph is an instrument used for recording the potential of the electrical
current that traverse the heart.
Electrocardiography is the process of recording an electrocardiogram.
An Electrocardiogram is a graphic record of algebraic summed potentials generated by the
cardiac muscle cells, recorded from the surface of the body using electrocardiograph machine.
The magnitude, polarity and configuration of the recorded electrocardiogram depends on the
location of the recording leads placed on the body surface.
Electrocardiogram (ECG, EKG) is a graphic representation of the electrical activity associated
with heart beat. In fact, this electrical activity initiates the heartbeat. ECG does not represent
the mechanical events of the heart (systole and diastole).

The heart is a mass of muscle tissue, and like other muscle tissues of the body, its activity is
associated with action potentials, APs. Thus, it acts as a small generator located in the body.
During activity, the wave of depolarization spreads through the heart during each cardiac
cycle. Since the body is a good volume conductor, this electrical activity spreads from the heart
to the body surface from where, after suitable amplification, it can be graphically recorded as
the electrocardiogram. Thus, the Electrocardiogram recorded at the body surface represents
the algebraic summation of activity of individual cardiac muscle cells.

AIM: To determine the electrical activity of the heart using Electrocardiography.

OBJECTIVES:
- To carryout electrocardiography correctly and successfully.
- To interpret the electrocardiogram recorded.
- To relate the interpretation with the heart status.
- To assess the functional integrity of the heart.
- To suggest the appropriate remedy if any that improve the status detected.
 METHODOLOGY:
EQUIPMENT USED
I. The ECG Machine.
The electrocardiograph works on the household current AC – 230V, or on battery, and has a
very sensitive galvanometer, G. The potentials picked up from the surface of the body are
suitably amplified before flowing through the galvanometer. It has the following controls:
a. Mains switch: The on/off switch controls the power supply. A filter cuts off unwanted
50Hz interference.
b. Calibration: Sensitivity is 1mV/10mm, so that a calibration signal of 1mV causes a pen
deflection of 10mm.
c. Centering: The baseline control knob is used for bringing the pen to the centre of the
paper.
d. Lead, Pb selector switch: It permits selection of various unipolar or bipolar electrodes.

II. Electrodes.
The electrodes for the limbs are flat metal plates which are kept in position by rubber straps.
The chest electrode is a metal cup which is kept in position by “suction” produced by a rubber
bulb. Electrode jelly is rubbed on the skin at the electrode positions to reduce skin resistance.
Cable lead wires connect the subject to the machine.
An esophageal electrode, which can be swallowed and made to lie behind the heart, is
employed for special purposes. An electrode at the tip of a cardiac catheter can record events
from within the heart, a record called His Bundle Electro gram (HBE).
III. ECG paper.
The standard graph paper is divided into 1 mm squares by thin lines every 5 th line being thick,
both horizontally and vertically. Each horizontal division of 1 mm represents 0.04 second, so
that the time duration between two thick lines is 0.2 seconds. Each small vertical division
represents 0.1 mV, so that 10 mm represent 1mV. This facilitates quick calculations of the
duration and amplitudes of various waves, and intervals of the ECG record. The paper
transport system pulls the paper from a roll (or folded stack) and moves it under the pen at the
standard speed of 25 mms-1.
IV. Pen Recording System.
This system is either an ink writing pen, or an electrically-heated stylus that inscribes on a
chemically treated paper. The Electrocardiogram record may also be displayed on a Cathode
Ray Oscilloscope (CRO).
V. Electrocardiographic Leads.
The term lead is used for the specific points of electrical contacts, as well as the actual record
obtained from any two points. Two types of leads can be employed;
 Direct leads: They are applied directly to the exposed heart, like during heart surgery, or
when carrying out an experiment.
 Indirect leads: These are applied away from the heart ie; on the skin surface. They are
limb leads, chest leads and esophageal lead. These leads are used in routine ECG
procedures.
ELECTRODE POSITIONS.
The ECG leads (electrodes) are of two types namely bipolar and unipolar.
In bipolar leads, the potential difference, p.d is recorded between two active electrodes. In
unipolar leads, one electrode is kept at zero potential while the other is the exploring
electrode.
1. BIPOLAR LEADS.
The two shoulders and the left thigh where it joins the torso form the Einthoven triangle.
Since the potentials at these points are the same as at the wrists and left ankle, the limb
electrodes can be attached at these location, as they are more convenient to use. The right
leg is used as a ground electrode. The bipolar leads may be bipolar limb leads or bipolar
chest leads.
a. Bipolar limb leads (Standard leads/classical limb leads)
These were the earliest leads to be used after Wilhelm Einthoven. These leads
measure the potential using two active electrodes placed on any two limbs and
represent the algebraic sum of the potentials of two constituent active (electrodes)
leads.
There are three bipolar limb leads namely;
- Lead I: It records the potential at the left arm, LA minus potential at the right arm,
RA.
¿¿

- Lead II: It is the potential at the left leg, LL minus potential at the right arm, RA.
¿¿

- Lead III: This records the potential at the left leg, LL minus potential at the left
arm, LA.
¿¿
 b. Bipolar chest leads.
One electrode is placed on different locations of the chest while other electrode is
placed on right arm, left arm and left leg. These are not normally used.
2. UNIPOLAR LEADS
These leads record the potential from a single region of the body (limbs or chest). One
electrode, the indifferent electrode, is kept at zero potential by connecting the three limb leads
to a common
central terminal in the machine where the currents from the limbs neutralize each other. The
other electrode can be on a limb or on the chest. Thus, there are three such limb leads and a
number of chest leads.
a) Unipolar limb leads.
Any of the limb electrodes can be used to record cardiac potentials in comparison to the
indifferent electrode kept at zero potential. Thus, there are three limb leads, each denoted by
the letter V (vector)—VR, VL, VF (left foot).
Augmented limb leads: Since the recorded voltages are small, disconnecting one lead from the
common terminal increases the potential by 50%. Hence the augmented limb leads are aVR
between RA and (LA+LL), aVL between LA and (RA+LL), and aVF between LL and (RA+LA).
The disconnection of a lead is automatically done in the ECG machine.
b) Unipolar chest leads (unipolar precordial leads).
These leads record the potentials from the anterior surface of the heart, from the right side to
the left side of the chest, in relation to the indifferent electrode (RA + LA + LL). The
standardized sites for the unipolar chest leads are as follows:
- V1 is in the 4th intercostal space, just to the right of the sternum.
- V2 is in the 4th intercostal space, just to the left of the sternum.
- V3 is halfway between V2 and V4.
- V4 is at the midclavicular line in the 5th intercostal space.
- V5 is in the anterior axillary line at the same level as V4.
- V6 is in the mid-axillary line in the 5th intercostal space.
VI. Volunteer subject.
VII. Volunteer ECG operator.
VIII. Table: For lying down the volunteer subject.
IX. Screen: Where the electrocardiographs appear after amplification.
X. Alcohol wipes: to clean the chest before placing the chest leads.
PROCEDURE:

1. The tutor will introduce the electrocardiograph machine in use with its operational
procedures.
2. The procedure of electrocardiography will be thoroughly explained to the volunteer
subject by the volunteer operator.
3. The subject will be screened off, asked to undress to expose the chest, both upper
limbs and both legs.
4. The subject then lies on his/her back on the couch, and relaxes while breathing quietly
throughout the procedure.
5. The rest of the body surface that is not to be used is covered with linen.
6. The ECG operator prepares the surfaces for the lead electrodes attachment by clearing
it with alcohol wipes.
7. Record manually lead by lead till you get all the 12 leads designated, then proceed to
record automatically all the 12 leads record as well.
8. Label the electrocardiogram recorded with the volunteer’s particulars namely; Name,
Sex, Age, time of recording any medicines taken, and any known condition the
volunteer subject has.
9. Switch off the electrocardiograph machine and disconnect off the subject.
10. Clean off the jelly on the subject with water and dry with cotton wool or tissue.
RESULTS:
ANALYSIS OF RESULTS

Use the following systematic approach in analyzing and reporting on the recorded 12 lead
electrocardiogram.

1. Estimate the frontal and Horizontal plane QRS axes.

 The six limb leads I, II, III, aVR, aVL and aVF look at the heart in vertical/frontal
plane.
 They record the electrical activity moving up and down and transversely (left and
right) across the heart.
 The six unipolar precordial/chest leads arranged the heart in horizontal plane. Since
heart is placed obliquely on chest, leads V1 and V2 lie over right ventricle, V3 and
V4 over interventricular septum, and V5 and V6 lie over the left ventricle.
 Lead aVR is oriented towards the cavities of the heart
 Leads I and aVL view the ventricle
 Leads II,III and aVF view the inferior surface of the heart.

2. Describe the atrial pacemaker and indicate its rate and regulating.
The atrial pacemaker is the Sinoatrial node, which is a small strip of modified cardiac
muscle, situated in the superior part of lateral wall of right atrium, just below the opening
of superior vena cava. The fibers of this node do not have contractile elements and are
continuous with fibers of atrial muscle, so that the impulses from the SA node spread
rapidly through atria. It is called the pacemaker because the rate of production of
impulses (rhymicity) is more in sinus node than in other parts. Its rate of impulse
production is about 70 – 80/minute.

REGULATION: The pacemaker’s role is regulated by the Vasomotor centre, motor axons to
the heart, sensory axons from the heart.
Vasomotor centre is the nervous centre that regulates heart rate, located in the reticular
formation of medulla oblongata and lower part of pons. It has got a Vasoconstrictor/Cardio
accelerator area (which increases the heart rate (increase in vasomotor tone) and causes
constriction of blood vessels in conditions of low arterial blood pressure), the
Vasodilator/Cardio inhibitory area (which decreases heart rate by increasing Vagal tone and
also causes dilatation of blood vessels in conditions of high arterial blood pressure).

3. Describe the nature and duration of atrial activation (P wave).

P wave is produced due to depolarization of the atrial musculature. This depolarization
spreads from sinoatrial node to all parts of the atrial musculature. The duration is 0.08
seconds with an amplitude of 0.2mV.

4. Describe any supra ventricular premature contractions.

 There are no premature contractions.

5. Describe the AV junction conductions.

Impulses from the sinoatrial node are conducted through internodal pathways (Anterior
internodal fibres/Bachman’s, middle internodal fibres/Wenckebach’s, posterior internodal
fibres/Thorel’s) into the Atrioventricular node (AVN) situated in the right intra atrial septum.
From the AV node, the bundle of His arises, after Wilhelm His, German anatomist. This
bundle bifurcates into right and left bundle branches within the membranous part of the
interventricular septum. Purkinje fibres (after Jan Evangelista Purkinje, Czech Physiologist)
arise from each of the bundle branches and spread all over the ventricular myocardium.

6. Describe the rate duration and regularity of ventricular activation and site of its
pace maker (QRS complex wave).
QRS complex/Initial ventricular complex, is where Q wave is a small negative, continued as
the tall positive R wave, followed by the small negative S wave.
The QRS complex is due to depolarization of ventricular musculature. Q wave is due to
depolarization of basal portion of interventricular septum. R wave is due to depolarization
of apical portion of interventricular septum and apical portion of ventricular muscle. S wave
is due to depolarization of basal portion of ventricular muscle near the atrioventricular ring.
The normal duration is between 0.08 – 0.1 seconds, and its pacemaker is the
atrioventricular node located in the right intra atrial septum.

7. Describe the course of ventricular activation and the shape of the QRS complex.
Ventricular activation starts with depolarization of basal portion of interventricular septum
(Q wave), followed by depolarization of apical portions of both the interventricular septum
and ventricular musculature (R wave), and lastly depolarization of basal portion of
ventricular musculature.
SHAPE: Q wave is small with amplitude 4mm or less. It is a quarter of amplitude less than
R wave in leads I, II, aVL, V5 and V6. In chest leads V1 to V6, R wave becomes larger, and
it is smaller in V6 than V5. S wave is large in V1 and larger in V2, and gradually becomes
smaller from V3 to V6.

8. Describe any abnormalities in J point and S – T segments.

J point is the junction QRS complex and S – T segments, and where the S – T segment
starts from.
 There are no any abnormalities.

9. Describe the T wave changes.

T wave is the final ventricular complex and a positive wave, with duration 0.1 seconds and
amplitude 0.4 mV. T wave is normally positive in leads I, II, V5 and V6, and inverted in lead
aVR. It is variable in other leads sometimes positive, negative or flat.

10. Describe the alteration in Q – T interval in relation to rate.

Q – T interval is that interval between onset of Q wave and the end of T wave, and
indicates ventricular depolarization and ventricular repolarization, thus signifies electrical
activity in ventricular musculature.
 The Q – T wave is prolonged in long Q – T syndrome, myocardial infarction.These
cause Bradycardia.
 It is shortened in short Q – T syndrome and hypercalcemia. These cause
Tachycardia.
QUESTIONS:
1. What is the significance of the following;

I. P wave.
Variation in duration, amplitude or morphology of the P wave helps to diagnose several cardiac
problems such as Right atrial hypertrophy (P wave is more than 2.5 mm in lead II and pointed),
Left atrial dilatation/hypertrophy (It is tall and broad based/M shaped), Atrial extra systole (It is
small, shapeless and followed by small compensatory pause), Hyperkalemia (It is absent or
small), Atrial fibrillation (It is absent), Middle AV nodal rhythm (It is absent), Sinoatrial block (It
is inverted or absent), Atrial paroxysmal tachycardia (P wave is inverted), Lower AV nodal
rhythm (Here, it appears after QRS complex).

II. QRS complex.

Variations in morphology, duration or amplitude of the QRS complex helps to diagnose cardiac
problems like Bundle branch block (QRS is prolonged or deformed), Hyperkalemia (It is
prolonged).

III. T wave.
Variations in amplitude, morphology or duration the T wave helps in diagnosis of cardiac
problems such as Acute myocardial ischemia (A hyper acute T wave develops which is tall,
broad based and slightly asymmetric), Old age, hyper ventilation, anxiety, myocardial
infarction, left ventricular hypertrophy, pericarditis (here the wave is small, inverted or flat),
Hypokalemia (It is small, inverted of flat), Hyperkalemia (It is tall and tented).

2. Why is P wave usually largest in standard lead II?

It is because standard lead II measures potential at right arm minus potential at left leg,
meaning that it measures potential across the right atrium and yet atrial depolarization starts
here due to the sinoatrial node.
 3. Why is T wave small or absent in lead aVL?
Lead aVL views the left ventricle but measures potential during ventricular depolarization yet
the T wave signifies ventricular repolarization.
4. What is the significance between the end of the P wave and beginning of QRS
complex?
The interval signifies conduction of nerve impulses by the atrioventricular node and be used to
determine the conductivity of the AV node.

5. What factors influence the duration of the following;

I. P – R interval: Factors include the conductivity of the conduction system of the
cardiac muscle ie; the sinoatrial node, internodal pathways, AV node, bundle of His,
right and left bundle branches and Purkinje fibres.
II. Q – T interval: Factors include conduction of the bundle of His, right and left
bundle branches and Purkinje fibres.

CALCULATION OF HEART RATE USING ELECTROCARDIOGRAPHY.

Here, we use the R – R interval;

Velocity of ECG machine=25 mm/ sec

25 x 60=1500 mm(small sq . between two R waves)

1500
=300 mm(big sq . between the two R waves)
5

4 .5 big squares between the R waves

300
=66 beats/minute
4 .5

 Heart rate=66 beats/minute

CONCLUSION:
The volunteer subject had a healthy heart with normal rhythm or heart beats.
REFERENCE MATERIAL

 Textbook of Practical Physiology 8th edition by C. L Ghai, MD.

Ganong’s Review of Medical Physiology 24TH edition by Kim E. Barret, Susan M.
Barman, Scott Boitano, Heddwen L. Brooks.
 Guyton Arthur Clifton, & Hall John E. (2016). Textbook of medical
physiology 13th edition. Philadelphia: Elsevier,inc.
 K Sembulingam & Prema Sembulingam . (2012). Essentials of Medical
Physiology 6TH edition. New Delhi: Jaypee Brothers Medical Publishers (P)
LTD.