Electrocardiogram

ECG or Electrocardiogram is a test that measures the electrical activity of heart.

A normal ECG has three distinct waveforms: the P wave, the QRS complex, and the T wave and
two segments:

 P wave represents Atrial depolarization.

 PR segment represents AV node silence
 QRS complex represents ventricular depolarization.
o Q wave: Ventricular Septumal Depolarization
o R wave: Major ventricular Depolarization
o S wave: Basal Ventricular Depolarization
 ST segment represents ventricular contraction
 T wave represents ventricular Re-polarization

Figure 1. ECG waves and their respective time period

Atrial fibrillation
Atrial fibrillation is an abnormal heart rhythm characterized by the rapid and irregular beating of atrial
chambers of the heart.

It may also start as other forms of arrhythmia such as atrial-flutter (atria receive organized electrical
signals, but the signals are faster than normal) that then transform into Atrial fibrillation.

Characteristics
Atrial fibrillation is characterized by rapid, irregular, uncoordinated depolarizations of the atria with no
definite P waves. Therefore, atrial contractions are chaotic and asynchronized. Because impulses reach
the AV node irregularly, ventricular rhythm is also very irregular.

The QRS complexes are normal in shape but occur sporadically. Variable lengths of time between
ventricular beats are available for ventricular filling.
Some ventricular beats come so close together that little filling can occur between beats. When less
filling occurs, the subsequent contraction is weaker. In fact, some of the ventricular contractions may be
too weak to eject enough blood to produce a palpable wrist pulse.

Pulse deficit
In this situation, if the heart rate is determined directly, either by the apex beat or by ECG, and the pulse
rate is taken concurrently at the wrist, the heart rate will exceed the pulse rate. Such difference in heart
rate and pulse rate is known as Pulse deficit. Normally, heart rate coincides with the pulse rate, because
each cardiac contraction initiates a pulse wave as it ejects blood into the arteries.

ECG showing Atrial Fibrilation

Observations:
 Rate: 400 beats/minute.
 Rhythm: Both are atrial rhythm and the ventricular rhythms are irregular
 Ventricular pattern is present and can be normal or faster than normal.
 There is no actual P wave, but a wavy line P waves are replaced by lower case "f" waves. No P
waves means there is no PR interval measurement.
 QRS complex is present.
 T wave is not evident because it is covered by many incomplete P or f waves.

Differential Diagnosis
Cardiac valve disorder, Hypertensive Cardiovascular disease, Cardiomyopathy, Thyrotoxicosis, Chronic
Obstructive Pulmonary Disease, Constrictive pericarditis.

Signs & Symptoms: Shortness of breath, Palpitations, Chest Pain.