NAME: Radoslaw Poweski

BANNER ID: B00279955

Lab 3 - Cardiac Cycle

A. Electrocardiogram

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 • Horizontally
–One small box - 0.04 s
–One large box - 0.20 s
• Vertically
–One large box - 0.5 mV

A. Typical ECG Strip Pattern

The diagram (Figure 1) is a typical plot of an ECG for a single heart beat.
Information contained with the figure permits calculation of the heart rate and
identification of any pathologies in the conductance of the heart.

Figure 1. Normal ECG

R

P
T

S
Q

1. For the above diagram identify which parts of the ECG correspond to;

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a. Atrial contraction – P-Q

b. Atrial relaxation - P

c. Ventricular contraction – R-T

d. Ventricular relaxation- T-R

2. Why is the P wave smaller in amplitude than the QRS wave ?

Both a relatively small muscle mass and voltage is needed for

contraction of atria.

B. Calculating Heart Rate

Normally the paper speed is set at 25mm/min.
Thus, 1 large square = 5mm = 0.20 seconds. Heart rate (bpm) can be calculated by
measuring the distance between R waves. There are several methods of doing this
including;
a. Counting the number of large squares (0.20 seconds) between two R waves
and dividing by 300.
b. Counting the number of small squares between (0.04 second) between R
waves and divide into 1500.

C. Calculating Voltage of Peaks

Determination of voltage is indicated by the y-axis. This gives information on the size
of the cardiac muscle that is contracting and so is indicative of hypertrophy. A large
square is equal to 0.5mV (Figure 1). Normal values are known for the amplitude of
these waves (see table 1 below). Figure 2 indicates the accepted intervals for the
duration of the components of normal ECG.

Figure 2. Normal ECG Expected Parameters

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 Table 1.

Normal
ECG -

Expected Parameters

PARAMETER EXPECTED FINDINGS

1. Calculate Use either Option 1 or Option 2 (bpm)
Rate 60-99

Look at the R-R distances ? (regular or irregular)

2. Determine
Regularity
Are there P waves? Visible before each QRS
Do the P waves all look alike?
Do the P waves occur at a regular
3. Check the P rate?
waves Is there one P wave before each
QRS?
Interpretation?

4. Determine Normal: 0.12 - 0.20 seconds. Normal <5

PR interval (3 - 5 boxes)
Normal
Normal: 0.04 - 0.12 seconds.
5. QRS
(1 - 3 boxes)
Duration

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Diagnosis

Normal

Below is the strip for normal sinus rhythm (NSR)

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E. The following strips are representative of;
Bradycardia, premature atrial contractions (PACs), tachycardia, ventricular
fibrillation.

Identify the strip associated with the above scenarios. Explain your reasoning.

ECG 1.

PARAMETER EXPECTED FINDINGS

1. Calculate Use either Option 1 or Option 2 (bpm)
Rate 40

Look at the R-R distances ? (regular or irregular)

2. Determine
Regularity
Are there P waves? Visible
Do the P waves all look alike?
Do the P waves occur at a regular
3. Check the P rate?
waves Is there one P wave before each
QRS?
Interpretation?

4. Determine Normal: 0.12 - 0.20 seconds. Normal

PR interval (3 - 5 boxes)
Normal

5. QRS Normal: 0.04 - 0.12 seconds.

Duration (1 - 3 boxes)

Diagnosis

Sinus Bradycardia

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ECG 2.

PARAMETER EXPECTED FINDINGS

1. Calculate Use either Option 1 or Option 2 (bpm)
Rate

Look at the R-R distances ? (regular or irregular)

2. Determine
Regularity
Are there P waves? Yes,
Do the P waves all look alike?
Do the P waves occur at a regular
3. Check the P rate?
waves Is there one P wave before each
QRS?
Interpretation?

4. Determine Normal: 0.12 - 0.20 seconds. Normal

PR interval (3 - 5 boxes)
Normal

5. QRS Normal: 0.04 - 0.12 seconds.

Duration (1 - 3 boxes)

Diagnosis

Sinus Tachycardia

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ECG 3.

PARAMETER EXPECTED FINDINGS

1. Calculate Use either Option 1 or Option 2 (bpm)
Rate

Look at the R-R distances ? (regular or irregular)

2. Determine
Regularity
Are there P waves?
Do the P waves all look alike?
Do the P waves occur at a regular
3. Check the P rate?
waves Is there one P wave before each
QRS?
Interpretation?

4. Determine Normal: 0.12 - 0.20 seconds.

PR interval (3 - 5 boxes)

5. QRS Normal: 0.04 - 0.12 seconds.

Duration (1 - 3 boxes)

Diagnosis

Arythmia

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ECG 4.

PARAMETER EXPECTED FINDINGS

1. Calculate Use either Option 1 or Option 2 (bpm)
Rate 150-200

Look at the R-R distances ? (regular or irregular)

2. Determine
Regularity
Are there P waves? no
Do the P waves all look alike?
Do the P waves occur at a regular
3. Check the P rate?
waves Is there one P wave before each
QRS?
Interpretation?

4. Determine Normal: 0.12 - 0.20 seconds.

PR interval (3 - 5 boxes)

5. QRS Normal: 0.04 - 0.12 seconds.

Duration (1 - 3 boxes)

Diagnosis

Ventricula Tachycardia

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B. HEART SOUNDS AND PULSES
You will listen to heart sounds using a stethoscope (this is known as auscultation).
These are normally represented by the phrase “lub-dub” or the first (S1) and second
(S2) heart sounds. Although the heart valves themselves work silently, their
functioning leads to turbulence and this results in the S1 and S2 sounds. We can
assign these sounds to phases of the cardiac cycle and they can be indicative of
defective valves.

Using the diagram below identify the aortic, pulmonary, tricuspid and mitral (some
use remember this through All Physicians Take Money) sites.

1. Can you detect the “lub-dub” sounds at the positions ? Is there any difference in
the sounds ? If so, can you explain why ? Fill in the table below.

Site Sound Valve(s) at this Site

Aortic

Pulmonary

Tricuspid

Mitral

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2. In summary, which valve(s) are responsible for “lub” and “dub” (S1 and S2)
sounds ?

3. Using the information above assign “lub” and “dub” sounds to the appropriate
stage of the cardiac cycle.

4. While listening to the heart sounds using the stethoscope locate the carotid artery
and feel the pulse. Do not use your thumb to feel the pulse. Why is this ? Also use
the ultrasound equipment to listen to pulse.

Does the appearance of the carotid pulse coincide with the “lub” or “dub” ?

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5. What does the strength of the pulse tell you about the origin of the carotid pulse ?
Which part of the cardiac cycle does the carotid pulse correspond to ?

6. You can listen to heart sounds at the URL;

http://www.wilkes.med.ucla.edu/Physiology.htm

Listen to those for aortic and pulmonary stenosis. In both of these are S1 or S2
sounds affected ?

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