: £S4_ By: Zaktvullah Yousutaai Eco: Ln ecg Electweat activity oP heart is Graphically Presented. OR Arophic — presentation of electrical activily of heart. RMP: Potential difference b/w inside & outside of Cell membrane. ~Nowmally inside of Myocandiom is wegative (-4emv), TMreghold Potential: (tom) 4s potentiat at whieh bs ich membrane of cell suddenly Pens Veltage gated Nat. channel. - whe ims w “eu ove Stimulated amp fees to threcghstd. Myocardial cells 4 Repolarization As Not cham fe ee ee wl Ss witially electronegative will Loose its Clectwnegativity , se become electropositive (ie: toward Depolarization). ¥ Depolari zation After depolavizatio, depolavizatin Sensitive oct g, kt chomnel oPens so &* is start smoving, outward ty cot cmove im So cell stort Loosing & Javing cation, 56 there is mo change im Potential, But as time Pass 0 For more high quality medical notes contact with whatsapp:+93728888256move & mere Cot chamnel Closed & mare Sq more Kt channels opened & heavy ket eFlux occurs due te svely chonge, (Ke? Lass) became ; reach to RMP Cie: RePolavieation. * Noval healt Celt is eK less oceny Se cell clectrenes ative ich in KK, $e curing depelavization outside of cell is vich im Na, go wd goes in As adjacent smyocovdial cell ave Connected by special CPP Junction go a5 cations move inte one cell, it alge Pass te othey cell amd tes potential of the next ce, upto threshold: RAs 4st cell become depolavized ‘Ik Conse depolavizatia of 2nd Cel and cel depolarization Conse dep elarietion of ayd cell omd G0 om ..--- eee amd sirmilorly depola viration o ww = wee ie 2 Rhip 25 Defolaridafion ——» RePslarization Action Potential Im atria & ventricle, Tre depolarization occur qene rally by not SIn SAG Av-nede jthe depolarization ave Yenerally occur by Ca. For more high quality medical notes contact with whatsapp:+93728888256ECG Machine act on Principle eof Galvonometer. Golvamometey is apPayokus which determine elechicet activity of cell on which its electrode ove agpler. when myocardium is mot stimulated the electrical activity will be mneutval "meedle at ‘ot position”, as when Cell ave wot stimuloted they ave megative Yrom side. ie: at RMP Electrical chavges move Bly © & O- if all cells ave eleckwnegative ot RMP there is no charge rove rom @ to ©, so electrodes will veport there is mo electrical activity, so Golwamemeter needle remain at Ze Position. $. Restiny No- electrical cell activity \2 cell ave stimuloted ot electode”A” Let of Na channels are opens & let of Not move in, depolarization occurs %& this wove of depclarization ocesm start renin, © to @ elected by vector. : Pointer of vector is moving im that divection ™ uihich, dePpolorization/chavges one moving. For more high quality medical notes contact with whatsapp:+93728888256length ef vector o¢ power of force ©B: More depelavizotim vector will be beng Less “ % Short. SS bl (See) pe Ses. i, As im this Case Positive charges ove “moving to divection of @ electwde, go needle will be deflected to @ side. when cells ave completely depolarized, no charge move, so” Vectoy will disappeay §& meedle meve back te neutral Pesitio: Length of vector of stvength of electromagnetic tied. 12 we tes thickness ct Myocardium to underge defelovization we eed move Not bf number of calls Tes, As more no move in wowe ef depalavization is Length Tes. As in this go dePlection Stent to there Stronger, so Vector case @ Current is moving to +ve electrode, should be sve but a5 current is is move detection. For more high quality medical notes contact with whatsapp:+93728888256In this case stimulation eceuys at Beside electrede So @ earvent moving from B—~> A (ave away Ym 4ve)-vecter sheuid be divected te megative side ¢. there is negative detection a ‘@ Ist point to. depolavize is Last point to -vepalarire. a ave chayges moving to ve electrode deYlection is ave. * —ve charges moving te -ve electrode dellection is sve. ie: Some charges moving to game electrode detection is ave: Te Ad eh & | dipcevice of @® clectrade, wove of depolarization is moving Yom @—+© as, «ve charge roving to sve electrade dellection is ave. 1B some cell is stimulated at © electrode for -vepolarizate tk meoms negative charges moving Prom ®—® se ~ve charge moving te -ve electrode, again dellectio is Positive. ° Tn Repolovizotim head of vectoy is divected to negative side & howe ove chavge. 2 If © é eae For more high quality medical notes contact with whatsapp:+93728888256why Some myocardial tissues Conduct ‘Last &e Some Conduct — glows.? oR * what ove effects on detlectio of meedie when Velocity ef Conduction tremugh ove ai fferent- y sp tf we take mda : vemtriculay wocordir Atyia A 4 Q catly, of ha Bome thickmessn84 bhimulate them aku(@) deplection ugit'be ven in beth Myocardium, As thicknes ave .yual So Length of vector ave Enel but as ventvicte has tos Conductiong fibers (Porkinii) go velocity 2 conduction thrugh « atria —» Modevole (je: needle move te sve side but slow). wm Venticle—» high (ie: needle aneve te ave side? ‘but rapidly): Electrical events wm heavt during ONE Cayding eyete. How these elec. events in 4 Cardiac cycle lead te And tow these vectors Lead teAs sA-mode ‘fires, wowe of depolaxvization spread to adjacent cells g ‘than Keep om emavind downword & letword ‘Ww atyia. wone of depolavizatim in akvia spread dovimward Ee leLiword by ovigion of depolarization im atyia Lies Right & up. As wight and left atrium is syrdtivm , se thay ore depolarized ot same time, se alt of them farm & (small) single vector, divecting downusord & let wad. This vector vepresent elect vical activity qenerating im beth atyia, so this is: Marcial depolarization vector ® ~As atvia ave thin, So This vector is smal. AS akvin Conduct with modevate velocity, $0 this small vectoy is smoving, downwayd & letward with Modeyote velocity. For more high quality medical notes contact with whatsapp:+93728888256 ®O 1st electrical event is ptviat Depolovization. when beth atria ave completely depolavized this depolarization ewrrent wit hit Zibrous omulus but Tibws amulug” is Non—Conductay So most of current will die eut & depolavizotio does not pass trom this band t vemtyicles . Pomt through which depolavizati epolayization Pass to vemwtvicle is "Av-node”. trem atria © Stimulation of Av=node. - Av-node is specialized ER ri Myo tardium grea y oN “\t is specialized Yer “Slow Conduction” so depolarization takes About OLsec te Pass rom atria to ventricle. Fast Gmductia wshy depolariation is slew doum ee Av-node is special 5 Ars Dairies Slow Conduction So it allows blood. {uly amd Ul the ventricles with, ventricle have high velocity of Conduction by Center, hase sides all Contract at some Hme. ° For more high quality medical notes contact with whatsapp:+93728888256Av-node’ is slows Conduicter % 1k Nowe Lange amount of cells but cally ore mall They owe ourramaed ak vightomple te divection of current: Tn purkinji system cette are dowge & less. @ se in Ay-node CSS Many cells Conduction is slow. Im puvkinji curvent pass. through Less cells Se Conduction is Tast- Yor current te Pass ik Should to reach trom 4—2, ce ® Nomber of — Gop-junctin bi Av-nodol cens very very less. ie: electrical windows ‘In Av-node amove slowely ‘Ww Av-mode- Number of Gop-Junc Kien iw current move Tost: ave \s less | So current Porkivji ave mere, So @® Av-node depoloyization Work Slowedy, so in Av-enede current Purkinji cells depolarization work Tasty, so in Purkinji depend om ct & Cot- channel is Slow. depend om Not g¢ tual chamng current is Yast. @as pvemede cells are z Smalley diametey tw move -vesi stance lo . > hey offey Tr porkinit cols to oe current ‘ owe longer, se they offey Tesi stomce. ey offer lets For more high quality medical notes contact with whatsapp:+93728888256© most impertomtly, In avemode RMP is —bomv. In Povrinji Romp is ~Yowv. Se Purkinji system is move electronegative - cations has te move in into AV-nodle as well Purkinji- Cations move amore vapidly ‘in cell which ave more be tk is electromegativity ef cell which attract Cations during depolarization, due to this reason Depolarization current in electronegative Av-mode is Slow S» in Purkiyji system is Jost. ~These ave the veosons that AV- node Ma cpecialized iw VV Slows Conduction ~Purkinji system is specialized tm vive Yast Conduction. Av-node is slow Conductey $e ECG Machi elect vicot activity of Avenade. + keene “dak = when miniature depolari2otio pass thao Aven, : : f node, i % electvitatly silent co ano sigvtted vectey is produced Yor Av-node. . ; On & ot (3) Stimulation of Puvkin)i system ae Ventnicles depolavization cccuy in -3-stefes © 4st septa depelovization. @ 2vdy Apex depolarization. ® wdly Bose depolarization. 4 ventricle For more high quality medical notes contact with whatsapp:+93728888256Septal dePolavization: Fibrous Pericordium Covey bundle Fibevs make them (nsolating. utes" >. Myccowdiom Sub Pevicordium' note » Cubendetarcion) Right ventral ‘ = et Depolowi aation ‘ ventricle Vector Msulating depolarizs loyye vectey [ (eH side of Myotavdiat Septum is depelaxired his wove also depolavize Llewey Pant ot septum. wone of depolarization 14 Produced in lower & lett Port of Later ventricutow Septum, & this wove of depolawization sus eeps Yoom lett side to vight side & Grom downward te upward: Ke defolavization wave im geptum mave upward & Vigatward 50° vector is up & ight, bo septal depolarization (current) vector is small b% compare to whole ventvicle , septum howe lower myocardium. this vectoy is small but Yast Conducting vector vent vicular depelavizetion occurs 1s ‘in Septum: @ For more high quality medical notes contact with whatsapp:+93728888256APeX DePolavization: *Inney myocardium is alse Called Sub Emdocardi # outer myocardium is called Sub—Pewi cardial myocurdi Um Fivst of alt depolarization eccuy in & tham depolawization move outwod: wleit ventricle is Wney myocardium B-times thickey than vight ventricle. So depolovization curent in wight vemtyicle while defolavization curvert in lett ventricle is stevg, is weaker Se vecter in wight ventricle is Short while im Lett ventricle is Long. But as all ventviculay vector time (ie: beth ventricles Contyact Vectors ome of both ventricles ane Produced aot came Simultomeously ¢, an thes ove added). This sum of Vector alge : Shows lett ventviculow Nectoy is strong & vight ventviculay vector is weaker ¥ LEU ventvicle depolarization, vector divected dawamuiard % lettuord. Right ventricle chepelawization: ms is divecked doumnusovd & right wart. AS both ventricles depolarized simultaneously so we add vectors of both ventricle .As Right ventricle 1S Smalley & have Smaller Vector, ¢ lett vector is stronger, so Net vector is divected downwond & Wtwerd: Nek vector vePresenting Majer ventricuioy depolayization- For more high quality medical notes contact with whatsapp:+93728888256Basal Depolarization: This is last part to be depolavize, so vector are synall amd Directed upword & Tight word. All vectors Produced In ventyicles ave sk vector becouse ventricle have SPecioli zed Conducting System called “Porkinji system” . How many vectots ove Produced in one — ac cycle? Pf MACE Be ye ay . During one heort cycle electrical vectors oy produced due ty electrical activity: om ~ These ‘electheal activities very toithully v - an gen activityies of heart For more high quality medical notes contact with whatsapp:+93728888256veach to surface of body, te. electrical activity due to condiacg sai veach te surface of body, mi =e Se we apply electrde om surtace ef body amd ameasure electrical activity ging MH MH the heart: x Applying efectrde te (ht Foot is gyualamt to applying electrode at Junctinm of trunk & tower Limb. x ARPlying electrode fo vight arm is gqyuali ' te applying electnde of Junction of “ight om & bunk: when there is mo electrial activ} in heart meedle 7 Galvamemeter is meutval. 4) Than Soon SA-node Yives & akvial vector is produced -as otvial vector is moving fowards © electrode , +ve de}lectio occur im Golvame-meter. =Dejlectio is 4ve amd with -moderahe velocity, n So P-wone is Jormed om ECG: As atria became Completely depolavized, again deflection become Zero (0). 2) Next electrical activity oceuy in AV-mede , but me sigrificant chamge occuv om ECG Strip: ie: heort is electrically silewt go needle yemains mevtval _prerresent Conduction through Aycrede oN For more high quality medical notes contact with whatsapp:+93728888256@ current veleasing into Perkinji system and Ventyiculay depolarization stavt: @® septot depolarization: smal vector is produced but this vector ig movin aay Yom © electrode, so theve is megative deblection Gut os this vector is Fost vector so otter negative deflection ib Wwmediately — movine UP word . This ~ve deflection shew ventviculey Septal depolarization This wave shows Stoyt cf vemtyieulor Contraction: —-voa ®© mext — Current move in wmajer ports of both ventricles: During this wave Major ventyvicwler depolarization occur § Shong Vector Produced, which ig directed dowwuiond fy le tward- Wis strong & Yast vector is cmoving towords +Vve electrode, so detection will be +ve & will be Yast & big. spond! So meedle Trrmave upword § than down wand (R-wave) © Basat depolarization: When depolarization curvent is cmovirnd to basal Part of ventyicles, § this Port will Produce “small vector emoving upwond & Riyht word - These vectors axe moving, anoy tom ave electrode, so pmduce ve deflection co \t produce small, negative roy detlection. For more high quality medical notes contact with whatsapp:+93728888256oe Kv venti lay depolarization ‘ s sean ree tba Basal ventricular depolarization S50eB At the gtmd of ORS Complex both ventvicles ave Completely depolovi zed. septal o basal Major oxen As completely depolarization, so ogain meedle shows me tluctuation. “walt ventricles are Completely depolarized There is no Yluekvation in meedle. mofter some time vepelarizatio in Yentricles stort: > Ports which owe depolowized Last is Ast to repolorive. As depolarization occur tom within outward, Repolovization occurs Yrom outward te mused: Vetter of Repolavization is opposit te vector of depolaviratin. Nek vector of Repolariration is moving upward & “rightward: For more high quality medical notes contact with whatsapp:+93728888256why ovtey Parts vepolavize tivst & mney Ports vepolavize last? During QRs & ST-segment venricle So, when — vemtricles were In systele ave Coutvacti Inner Myocaydlivm vesseles ave Contract by ovtey vessele & calls bloed. But blood Ylow te cuter Myccordivm is bettey than muword. cerita, —_ Dlaod Plows ig Maaimtained better in Outer Myocardium cburing, systele , go vepolond zation stort Pom outey Myocardium. * Depolarizabiin — stant “bom iwnew MyeCardivm hy ik is neon to Portinji system. Three vectors Pormed in is Jost process. But In Repola zation ome repolavirotinn is a slow Yast & Ki chamneds ave when depolarizatin occur, 1st septum depolavize > Than Majer vemtvicles—_, Tian Basot Ports due to this veason 3~- woes Tomedin cq, Mepelonitation is fe fricied Sree SB vepelomirotion starts, it is net pinished &, basal For more high quality medical notes contact with whatsapp:+93728888256 depelari zation by depolavizntir Vector is Jormed be Process, BZ Net-chomnels axe Slow.vepolavization staxt as vepolenization is slow, g5 yepolanization of ait these areas will be overlap Ee ag Strongest vector will ™Meve the vector upward & Rightward- As -vepolorizimg vector is me ca ea word (14s hi is toward ~ve). Se AS a rule -ve tousord -ve become sve, Cie same vector is moving to the Soume electrode), Se the deYlection of needle ave toward *VE This vecter is ‘moving Bradaalyy So sone js Produce +ve > But gvadual. —» T-wave ie: T- save SX isoelectric line; ts straight Line when meedle is mal Ttuctuating: > Soon > ventyiculay vepolaritation s$— et FT Segment Sement PR- seament; Bin end of purowe & begining of QRS- 7 ideally tt shouid be cated as PO- segment, but Q-wowe sometime wet seen, so tt is Called ag pR—segmnent. This interval represent — ventricular depolarizakion Plataen phased ventricular vepolari zation. + It Shows begining of depolarization te end of ‘Yepolavization- duvi this Av-volwe ove ' ariee) Produce Ist heart le: systole, Sound: watter that during, this time aortic & Diastole occur+ Ne | Pulmonary, volves closes, ¢, y ww J Preauce and heart Sound: St Bio Ist heovt sound & gynd heart Sound is systole: utes ~\-< U-wove ECG, small “U" wove j it which i , is Pvesemt which is due to Pagillary muscles why U-wave occuy offer T-wavep sometime electrical activity in yventviewtoy Papillary Muscle, is out e8 Phase sith the vest of ventyicle. » Ouving ventriculoy systole these muscles alse Contract , so mitral Valve is closed $ prevent ‘Fequrai tation , So It Moke ‘dependant 0") e i\ done Called "UM Wave. pee sae Sometime in iy orsiat For more high quality medical notes contact with whatsapp:+93728888256xTiming & Duvation of Ecq waves Seqment & tervals: : ie 1 [4] — O25 dot4sec PR waters F QT imtewal Co-4 sec) * Als meedle Yluctuates , it draw line on PaPer, as paper amoving undey Line. x Speed of Paper is adjusted One minute Zoo lovge sauares je: Im minute m such a way that in Passes undey Pointer. electrical activity of heart is dyawn on 300 big squares. 300 big syvaress Lminvte o¢ 300 big syvaves: Co see A big sqyuave = £. » OR see a big Sayvowe = Ssmall syvares = o-Asec So Lsmall soyvove = ok = for ed see. ae Recemercercet So Mm 0-04sec one small syuove Pass undey needle: For more high quality medical notes contact with whatsapp:+93728888256= P-wove taxes 9 & a half sma squares. 4 PR- segment is also Q amd a half Small squares. So whot is time Yor Q— syuares? 1 small sayuave = 0.04 sec 2X4 small Syuaes = O- OU-+~ Lomall syvewe a ae half smatt syuare are orto tse. lt means electrical curvent trom sA-node takes O-Lsee te spread through atria g to veach Av-nedt: pokes Duratim = of PR- segment is goin o-L sec, se O-1se Jor curvent te Pass trom atria te ventricle: PR-intevval = P-maves PR-seqment ay a PR-ivtevval = 5 gmat seyuaves F small soyvavess 0-2 sec he ees [toss PR-im terval Sec Her ereneeee eS Hees ewe eS cee ‘ \ QRs-comples is also 24% Smal sqyue Se, durvotion of @RS-Complex= o- Lec Se,In O-lsee ventyicle dePolarization spread thw 3 Septum + Majoy Parts + Basal parts: For more high quality medical notes contact with whatsapo:+93728888256So, upte now we have three Byud te Tr : \ AZ amd it is P-wave 2). \ PR-sey 2% | three 25 = QRS- Comp 2Y a QT- ntewal fokes fo — 41 small This is tom begining of @-wone te the tmd of T- wowe- jectrica Se, we say whole ot ventviclt ulow Aackivity oceuy Gn 1o small sy vores. Sqvaves Jo small sayuavesxo. ol = 0-4 sec So, Q@T-intewal = o- 04sec Yor vemembying we may Say): QRS =2—-3 smal syvores (0-08 —O-!25ec) P-waves 2-3 smatt seyvaves (6:08 ——o- l2sec) QT-interval = lo—tt small Ssvawes (0-4 —o- MU see) PR-\nteyval: 2—3 Smal Squares (0-08—— ona see) a%a we ow @& For more high quality medical notes contact with whatsapp:+93728888256