Electrocardiogram (ECG)
Prepared by: TA. Sabreen Elsedeek
Critical Care and Emergency Nursing
Rules
•Mobiles off
•Ask questions
•Listen actively
Objectives:
By the end of this lecture, the students will be able
to:
• Discuss the composition of the cardiac cycle
and cardiac properties
• Describe how impulse conduction works in the
heart
• Identify types of ECG monitoring.
• Describe the components of an
electrocardiogram complex.
Outline:
• Cardiac cycle and cardiac properties.
• Intrinsic conduction system.
• Types of ECG.
• ECG Leads.
• ECG paper.
• Characteristics of normal ECG tracing.
To record ECG, you’ll
need to understand the
cardiac cycle and
cardiac conduction
system
Cardiac cycle
The cardiac cycle is composed of both the
electrical activity due to automaticity and
the mechanical (muscular) response known
as contraction.
The generation and transmission of
electrical impulses depend on the
automaticity, excitability, conductivity, and
contractility of cardiac cells.
Electrophysiologic Properties of the Heart
Automaticity:
Ca n generate an electric impulse on its
own
Excitability:
Non-pacemaker cells can respond to
impulses and depolarize
(Cont.)
Conductivity: Can transmit impulse from
cell membrane to cell membrane
Contractility: Cardiac muscle cells can
shorten fiber length in response to
electrical stimulation, creating sufficient
pressure to push blood forward
(Mechanical activity)
Cardiac cycle(cont.)
The electrical activity can be divided into
two phases called depolarization and
repolarization. The mechanical response is
divided into diastole and systole.
Depolarization is the active phase of
electrical activity. Repolarization is the
resting phase during which electrical
activity is minimal.
(Cont.,)
• The phase of the cardiac cycle when the
myocardium contracts is termed systole.
•The phase of the cardiac cycle when the
myocardium is relaxed is termed diastole.
What is an ECG?
Records electrical activity of the heart
Gives us information about cardiac rhythm,
ischemia/infarction, and some generalized
disorders (e.g., electrolyte imbalance)
4 limb and 6 chest electrodes = 12 lead ECG
Each lead gives a different viewpoint of
electrical activity in the heart
purpose of ECG Tracing
To detect:
Ischemia/infarction
Arrhythmias
Ventricular and atrial enlargements
Conduction defects
Effects of some drugs and electrolytes
(Digoxen &potassium).
Types of ECG
Resting (12-lead ECG)
single-lead ECG
Holter monitor.
Stress ECG
12 Lead ECG
Single-lead ECG (a rhythm strip)
Standard Limb Leads
Cont.,
AVR looks from the right shoulder into
the middle
AVL looks from the left shoulder into the
middle
AVF looks from the left foot to the middle
Lead Placements
V1 - 4th ICS, Right sternal border
V2 - 4th ICS, Left sternal border
V3 - Midway between V2 and V4
V4 - 5th ICS, Mid clavicle
V5 - Anterior aspect of axilla, same line as V4
V6 - Mid axilla, same line a V4
4 limb leads.
Chest Leads
ECG paper
One small box = 0.04 seconds
One large box = 5 small boxes = 0.2
seconds
5 large boxes = 1 second
300 large box= 1 min
P wave
It represents atrial depolarization
Location: precedes the QRS complex.
Amplitude: 2-3 mm high.
P wave
Duration: 0.06 to 0.12 seconds (1.5 to 3
small blocks).
Configuration: rounded and upright.
Deflection: Positive
P wave
PR Interval
Start of P wave to start of QRS
Normal = 0.12-0.2 s (3-5 small squares)
QRS complex
Represents ventricular depolarization.
Measured from the beginning of the Q (or
R) wave to the end of the S wave.
Should be <0.12 s duration (less than 3
small boxes).
QRS complex
ST segment
The isoelectric segment following
depolarization and preceding ventricular
repolarization From the end of the QRS to
the beginning of the T wave
ST segment
Elevation or depression of the ST
segment by 0.1 mV from the baseline is
abnormal
T wave
Represents ventricular recovery or
repolarization
T follows the QRS complex and is
usually in the same direction as the
QRS complex. If QRS is
predominantly negative an inverted
T wave is not necessarily abnormal
T wave
Normal Sinus Rhythm
• Originates in the sinoatrial node
(SA)
• Rhythm: atrial/ventricular regular
• Rate: atrial/ventricular rates 60 to
100 bpm
• P Waves: present, consistent
configuration
Normal Sinus Rhythm (cont.)
• One P wave before every QRS
• PR interval: 0.12 to 0.20 seconds
and constant
• QRS duration: 0.04 to 0.10
seconds (1 to 3 small blocks) and
constant
Questions
