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Directions to DSO building for LSM3212 ECG practical

Please meet outside Hippocrates room of DSO building. To get there, go to level 2 of MD9 and cross the link bridge between MD9 and the DSO building. DO NOT come through the main entrance of the DSO building building.

DSO (Kent Ridge) Building DMERI@DSO 27 Medical Drive, Singapore 117510

LSM 3212 Electrocardiogram ( g (ECG) )


DSO building (16th February, 2011)

Assistant Professor TRAN Thai Lung Disease Research Laboratory Department of Physiology, MD9, level 4 National University of Singapore (phstt@nus.edu.sg) ( h tt@ d )

Objectives Objecti es
Understand the relationship between heart rate response and exercise intensity intensity. B able t d t Be bl to determine common ECG waves and i d intervals. Be able to calculate heart rate using ECG recordings. Experience placing leads for 12-lead ECG.

Assessment
Mini Quiz constitutes 5% of overall year mark

Ng Rainer, Boys 50m Backstroke, Silver

Li Jiawei, Feng Tianwei & Wang Yuegu

The dual application of Sports Science


Biomechanics Exercise Ph si l Ex cis Physiology Sport Ps ch l Sp t Psychology Motor Learning Growth and Development

The importance of Pre-Exercise Screening


Screening for any pre-existing health conditions

The importance of Pre-Exercise Screening

Graded Exercise Testing (GXT)


Process of imposing stress in the heart to induce a response. response Useful for:
diagnosis of heart disease assessment of aerobic fitness

Exercise protocol used is dependent on purpose of the test and profile of test population. Clinical cases are done under medical supervision

Lab Activity 1:

Graded Exercise Testing


Resting 1 min: _____bpm Resting 2 min: _____bpm bpm Resting 3 min: _____bpm 25W:_____bpm p 50W: _____bpm 75W: _____bpm 100W: _____bpm 125W: _____bpm Recovery 1 min: _____bpm R i b Recovery 2 min: _____bpm Recovery 3 min: _____bpm bpm Recovery 4 min: _____bpm y _____ p Recovery 5 min: _____bpm

Pl Place l d on subject. leads bj t Subject gets on cycle ergometer.


h i ht of cycle ergometer is height f l t i adjusted so that there is a 15o to 20o bend at the knees at full extension.

H k Hook-up ECG leads t l d to monitor. Record heart rate at rest, exercise and recovery recovery.

Exercise 1
Calculation of Maximum Heart Rate (MHR)
MHR = 220 - Age %MHR = MHR

%MHR =

220 - Age

Age 20; Exercise HR at 75W = 95 b A 20 E i t bpm Example MHR = 220 20 = 200bpm 95 X 100% = 47.5% %MHR = 200

HR

( (

HR

X 100%

X 100%

Electrocardiogram = ECG
The ECG is a graphical representation of the hearts electrical activity.
QRS complex

Q S

Atrial At i l depolarization

Ventricle depolarization V ti l d l i ti (& atrial repolarization)

Ventricle V ti l repolarization

Representative heart conditions detectable through electrocardiography

Exercise 2
Calculation of Heart Rate from ECG tracings C l l ti fH tR t f t i
RR interval

1mV V 0.1mV

1 x 5mm Square 0.2sec

P Q S

P Q S

V Voltage (mV V)

0.04sec

Time (sec)
Speed of recording = 25 mm/sec (or 1mm/0.04sec)

Heart Rate from ECG tracings =

300
Number of 5mm squares in an RR interval

Eg: if there are 2.5 (5mm) squares between 2 R waves, then the HR would be HR = 300/2.5 = 120bpm

Lab Activity 2: y

Placement of ECG leads

There are 12 such leads in a regular 12 lead ECG, each of which analyze a different plane of the heart and are therefore useful in diagnosing different conditions and localizing disease. BIPOLAR l d leads: Have a single (+) and a single (-) electrode between which electrical potentials are measured
TWO electrodes are used to record a lead

Three types of ECG leads: 1) Limb leads (Bipolar) 2) Augmented limb leads (Unipolar) 3) Chest leads (Unipolar)

UNIPOLAR leads: Have a single (+) electrode and uses a combination of the other electrodes to serve as a composite (-) electrode. Each lead records from a different angle (viewpoint) diff t l ( i i t) provides different view of the same cardiac activity
ONE electrode is used to record

Leads: LIMB & AUGMENTED LIMB


LIMB LEADS (Bipolar)
Records the difference in potential between two electrodes. RL = serves as a ground and i not used f d is t d for recording.

RA

LA

RL

LL

AUGMENTED LIMB LEADS (Unipolar)


AVR = Right arm (+) AVL = Left arm (+) AVF = Foot Left (+) AV = A Augmented V lt t d Voltage

Records the potential reaching one p g electrode (+) in comparison to the rest of the body

Leads: CHEST
These 6 chest l d may be Th h leads b visualized as lying in the HORIZONTAL plane (the plane cuts the body into top and bottom halves)
Leads V1 &V2 orient over the RIGHT side of the heart Leads V5 & V6 orient over the LEFT side of the heart Leads V3 &V4 orient over the INTERVENTRICULAR SEPTUM (the right and left branches course through the i t th interventricular septum) ti l t )

CHEST LEADS (Unipolar)

Each lead records from a different angle (viewpoint) provides different view of the same cardiac activity