ECG
Presented By
Dr. Khalada Akter
MBBS, MD (Physiology)
Assistant Professor
Department of Physiology
Eastern Medical College,
Cumilla
When the cardiac impulse passes through the heart,
electrical current also spreads from the heart into the adjacent
tissues surrounding the heart.
A small portion of the current spreads all the way to the surface
of the body.
If electrodes are placed on the skin on opposite sides of the
heart, electrical potentials generated by the current can be
recorded; the recording is known as an electrocardiogram.
Electrocardiogram (ECG)
Definition of ECG: ECG is a graphical representation of the
electrical activity associated with heart beat.
ECG principle
Because the body fluids are good conductors (because the
body is a volume conductor), fluctuations in potential that
represent the algebraic sum of the action potentials of
myocardial fibers can be recorded extracellularly.
The record of these potential fluctuations during the cardiac
cycle is the (ECG) electrocardiogram.
The electrocardiogram is composed of both depolarization
and repolarization waves.
Electrocardiograph
Is the instrument by which the electrical activities of the
heart are recorded.
Relationship of the Electrocardiogram
to the Cardiac Cycle
The electrocardiogram shows the P, Q,
R, S, and T waves.
They are electrical voltages generated
by the heart and recorded by the
electrocardiograph from the surface of
the body.
Relationship of the Electrocardiogram
to the Cardiac Cycle
The P wave is caused by spread of
depolarization through the atria,
and this is followed by atrial
contraction, which causes a slight
rise in the atrial pressure curve
immediately after the
electrocardiographic P wave.
Relationship of the Electrocardiogram
to the Cardiac Cycle
The QRS waves appear as a result of
electrical depolarization of the
ventricles, about 0.16 second after the
onset of the P wave, which initiates
contraction of the ventricles and
causes the ventricular pressure to
begin rising.
The QRS complex begins slightly
before the onset of ventricular systole.
Relationship of the Electrocardiogram
to the Cardiac Cycle
The ventricular T wave in the
electrocardiogram, represents the
stage of repolarization of the ventricles
when the ventricular muscle fibers
begin to relax. Therefore, the T wave
occurs slightly before the end of
ventricular contraction.
Characteristics of the Normal
Electrocardiogram
The normal electrocardiogram is composed of a P wave, a QRS
complex, and a T wave.
The QRS complex is often, but not always, three separate
waves: the Q wave, the R wave, and the S wave.
The P wave is caused by electrical potentials generated
when the atria depolarize before atrial contraction begins.
The QRS complex is caused by potentials generated when
the ventricles depolarize before contraction, that is, as
the depolarization wave spreads through the ventricles.
Therefore, both the P wave and the components of the
QRS complex are depolarization waves.
The T wave is caused by potentials generated as the
ventricles recover from the state of depolarization. This
process normally occurs in ventricular muscle 0.25 to
0.35 second after depolarization, and the T wave is
known as a repolarization wave.
The major complexes in ECG are
‘P’ wave, is produced due to the depolarization of atrial
musculature.
Duration = 0.1 sec.
Amplitude = 0.1 – 0.12 mV.
‘QRS’ complex, is obtained because of the depolarization of
ventricular muscle
Duration = 0.08 – 0.1 sec.
‘T’ wave, is due to the ventricular repolarization. Duration = 0.2 sec.
How to read an ECG?
Interpretation/ Findings of ECG
The ECG paper speed is ordinarily 25 mm/sec. As a result,
each 1 mm (small) horizontal box corresponds to 0.04 sec
(40 ms)
Normal Electrocardiogram
INTERVALS AND SEGMENTS OF ECG
‘P-R’ interval:
It is the interval between the onset of ‘P’ wave and the onset of ‘Q’ wave.
The normal duration is 0.18 sec. and varies between 0.12 and 0.2 sec.
Clinical significance:
‘P-R’ interval is prolonged in bradycardia and first degree heart block.
It is shortened in tachycardia, Wolf-Parkinson-White syndrome, Lawn-
Ganong-Levine syndrome, Duchenne muscular dystrophy and type II
glycogen storage disease.
INTERVALS AND SEGMENTS OF ECG
‘Q-T’ Interval:
Duration: 0.4-0.42 sec.
Clinical Significance:
‘Q-T’ interval is prolonged in long ‘Q-T’ syndrome, myocardial
infarction, myocarditis, hypocalcemia and hypothyroidism.
‘Q-T’ interval is shortened in short ‘Q-T’ syndrome and hypercalcemia.
‘S-T’ Segment:
Duration: 0.08 sec.
The time interval between the end of ‘S’ wave and the onset of ‘T’
wave is called ‘S-T’ segment. It is an isoelectric period.
‘R-R’ Interval
Significance:-
‘R-R’ interval signifies the duration of one cardiac cycle.
Duration: The normal duration of ‘R-R’ interval is 0.8
second when heart rate is 75 beats/min.
Measurement of ‘R-R’ interval helps to calculate:
•Heart rate
•Heart rate variability
60
Heart rate
R R interval
Clinical Significance
‘P’ wave:-
‘P’ wave is normally positive (upright) in leads I, II, aVF, V4, V5, and
V6. It is normally negative (inverted) in aVR. It is variable in the
remaining leads, i.e. it may be positive, negative, biphasic or flat.
Variation in the duration, amplitude and morphology of ‘P’ wave
helps in the diagnosis of several cardiac problems such as:
Right atrial hypertrophy: ‘P’ wave is tall (more than 2.5 mm) in lead
II. It is usually pointed.
ECG LEADS
• ECG is recorded in 12 leads which are generally classified
into two categories.
• Bipolar leads
• Unipolar leads
Bipolar Leads:
Also known as standard limb leads
There are three standard limb leads:
Limb lead I
Limb lead II
Limb lead III
The unipolar leads are of two types:
Unipolar limb leads
Unipolar chest leads
Unipolar limb leads are of three types:
aVR lead:- Active electrode is from right arm.
aVL lead:- Active electrode is from left arm.
aVF lead:- Active electrode is from left leg (foot).
Position of Chest Leads
V1 : Over 4th intercostals space
near right sternal margin
V2 : Over 4th intercostals space
near left sternal margin
V3 : In between V2 and V4
V4 : Over left 5th intercostals
space on the mid clavicular line
V5 : Over left 5th intercostals
space on the anterior axillary line
V6 : Over left 5th intercostals
space on the mid axillary line
Thank You
