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+2
JAR
-2
B -
+ A
POS
NEG
BATTERY
EINTHOVENS TRIANGLE
AND LIMB LEADS
B
B
String Galvanometer
Schematic.
VOLTAGE!!
As amplitude in
Millivolts.
Baseline at 0mv
TIME!!
Duration in fractions of a second
Atrial Depolarization
P wave (Lead I)
Zero
potential
P
+
+
0
-
Peak
Potential
Right Bundle
Branch
Septal fascicle
P
Left Anterior
Fascicle
P= Purkinje Fibers
Ventricular Septal
Depolarization- the Q Wave
0
Q
3
4
+
0
B.
A
B.
+
+
QRS Configurations
RSR
QRS
RS
QR
QS
+
0
A
0
+A
-150
B -
-B
B
120
A
B 90
-30
A
V6
V5
V1
V2
Over right
ventricle
V3
Over the
Left Ventricle
V4
Over Interventricular
Septum
Z
X
Anterior Leads
V1,V2,V3,V4
Inferior Leads
II,III,AVF
Left lateral
Leads
I, AVL,V5
V6
180
G
F
E
A B
C D Mean Vector
+90
Lead I 0
Lead
II
Lead III
Lead III
Lead
120
II
REMEMBER EINTHOVEN
60
Lead I 0
Lead III
120
Lead
II
60
-90
-60
aVR- -150
aVL - -30
+180
I- 0
Normal
+150
Range
III- +120
+30
II - +60
aVF- + 90
-90
Lead II QRS UP
-30
I-0
+180
Lead I
QRS UP
+150
II - +60
+90
-30
NORMAL AXIS
+60
Lead perpendicular to the
isoelectric QRS
II
Cardiac Muscle
-----------------++++++++++
Lead
Meter
Cardiac Muscle
++++ ---------------- +++++
Lead
Meter
Cardiac Muscle
---------+++++
++++
------Lead
Meter
LA
RA
M
ea
n
QR
S
RV
LV
Lead I
+
+
Lead II
I
AVF
Extreme
Right axis
deviation
AVF
Left axis
deviation
0 Lead I
Right axis
deviation.
Normal axis
I
AVF
AVF
+90 Lead AVF
Ventricular Hypertrophy 1
Limb Leads
Precordial Leads
Ventricular Hypertrophy 2
Precordials
S wave
R exceeding 18mm
R exceeding 26mm
Wind 10 knots
20 knots
LEAD I
Perpendicular
Mean Vectors
-
No Voltage Reading
LEAD I
NO PROJECTED VECTOR!!!!!
LEAD I
Figure B
.02 sec
.05 sec
.035 sec
.06 sec
6mm
6mm
RS waves
R= 8mm
S= -2mm
Total = 8-2=6mm
or .6mv
-15
170
170
NORMAL
INFARCTED
J point in V2
an anterior
Lead
Cardiac Arrhythmias
Result from disturbances of
IMPULSE
PROPAGATION
IMPULSE
INITIATION
Conduction Blocks
Reentry rhythms
SA Node
Ectopic Foci
Alteration of SA Rhythm
Autonomic nervous system usually
involved.
P, QRS, T waves normal.
Duration of Cardiac Cycle P-P interval
shortened or prolonged.
Sinus Bradycardia- Slow Rhythm.
Sinus Tachycardia- Fast Rhythm.
Cardiac frequency changes gradually.
Bradycardia
Normal Rhythm
Bradycardia
Tachycardia
Normal Rhythm
Tachycardia
AV Transmission Blocks
Impulse transmission through
conduction tissue blocked.
His Bundle Electrogram may be used
to localize block.
Atrial Wave
His Bundle
Wave
V
Ventricular wave
Paroxysmal Tachycardia
Abrupt onset and termination.
Origin is ectopic site.
Reentry circus movements most
frequent cause.
High frequency.
Can cause lightheadedness or
syncope.
Rapid contractions reduce ventricular
filling.
Paroxysmal Supraventricular
Tachycardia
Fibrillation
Arrhythmia that is ineffectual in
pumping blood.
Atria or Ventricles may be involved.
Is due to fragmentation of reentry
loop into multiple irregular circuits.
Atrial Fibrillation
Ventricular Fibrillation
Mechanism of Ventricular
Fibrillation
Causes of reentry
Circus movements
60 Hz AC Induced VF
60Hz 120VAC
Applied here
End result
Atrial Flutter
F wave
Normal EKG
SEQUENTIAL APPROACH TO
THE EKG
Gain familiarity with the normal EKG.
Evaluate the rhythm.
Calculate rate.
Evaluate each P wave, QRS, ST segment
and T wave in each lead.
Mean QRS Axis
Abnormalities of the P wave
Abnormalities of the QRS
ST and T wave abnormalities.
Each individual
horizontal and vertical
line is ruled in 1 mm
Each horizontal space
represent a time
interval of 0.04 sec
Each vertical space
represents a voltage
change of 0.1 mv
0.5
mv
0.2 sec.
HEART RHYTHM
Every P wave followed by a QRS.
Every QRS preceded by a P wave
P wave upright in leads I, II, III
PR interval greater than .12 sec
P wave rate 60-100BPM with < 10%
variation. < 60 - sinus bradycardia,
>100sinus tachycardia. Variation of
more than 10% = Sinus arrhythmia
= 1500
# of small boxes between 2 beats
Example
23
AV BLOCK
Exercise Intolerance
Hyperkalemia
Haemodialysis
Hypokalemia
Vomiting (prolonged)