Electrocardiogra(m)phy
prakash
Willem Einthoven receives Nobel Prize
The EKG is not only the oldest but, in fact, over 100 years
after its introduction, continues as the most commonly used
cardiovascular laboratory procedure.
The electrocardiography is a technique of
recording the bio-electric currents generated
by the heart. The graphical display of this
recording is called electrocardiogram.
Electrocardiography
ECG - electrocardiogram
graphic recording of electrical events
established electrode pattern results in specific
tracing pattern
electrical pattern reveals blood supply problems
Electrophysiology
If an electrode is placed so that wave of
depolarization spreads toward the recording
electrode, the ECG records a positive (upward)
deflection.
If wave of depolarization spreads away from
recording electrode, a negative (downward)
deflection occurs.
Cardiac Cycle
Cardiac Cycle: the electrical, pressure and
volume changes that occur in a functional
heart between successive heart beats.
• Phase of the cardiac cycle when
myocardium is relaxed is termed diastole.
• Phase of the cardiac cycle when the
myocardium contracts is termed systole.
Atrial systole: when atria contract.
Ventricular systole: when ventricles contract.
Flow of Cardiac Electrical
Activity
SA node Atrial muscle
Internodal Atrial muscle
conducting
fibers
AV node (slow)
Purkinje fiber
Ventricular muscle
conducting system
Cardiac Anatomy
Superior
vena cava
Pulmonary
veins Atrioventricular (AV) node
Sinoatrial (SA)A node Left atrium
Atrial muscle Mitral valve
Internodal
conducting
tissue
Tricuspid valve Purkinje
Ventricluar fibers
muscle
Inferior Descending aorta
vena cava
ECG
Electrical currents generated
by cardiac muscle during
depolarization &
repolarization spread
into the tissues surrounding
the heart and are conducted
through the body fluids
ECG
3 distinct waves are
produced during
cardiac cycle
P wave caused by
atrial depolarization
QRS complex caused
by ventricular
depolarization
T wave results from
ventricular
repolarization
Fig 13.24
13-63
Components of the ECG
• P wave: Depolarization of both atria
• Relationship between P and QRS helps distinguish various
cardiac arrhythmias
• Shape and duration of P may indicate atrial enlargement
• PR interval: from onset of P wave to onset of QRS
• Normal duration = 0.12-2.0 sec (120-200 ms) (3-4 horizontal
boxes)
• Represents atria to ventricular conduction time (through His
bundle)
• Prolonged PR interval may indicate a 1st degree heart block
Components of the ECG
• QRS complex: Ventricular depolarization
• Larger than P wave because of greater muscle mass of
ventricles
• Normal duration = 0.08-0.12 seconds
• Its duration, amplitude, and morphology are useful in
diagnosing cardiac arrhythmias, ventricular hypertrophy,
electrolyte derangement, etc.
Components of the ECG
ST segment:
• Connects the QRS complex and T wave
• Duration of 0.08-0.12 sec (80-120 msec
T wave:
• Represents repolarization or recovery of ventricles
• Interval from beginning of QRS to apex of T is referred to as the
absolute refractory period
QT Interval
• Measured from beginning of QRS to the end of the T wave
• Normal QT is usually about 0.40 sec
• QT interval varies based on heart rate
START OF P
WAVE
P wave peak
Later P wave
End of P & starting of Q
• PR interval:
• From onset of P wave to onset of QRS
• Normal duration = 0.12-2.0 sec (120-200
ms) (3-4 horizontal boxes)
• Represents atria to ventricular conduction
time (through His bundle)
• Prolonged PR interval may indicate a 1st
degree heart block
Fig. 13.24g
Normal EKG
Q-T interval
0.35 sec
P-R
interval
R R
0.16 sec
P T P T
Atrial Q Ventricular Q
depolarizatio S repolarization S
n
Ventricular
depolarizatio
n
Electrocardiographic Leads
limb leads
Three Bipolar Limb Leads= “bipolar” means
that the ECG is recorded from two electrodes
located on different sides of the heart i.e. on
the limbs
“lead” is not a single wire connecting from the
body but a combination of two wires and their
electrodes to make a complete circuit between
the body and the electrocardiograph
Types of ECG Recordings
Bipolar leads record voltage
between electrodes placed on
wrists & legs (right leg is
ground)
Lead I records between right
arm & left arm
Lead II: right arm & left leg
Lead III: left arm & left leg
Fig 13.23
13-61
Interpretation of ECG
Through ECG analysis, it is possible to trace the
conduction through the heart, the size and orientation
of the heart, and even to locate regions of the heart
which have suffered injury, ischemia (oxygen
deprivation), or necrosis (tissue death).
Sinus Bradycardia
Sinus Tachycardia
Sinus Arrhythmia
Ventricular Fibrillation
1st Degree Heart
Block 2nd Degree Heart
Block
3rd Degree
Heart Block
Premature Atrial Contraction
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