ECG

LECTURE
GINAFER G. DE GUIA
Level III Medical Resident
Electrocardiogram
Graphic interpretation of
electric potentials generated by
the heart
ACTION POTENTIAL
• The resting membrane potential is determined by the
conductance to K+ and approaches the K+ equilibrium
potential

• Inward current brings positive charge into the cell and

depolarizes the membrane potential.

• Outward current takes positive charge out of the cell and

hyperpolarizes the membrane potential

• The role of Na+K+-adenosine triphosphatase (ATPase) is to

maintain ionic gradients across cell membranes.
NORMAL PACEMAKER
RATES
• SA Node – Rate 60-100 bpm

• AV Node – Rate 40-60bpm

• Purkinje Cells- Intrinsic Rate of 15-40bpm

12 Leads ECG
12 leads includes:
• 3 limb leads (I, II, III)
• 3 Augmented leads ( aVL, aVR. aVF)
• 6 precordial leads (V1-V6)
LIMB LEADS
AUGMENTED LEADS
CHEST LEADS
The Right Sided 12-Lead
ECG
15 Lead ECG
BASIC STEPS in ECG
Reading
R hythm
H eart Rate

Mean A xis
H ypertrophy

Intervals/Infarction
Mis cellaneous
Step 1: Identify the
basic RHYTHM
Assess the P waves
Determine the REGULARITY
Step 2: Determination
of the RATE
Step 2: Determination
of the AXIS
Step 3: Determination of
Chamber Enlargements
(HYPERTROPHY)
Step 4: Check for
Abnormalities
(INFARCTION)
ECG Criteria for Infarct/Ischemia

• Ischemia
• > 2 contiguous leads
• ST Segment depression - >1mm
• Deep T wave Inversion - >5mm
• Infarction
• ST Elevation
• >1 mm in limb leads
• >2mm in chest leads
• Pathologic Q waves
• > 0.04 sces
• >25% of R wave
5.5 – 6.5 – Peaking or tenting of T waves
6.5 – 7.5 – Diminution of P waves
7 – 8 – Widening of QRS
> 8 – Sinewave pattern
Normal Sinus Rhythm
Sinus Bradycardia
Sinus Tachycardia
Sinus Pause