Electrical Conduction and ECG

ECG

 Muscle cell is electrically activated, result is mechanical

response.
 ECG (electrocardiogram) measures the electrical activation
(depolarization ) and recovery (repolarization) of the cell
membranes of the myocardial tissue.
 ECG does not measure and mechanical response of the heart,
however, since electrical and mechanical activities are closely
related, ECG is used to diagnose certain abnormalities of the
mechanical action of the heart.

 areas of ischemia or myocardial damage

 LV Hypertrophy
 electrolyte disturbances / drug toxicity
 Normal Cardiac Cycle

Systole Diastole

Electrical Depolarization Repolarization

“impulse “activate” “recovery”
”
Mechanic Contract Relax
al “empty” “fill”
“pump,
contracti
on”
ECG Complexes
 Cardiac Vectors

 The electrical potentials produced by the heart are the sum of minute
amounts of electricity generated from each individual cardiac muscle
cell.
 A vector is the visual representation of the summation of the millions of
individual depolarizations.
 A vector is a graphic illustration of a physical force that has both
magnitude and direction.
 Electrical current can be represented by a vector.
 When atrial and ventricular myocytes depolarize and repolarize, a large
current is created.
 ECG reflects the electrical activity of the entire heart – the sum of all the
action potentials of all the cardiac cells.
 Cardiac Vectors

 The deflections recorded by an ECG are either isoelectric, positive or

negatively deflected depending on the orientation of the axis of the
recording lead with respect to the direction of the current.

 Vector travelling in the same direction, toward the positive electrode

will be recorded as Positive
 Vector travelling in the opposite direction, away from the positive
electrode will be recorded as Negative
 Vector travelling on an angle to the axis (either toward or away from
positive electrode) will have less amplitude
 Vector of current flow is directed perpendicular to the axis in either
direction will be recorded as biphasic.
 Biphasic deflection has equal positive and negative components.
• ECG description
• amplitude (voltage)
• recorded in mm
• positive or negative or biphasic
• width (duration)
 Axis

Quadrants
 Normal – positive lead I and aVF
 Left – positive lead I and negative aVF
 Right – negative lead I and positive aVF
 Extreme right – negative lead I and aVF

AXIS
ECG Complexes
 ECG Paper
 Small boxes = 1 mm / 0.04 seconds
Large boxes = 5 mm / 0.20 seconds

One second is 5 large boxes

Three seconds is 15 large boxes
Six seconds is 30 large boxes
Each minute has 300 large boxes
 Paper speed = 25 mm / sec
 What Is In Each Beat?
(the cardiac cycle in waves, complexes, and intervals)

 P Wave – atrial contraction or depolarization, (usually upright)

 QRS Complex – time for ventricular contraction or depolarization

(usually upright) (0.06 - 0.11 sec) (delays in the bundle branches will
widen the QRS)
 T Wave – ventricular repolarization “recharging” (usually upright)

 PR Interval – time between atrial depolarization to ventricular

depolarization (beginning of P wave to beginning of QRS)(0.12 - 0.20sec)

(prolonged PR = delays in the AV node conduction)
 QT Interval – represents one complete ventricular depolarization and

repolarization (beginning of QRS to the end of the T wave) (0.32 – 0.44sec)

(disturbances are usually due to electrolyte disturbances or drug effects)
ECG Complexes
Reading a Rhythm Strip
What Do I Look For?
Regularity - What is the R – R Interval?

Rate - Is the rate normal (60-100), slow, or fast?

***Six-second strip method - (30 big boxes) & multiply
times ten

P Wave – Is there a P wave before every QRS? Is it upright?

QRS Complex – Is there a normal QRS complex following

each P wave? Wide or normal?

T wave – How does your T wave look? Upright?

Measure your intervals – PR Interval, QRS, QT

 ECG Waves

 P wave
 atrial
depolarization
 ≤ 2.5 mm in
amplitude
 < 0.12 sec in
width
 PR interval (0.12 -
0.20 sec.)
 time of stimulus
through atria and AV
node
 prolonged interval
= first-degree
heart block
 ECG Waves
 QRS
 Ventricle depolarization
 Q wave: when initial deflection is negative
 R wave: first positive deflection
 S wave: negative deflection after the R wave
 ECG Waves
 QRS
 May contain R wave only
 May contain QS wave
only
 Small waves indicated
with small letters (q, r, s)
 Repeated waves are
indicated as ‘prime’
 Q waves
 Pathologic Q waves are a sign of previous myocardial
infarction.
 They are the result of absence of electrical activity. A myocardial
infarction can be thought of as an electrical 'hole' as scar tissue is
electrically dead and therefore results in pathologic Q waves.

 Pathological (abnormal) Q waves are defined as greater than 1/3

the height of the R wave, greater than 0.04 sec (40 msec) in
duration.
 ECG Waves

 QRS
 width usually 0.12 second or less
 ECG Waves

 RR interval
 interval between two consecutive QRS complexes
 ECG Waves
 J point:
 end of QRS wave
 beginning of ST segment
 ST segment
 beginning of ventricular repolarization

 normally isoelectric (flat)

 changes, elevation or depression, may indicate pathological

condition
ECG Waves
 ECG Waves

 T wave
 part of ventricular repolarization
 asymmetrical shape
 usually not measured
 normally upright in lead II
 ECG Waves
 QT interval

 from beginning of QRS to the end of the T wave

 ventricular repolarization
 length varies with heart rate

RR HR QT
(sec) (bpm) (sec)

1.00 60 0.43

0.40 150 0.27

 ECG Waves

 Rate Corrected QT Interval

 QTc = QT divided by square root of RR
 normal is less than or equal to 0.44 sec.
 ECG Waves

 Long QT interval
 certain drugs
 electrolyte disturbances
 hypothermia
 ischemia
 infarction
 subarachnoid hemorrhage

 Short QT interval
 drugs or hypercalcemia
 ECG Waves

U Wave
 last phase of repolarization
 small wave after the T wave
 not always seen
 significance is not known
 Heart Rate Calculation

 Count boxes (for regular rhythm HR)

 Count the number of large boxes
between two consecutive QRS
complexes. Divide 300 by that
number
 300 ÷ 4 = 75
 Count the small boxes. Divide 1500
by that number
 1500 ÷ 20 = 75
 Heart Rate Calculation

most accurate
1500 divided by the
take time to calculate
number of small boxes
only use with regular
between two R waves
rhythms

300 divided by the

quick 1 lg sq = 300 bpm
not too accurate 2 lg sq = 150 bpm
number of large boxes
only use with regular
between two R waves 3 lg sq = 100 bpm
rhythm
4 lg sq = 75bpm
5 lg sq = 60 bpm
10 multiplied by the less precise 6 lg sq = 50 bpm
number of R waves in 6 use with irregular rhythms
seconds very quick
 The ECG as a Combination of Atrial and
Ventricular Parts

 Atrial ECG = P wave

 Ventricular ECG = QRS-T waves
 Normally, sinus node paces the heart and P wave precedes QRS
 P-QRS-T
 Sometimes, atria and ventricles paced separately (e.g. complete
heart block)