Electrocardiography

(ECG)
 Electrocardiogram

• Recording of electrical activity caused by action potentials generated on the

outer surface of ventricular and atrial chambers

• The obtained curve is called an electrocardiogram

• The recording device is called an electrocardiograph

 Electrocardiograph specifications

Electrodes: flat metal plates for connection on the limbs and chest

Lead wires: with different colors and abbreviated signs related to hands, feet and chest

Amplifier: to amplify and enlarge the size of the potentials

Recording screen
• Power button (to turn the device on and off)
• Start/stop button (to start or stop the electrocardiogram recording)
• Earth wire (to conduct excess electrical currents and device noises to
ground)
• Mode button ( Manual or Automatic)
• Sensitivity button (to determine the amplitude and voltage of
electrocardiogram waves)
10, 20 ,50 mm/1mv
• Paper speed (velocity) button (to determine the time of the waves and
other components of the electrocardiogram )

10, 25, 50 mm/sec

• Filter button (to eliminate electrical currents caused by other muscles
and nervous system)
ECG paper
 Lead I

270°

I
180° 0° • Right hand : negative electrode
• Left hand : positive electrode
90°

7
 Lead II

270°

II
180° 0° • Right hand : negative electrode
• Left foot : positive electrode
90° 60°

8
 Lead III

• Left hand : negative electrode

270°
• Left foot : positive electrode

III
180° 0°

120° 90°

9
 aVR

• Right hand : positive

270° electrode
210°
aVR • Left hand and left foot :
180° 0° negative electrode

90°

11
 aVL

270°
• Left hand : positive
electrode
-30°
aVL • Right hand and left foot :
180° 0°
negative electrode
90°

12
 aVF

270° • Left foot : positive electrode

-30° • Right and left hand : negative
aVF
180° 0° electrode

90°

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 Precordial (chest) Leads

V1: fourth intercostal space to right of

sternum
V2: fourth intercostal space to left of
sternum
V3: directly between leads V2 and V4
V4: fifth intercostal space at left
midclavicular line
V5: level with V4 at left anterior axillary
line
V6: level with V5 at left midaxillary line
 Determining normal sinus rhythm
The existence of the equal and isomorphic P wave in each selected
lead (Lead II).
Positive P wave in lead II and negative in aVR

Normal PR interval (0.12- 0.20 msec)

Normal heart rate (60-100 beats/min)

Equal RR or PP intervals in the selected lead

Determining the electrical axis of the
heart
Average = 59°

Normal range = -30° to +110°

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To calculate the electrical axis of the heart, two limb leads (out of 6 leads) should
be selected.

In this example, leads I and III are selected.

Calculate the algebraic sum of the QRS complex voltage in the lead I

Determine the resulting algebraic sum on the vector of lead I

Draw a perpendicular to the specified point on the vector of lead I

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Calculate the algebraic sum of the QRS
complex voltage in the lead III

Determine the resulting algebraic sum on

the vector of lead III

Draw a perpendicular to the specified point

on the vector of lead III

From the intersection point of the two drawn

perpendiculars, draw a vector towards the
center of the circle and then extend it to
intersect the circle.

The obtained vector is the electrical axis of

the heart

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 Calculation of the heart rate using electrocardiogram

60
1) Divide 60 by the average RR distance RR

2) Divide 1500 by the number of small squares between two

consecutive RR
1500
Number of small squares

3) Divide 300 by the number of large squares between two consecutive RR

300
Number of large squares

22