ELECTROCARDIOGRAM .

PRIYADHARSHINI
ANAESTHESIA TUTOR
• INTRODUCTION
• LEADS
• WAVES OF ECG
• ECG BOXES
• P WAVE
• QRS COMPLEX
• USES
• ECG CHANGES AND DIAGNOSIS
 INTRODUCTION
• ELECTRICARDIOGRAM IS A REPRESENTATION OF THE
ELECTRICAL ACTIVITY
OF THE CARDIAC CYCLE.
• WILLIEN EINTHOVEN DUTCH PHYSIOLOGIST FATHER OF
MODERN ELECTROCARDIOGRAPHY – HE DEVOLOPED THE
TECHNICAL OF ELECTROCARDIOGRAPHY.
 LEADS

2TYPES
• BIPOLAR LEADS
• UNIPOLAR LEADS
4LIMBS AND 6 LEADS COLOUR
• R ( RIGHT WRIST) - (RED)
• L (LEFT WRIST) - 💛(YELLOW )
• N ( NEUTRAL ) - 🖤(BLACK)
• F(FOOT) - 💚(GREEN)
• V1 or C1 - (RED)
• V2 or C2 - 💛(YELLOW)
• V3 or C3 - 💚(GREEN)
• V4 or C4 - 🤎(BROWN)
• V5 or C5 - 🖤(BLACK)
• V6 or C6 -💜(PURPLE )
WAVES

• P WAVE - ATRIAL DEPOLARIZATION

• QRS – VENTRICLE DEPOLARIZATION
• T WAVE – VENTRICULAR REPOLARIZZATION
 ECG BOXES

• 1mm – one small box

• 5mm – one big box
SPEED
• 25mm/s Normal
• X axis 1mm – 0.04sec
5mm- 0.20 sec
• Y axis 1 mm – 0.1mV
5mm- 0.5 mV
ECG PAPER
RHYTHM

• R-R INTERVAL IS EQUAL .THIS IS A NORMAL SINUS RHYTHM .

• IRREGULAR RR INTERVAL IS CALLED SINUS ARRHYTHMIA
 RATE
• TAKE THE NUMBER OF “BIG BXES”BETWEEN NEIGHBORING QRS
COMPLEXES ,AND DIVIDE THIS INTO 300.THE RESULT WILL BE
APPROXIMATELY EQUAL TO THE RATE.
ALTHOUGH FAST , THIS METHOD ONLY WORKS FOR REGULAR RHYTHMS.
REGULAR RHYTHM = 300 DVIDE RR INTERVAL [LARGE BOX]
IRREGULAR RHYTHM = NO.OF.R WAVES IN 6 SEC MULTIPLE 10
 P WAVE

1.INCREASE - RIGHT ATRIAL ENLARGEMENT

2.INCREASE M SHAPED - LEFT ATRIAL ENLARGEMENT
3.DECREASE OR ABSENT - HYPERKALEMIA OR ATRIAL FIBRILATION
 QRS COMPLEX

• PROLONGED - HYPERKALEMIA
• M SHAPE SEEN IN V1
W SHAPE SEEN IN V6 - BUNDLE OF BLOCK
• BROAD QRS - VENTRICULAR ARRYTHMIA
 Q - T INTERVAL

PROLONGED - LONG Q T SYNDROME

MYOCARDIAL INFARCTION
MYOCARDITIS
HYPOTHYROIDISM
HYPOCALCEMIA
SHORTENED - SHORT Q T SYNDROME HYPERCALCEMIA
 ST SEGMENT

• ELEVATED - ANTERIOR OR INFERIOR MYOCARDIAL INFARCTION

LEFT BUDLE BRANCH BLOCK
ACUTE PERICARDITIS
• DEPRESSED - ACUTE MYOCARDIAL ISCHEMIA
POSTERIOR MYOCARDIAL INFARCTION
VENTRICULAR ENLARGEMENT
HYPOKALEMIA
• SHORTENED - HYPERCALCEMIA
• PROLONGED - HYPOCALCEMIA
QUIZ
QUESTIONS

• What is p wave?
• What is qrs wave?
• What is T wave?
• Large box calculation?
• Small box calculation?
• Father of electrocardiography?