ECG – Basic Principles

Dr. Bantayehu Sileshi, Associate Professor, VUMC

August 19, 2021
Learning Objectives
• The electrocardiogram (ECG) provides a graphic record of the electrical
activity of the heart.

• Depolarization of cardiac cells proceeds in an orderly fashion in the

normal situation beginning in the sinus node, and then spreading
sequentially through the atria, atrioventricular (AV) node, and ventricles.

• The sequential movement of electrical current with each depolarization,

from the sinus node to the entire ventricular myocardium, creates
specific phases of the ECG.

• The electrical activity of the heart is captured by recording electrodes or

“leads” placed on both arms and legs (called the limb leads), and six on
the chest (called the precordial leads).
Outline

Cardiac Cell Action Potential

ECG lead placement

Basic principles of ECG Analysis

Outline

Cardiac Cell Action Potential

ECG lead placement

Basic principles of ECG Analysis

 Ventricular Nodal Action
Action Potential Potential
ECG
Outline

Cardiac Cell Action Potential

ECG lead placement

Basic principles of ECG Analysis

Limb Lead System (3 lead ECG)
Augmented Limb Leads (5 lead ECG)
Precordial Leads
Outline

Cardiac Cell Action Potential

ECG lead placement

Basic principles of ECG Analysis

ECG Grid
• P wave - <0.12 sec (3 small boxes)

• PR interval – 0.12-0.2 sec (3-5

small boxes)

• QRS – 0.06 – 0.12sec

(1 ½ - 2 ½ small boxes)

• QT - <0.44 sec
Heart Rate Determination

• 300 / number of large boxes between two QRS complexes

OR

• 60 / Time between QRS complexes

Learning Objectives
• The electrocardiogram (ECG) provides a graphic record of the electrical
activity of the heart.

• Depolarization of cardiac cells proceeds in an orderly fashion in the

normal situation beginning in the sinus node, and then spreading
sequentially through the atria, atrioventricular (AV) node, and ventricles.

• The sequential movement of electrical current with each depolarization,

from the sinus node to the entire ventricular myocardium, creates
specific phases of the ECG.

• The electrical activity of the heart is captured by recording electrodes or

“leads” placed on both arms and legs (called the limb leads), and six on
the chest (called the precordial leads).