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# ELECTRO CARDIOGRAM ECG

BASIC PRINCIPLE

LEARNING OBJECTIVES
At the end of the lecture the student should be able to know
Basic principle in generation of ECG waves
About ECG paper and its calibration

ELECTROCARDIOGRAM ECG
Graph of electrical activity of heart

hypokalemia)

tests

hypothermia

## PROPAGATING ACTIVATION WAVEFRONT

At rest, cells have a negative transmembrane
voltage surrounding media is positive
When cells depolarize, they switch to a positive
transmembrane voltage surrounding media
becomes negative
This leads to a propagating electric vector
(pointing from negative to positive)

## Wave of depolarization traveling towards a positive

electrode causes an upward deflection on the ECG

## Wave of depolarization traveling away from a

positive electrode causes a downward deflection on
the ECG.

COMPONENT OF ECG
WAVES
P atrial depolarization
QRS complex ventricular depolarization
T ventricular repolarization
SEGMENTstraight line between waves
S-T segment
end of ventricular depolarization to start of vent.
Repolariztion
INTERVAL---wave+segment
P-R interval
Q-T interval

RECORDING ECG
ECG PAPER
Recorded on a calibrated graph paper
Smallest divisions are 1mm square in both X and Y axis
Runs at a paper speed of 25 mm/sec
X axis represent time
Y axis represents voltage
On Y axis 1 mm=0.1 mV
On X axis 1mm =0.04 sec

VERTICAL AXIS
1 small square = 0.1 mV
10 small square =10 mV
1 big square = 5 small square = 0.5 mV
2 big square = 10 smallsquare= 1 mV
ECG PAPER HORIZONTAL AXIS
1 inch = 1 second
Each inch is divided by dark black lines into 5 big square
Each big square= 1/5=0.2 sec

## Each big square is further divided into 5 small square

1 small square = 0.2/5= 0.04 sec
1smallsquare = 0.04 sec =1mm
1 second =25 smallsquare
60second =1min =25 X 60=1500 small square =300 big square

## ECG PAPER CALIBRATION

two electrodes which are placed on body surface and connected to
ECG machine for measuring the potential fluctuations between two
points
Standard ECG has 12 lead system

Another classification is

1 positive 1 neagtive elecrode
Right arm always negative
Left leg always positive
L1 between LA(+) and RA(-)
L2 between LF(+) and RA(-)
L3 between LF(+) and LA(-)

1 positive electrode
1negative reference point
aVL,aVF, aVR
Verticalplane
V1-V6

horizontalplane

aVR
from Right Arm Positive
Other 2limbs negative
aVL
from Left Arm Positive
RA and LF negative
aVF
from Left Foot Positive
RA and LA negative

POSITION
V1

V2

V3

V4

V5

V6

## Fifth ICS Left mid axillary line

The 12 leads allow tracing of electric vector in all three
planes of interest

Bipolar

I, II, III

Unipolar

## aVR, aVL, aVF (augmented limb leads)

V1-V6

ANATOMIC GROUPS

P WAVE
Depolarization of both atria;
First upward deflection

## Followed by QRS complex

Shape and duration of P may indicate atrial
enlargement

PR INTERVAL

QRS COMPLEX

of ventricles

## Composed of Q, R ,and S wave

Q wave
negative deflection after P wave
Depolarization of septum
Not always seen
R wave
First positive wave after Q or P
S wave
Negative
J POINT
Point where QRS complex returns to isoelectric line
Beginning of ST segment

ST SEGMENT
Early repolarization of ventricles
From Jpoint to onset of T wave

T WAVE:

## Interval from beginning of QRS to apex of T is referred to

as the absolute refractory period

QT INTERVAL

wave

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