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ELECTRO CARDIOGRAM ECG

BASIC PRINCIPLE

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

ELECTROCARDIOGRAM ECG
Graph of electrical activity of heart

Gold standard for diagnosis of cardiac arrhythmias

Helps detect electrolyte disturbances (hyper- &


hypokalemia)

Allows for detection of conduction abnormalities

Screening tool for ischemic heart disease during stress


tests

Helpful with non-cardiac diseases (e.g. pulmonary embolism or


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)

PROPAGATING ACTIVATION WAVEFRONT

BASIC PRINCIPLE OF ECG RECORDING

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

ECG LEADS SYSTEM


Lead
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
6 limb leads

6 chest leads
Another classification is
Bipolar leads---- standard limb leads
Unipolar leads---- augmented limb leads, chest leads

BIPOLAR LIMB LEADS


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(-)

UNIPOLAR LEADS
1 positive electrode
1negative reference point
Summation of 2 negative leads
Augmented unipolar limb leads
aVL,aVF, aVR
Verticalplane
Precordialchest leads
V1-V6

horizontalplane

AUGMENTED LIMB LEADS


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

PRECORDIAL (CHEST) LEAD


POSITION
V1

Fourth ICS, right sternal border

V2

Fourth ICS, left sternal border

V3

Equidistant between V2 and V4

V4

Fifth ICS, left Mid clavicular Line

V5

Fifth ICS Left anterior axillary line

V6

Fifth ICS Left mid axillary line

ECG INFORMATIONIN DIFFERENT LEADS


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

SUMMARY OF LEADS

Bipolar

Limb Leads

Precordial Leads

I, II, III

(standard limb leads)


Unipolar

aVR, aVL, aVF (augmented limb leads)

V1-V6

ANATOMIC GROUPS

P WAVE
Depolarization of both atria;
First upward deflection

Duration less than 0.1 sec

Followed by QRS complex


Shape and duration of P may indicate atrial
enlargement

PR INTERVAL

From onset of P wave to onset of QRS

Normal duration = 0.12-2.0 sec (120-200 ms) (3-4 horizontal boxes)

Represents atria to ventricular conduction time (through His bundle)

Prolonged PR interval may indicate a 1st degree heart block

QRS COMPLEX

Represents ventricular depolarization

Larger than P wave because of greater muscle mass


of ventricles

Normal duration = 0.08-0.12 seconds

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:

Represents repolarization or recovery of ventricles

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


as the absolute refractory period

QT INTERVAL

Measured from beginning of QRS to the end of the T


wave

Normal QT is usually about 0.40 sec

QT interval varies based on heart rate

EVENTS IN FORMATION OF ECG WAVES

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