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LA RA (SAN) (HB) VV
(BB)
(AVN)
RA
LA
Diastole
Recovery Recovery
Electrical
Excitation
Depolarization
Shortening
Repolarization
Lengthening Relaxation Filling
Mechanical
Contraction Emptying
Cardiac arrhythmias
Insufficient coronary blood flow
BIPOLAR LIMBS LEADS Lead I Lead II Lead III Left arm Left leg Left leg Positive input
aVR
aVL aVF V1
Right arm
Left arm Left leg
Positive input
V2
V3 V4 V5 V6
Paper speed
25 mm/second 50 mm/second
6. QRS-complex morphology
7. ST-segment morphology
8. T-wave morphology
9. QTc interval
Q R R
QS
The normal cardiac rhythm is called sinus rhythm because it is produced by electrical impulses formed within the SA node Sinus rhythm is essentially but not absolutely regular The P-wave axis of sinus rhythm is between 300 and 750 An abnormal P-wave axis is usually accompanied with an abnormally short PR interval. However, a short PR interval with in the presence of normal P-wave axis suggests an abnormal conduction pathway
P waves and QRS complexes are used to determine cardiac rate and regularity Over a particular interval of time, normally, there are same numbers of P waves and QRS complexes Heart rate: * 1500 divided by number of small squares between successive P waves or QRS complexes * 300 divided by number of large squares between successive P waves or QRS complexes Normal heart rate: 60-100 beats per minute (bpm)
Normal axis: between 30 degrees and +90 degrees Right axis deviation (RAD): between +90 degrees and 180 degrees
Left axis deviation (LAD): between 30 degrees and 120 degrees
-1200
-90 0
-600
aVR -1500
1800 150 0
1200
III
900
60 0
aVF
II
P-wave morphology
1. The contour: is normally smooth and monophasic (entirely positive or negative) in all leads except V1 or occasionally V2 2. Upright or positive P waves are normally seen in leads I, II, aVL, aVF, V4-V6 and downward in lead aVR. P wave in lead III may be either upright or downward. 3. P-wave duration is normally less than 0.12 seconds 4. The maximal amplitude is normally no more than 0.2 mv
Abnormal P waves
The PR interval
1. The PR interval measures the time required for an electrical impulse to travel from the atrial myocardium adjacent to the SA node to the ventricular myocardium adjacent to the fibers of the Purkinye network 2. The duration is normally from 0.11 to 0.20 seconds
3. PR interval varies with the heart rate. The faster the heart rate, the shorter the PR interval
Abnormal PR interval
1. Q waves
The presence of Q waves in leads V1, V2, and V3 should be consider abnormal. The absence of small Q waves in leads V5 and V6 should be consider abnormal
Abnormal Q waves
Abnormal Q waves
2. R waves
The positive R wave normally increases in amplitude and duration from lead V1 to V4 or V5. Loss of normal R-wave progression is considered abnormal
3. S wave
S wave should be large in V1 and then progressively smaller to V6
4. Ratio of R/S
Amplitude in V1 and V2 is normally less than 1. R in V5 or V6 + S in V1 or V2 is not more than 35 mm
Abnormal R wave in V1
abnormality
6. Amplitude of QRS complex
is no more than 0.5 mV in any limb leads and no more than 1.0
mV in any of the precordial leads
0.19 s
Morphology of the ST
segment
1. The ST segment represents the period during which the ventricular myocardium remains in an activated or depolarized state 2. ST segment normally located at the same horizontal level with the PR segment 3. Normal variations: Slight upsloping, downsloping, or horizontal depresion Early repolarization : displacement of ST segment by as much as 0.1 mV in the direction of the ensuing T wave 4. ST segment may be altered when there is prolonged QRS complex
Normal ST segment
U waves
The T wave
The T waves are positively directed in all leads except aVR (negative) and V1 (biphasic) T waves do not normally exceed 0.5 mV in any limb lead or
The U wave
U wave is either absent or present as a small wave following the T wave and is usually most prominent in leads V1 and V2. Increased prominence of the U wave indicates the possibility of hypokalemia
1. The QT interval measures the duration of electrical activation and recovery of the ventricular myocardium 2. The QT interval decreases as the heart rate increases and therefore should be corrected for cardiac rate (QTc interval) 3. QTc= QT/RR interval (in seconds) The upper limit of QTc is 0.46 second (slightly longer in females) 4. QT interval varies among different leads. The longest QT interval measured in multiple leads should therefore be considered the true QT interval
Thank You
What is an Electrocardiogram ?
An ECG is the recording (gram) of the
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Depolarizing cell
Resting cells
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Depolarized cells
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Depolarized cells
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Repolarizing cell
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Repolarized cells
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