ECG Teaching

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ECG Teaching

The ECG is the most important test for interpretation of the cardiac
rhythm, conduction system abnormalities, and the detection of myocardial
ischemia.

The ECG is also of great value in the evaluation of other types of cardiac
abnormalities including valvular heart disease, cardiomyopathy,
pericarditis, and hypertensive disease.

Finally, the ECG can be used to monitor drug treatment (specifically


antiarrhythmic therapy) and to detect metabolic disturbances.

Pattern recognition is helpful

The ECG is a plot of voltage on the vertical axis against time on the
horizontal axis.

The ECG waves are recorded on special graph paper that is divided into 1
mm2 grid-like boxes

ECG paper speed is ordinarily 25 mm/sec. As a result, each 1 mm (small)


horizontal box corresponds to 0.04 sec (40 ms), with heavier lines forming
larger boxes that include five small boxes and hence represent 0.20 sec
(200 ms) intervals.

Vertically, the ECG graph measures the height (amplitude) of a given wave
or deflection. The standard calibration is 10 mm

This electrical activity generated by the heart can be measured by an array of electrodes placed
on the body surface.

The different waves that comprise the ECG represent the sequence of depolarization and
repolarization of the atria and ventricles. The different waves that comprise the ECG represent
the sequence of depolarization and repolarization of the atria and ventricles.
The different waves that comprise the ECG represent the sequence of depolarization and
repolarization of the atria and ventricles.

P wave (atrial depolarization)


PR interval, which normally ranges from 0.12 to 0.20 seconds in duration.

QRS complex (ventricular depolarization) The duration of the QRS complex is


normally 0.06 to 0.10 seconds.

ST segment. This represents the period at which both ventricles are completely
depolarized. The ST segment is very important in the diagnosis of ventricular ischemia or
hypoxia because under those conditions, the ST segment can become either depressed or
elevated.

T waves - The T wave represents ventricular repolarization.


U wave - Sometimes a small positive U wave may be seen following the T wave (not shown in
figure at top of page). This wave represents the last remnants of ventricular
repolarization. Inverted T waves or prominent U waves indicate underlying pathology or
conditions affecting repolarization.

QT interval
Sinus rhythm
Sinus Tachycardia
Sinus Bradycardia

Tachycardia

Atrial

Ventricular
Brady arrythmias

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