ELECTROCARDIOGRAPHY
WEEK 5
HISTORY OF ECG
HISTORY OF ECG
• 1842- Italian scientist Carlo Matteucci realizes that electricity is associated with
the heart beat.
• 1876- Irish scientist M a r y analyzes the electric pattern of frog's heart.
• 1895- William Einthoven, credited for the invention of EKG
• 1906 - using the string electrometer EKG, William Einthoven diagnoses some
heart problems
• 1924- the noble prize for physiology or medicine is given to William Einthoven
for his work on EKG
• 1938 -AHA and Cardiac society of great Britain defined and position of chest
leads
INTRODUCTION
An electrocardiogram or ECG
• Is a graphic recording of the electrical
activity of the heart
• Converts the heart’s electrical activity into
lines called “waveforms
• Can be seen on a monitor or printed out
paper
THE WIRING DIAGRAM OF THE HEART
PURPOSE/IMPORTANCE
vverify these alterations in heart rhythm
vprovides information about the specific type
of heart disease
vprovides information about which region in
the heart is affected.
REASON WHY ECG IS DONE
vIf the patient had heart disease in the past.
vIf the patient has a medical condition that predisposes to
heart disease, such as hypertension, diabetes, high
cholesterol, or inflammatory disease.
vIf the patient has other significant risk factors for cardiac
disease.
vAn ECG is also required prior to any type of heart surgery.
INDICATIONS
v heart arrhythmias
v conduction abnormalities
v Myocardial infarction
v CAD
v hypertrophic cardiomyopathy
v signs of congenital electrical abnormalities
v electrolyte imbalances
v congenital heart defects
v infections involving the heart
RISK AND CONTRAINDICATIONS
• ECG is a safe test that does not cause
health complications.
EXAMINATION PROTOCOL
1. Before the Examination
• No preparation required for taking ECG.
1. During the Test
• Pre-Test- Once in position, a total of ten electrodes are
attached with a sticky, but easy-to-remove adhesive. One
electrode is placed on each arm and leg, and six on the chest.
EXAMINATION PROTOCOL
3. POST TEST- AFTER THE TEST the electrodes
are removed
• There are no limitations on patient’s activity
• Rarely, the adhesive can cause allergic reactions or rashes,
which may not be obvious until about 24 hours after the test.
RESPONSIBILITIES OF ECG TECHNICIAN
1.The technicians should remind the patients to lie flat and
relaxed as possible
2.Remind the patient not to wear jewelries/metal during
ECG.
3.Check the machine for proper standardization.
4.Check if the machine is properly grounded.
5.The technicians should ensure correct placement of leads
while taking ECG
ECG EQUIPMENT
ECG EQUIPMENTS
ECG EQUIPMENTS
Electrodes
• Are applied at specific locations on
the patient's chest wall and
extremities to view the heart's
electrical activity from different
angles and planes
ECG EQUIPMENT
LEAD WIRES OR CABLE CONNECTIONS
• Clip
• Snap
ECG EQUIPMENT
ECG paper
• is a graph paper used to measure rates
of impulse formation and the duration
of the electrical events that occur in
the heart
• Made up of vertical and horizontal lines,
which form large and small boxes
LEAD SYSTEM
• A 12-lead electrocardiogram (ECG) is a medical
test that is recorded using leads, or nodes,
attached to the body. Electrocardiograms,
sometimes referred to as ECGs, capture the
electrical activity of the heart and transfer it to
graphed paper.
• The ECG is made up of 12 characteristic views of
the heart:
§ 6 from limb leads
§ 6 from chest leads
6 LIMB LEAD
1. 3 Bipolar limb leads
§ (Standard limb leads)- I, II, III
2. 3 Unipolar Augmented leads
§ (aVR, aVL, aVF)
§ Obtained through 4 electrodes
placed on the RA,RL,LA,LL
6 CHEST LEADS (V1,V2,V3,V4,V5,V6)
ØV1- Electrode positioned in the 4th intercostal
space in the right sternal border
ØV2- 4th ICS in the left sternal border
ØV3- Midway between V2 and V4
ØV4- 5th ICS in the left midclavicular line
ØV5- Same level as V4, anterior axillary line
ØV6- Same level as V4 and V5 ,midaxillary line
NORMAL ECG
P WAVE
• The P wave is the first positive deflection
on the ECG
• It represents atrial depolarization /
contraction
• Normal duration: < 0.12 s (< 120ms or 3
small squares)
• In a sinus rhythm, there should be a P
wave before each QRS complex
QRS COMPLEX
• Represents ventricular depolarization.
• Composed of 3 waves:
ØQ wave is the first negative deflection.
ØR wave is the first positive deflection
after the P wave.
ØS wave is the negative deflection
following R wave.
PR INTERVAL
• Measured from the beginning of P
wave to the beginning of QRS
complex.
• The normal PR interval is 0.12 - 0.2
sec, represented by 3-5 small
squares.
ST SEGMENT
• an isoelectric line representing early
ventricular repolarization
T WAVE
• The T wave is the positive
deflection after each QRS
complex.
• It represents ventricular
repolarisation.
U WAVE
• results from slow repolarization
of ventricular Purkinje fibers
• The U wave is a small (0.5 mm)
deflection immediately following
the T wave, usually in the same
direction as the T wave.
QT INTERVAL
• represents total time required
for ventricular depolarization
& repolarization from the
beginning of QRS complex to
the end of T wave
• normal QT interval is 0.36 to
0.45 sec
