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Basics of ECG

The document provides an overview of basics of electrocardiography (ECG) including: 1) It describes the normal impulse conduction pathway through the heart and explains how this relates to the components of the ECG (P wave, QRS complex, T wave). 2) It outlines the steps for analyzing cardiac rhythm on an ECG - calculating the heart rate, determining regularity, assessing P waves, and measuring the PR interval and QRS duration. 3) It provides an example of normal sinus rhythm on ECG and explains that this rhythm results from the normal conduction of the electrical impulse through the heart's pacemaking and conduction system.

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Nachiket Vijay Potdar
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243 views32 pages

Basics of ECG

The document provides an overview of basics of electrocardiography (ECG) including: 1) It describes the normal impulse conduction pathway through the heart and explains how this relates to the components of the ECG (P wave, QRS complex, T wave). 2) It outlines the steps for analyzing cardiac rhythm on an ECG - calculating the heart rate, determining regularity, assessing P waves, and measuring the PR interval and QRS duration. 3) It provides an example of normal sinus rhythm on ECG and explains that this rhythm results from the normal conduction of the electrical impulse through the heart's pacemaking and conduction system.

Uploaded by

Nachiket Vijay Potdar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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BASICS OF ECG

Chapter Objectives
• To recognize the normal rhythm of the heart -
“Normal Sinus Rhythm.”

• To recognize the 13 most common rhythm


disturbances.

• To recognize an acute myocardial infarction on a


12-lead ECG.
Normal Impulse Conduction

Sinoatrial node

AV node

Bundle of His

Bundle Branches

Purkinje fibers
Impulse Conduction & the ECG

Sinoatrial node

AV node

Bundle of His

Bundle Branches

Purkinje fibers
Cardiac Action Potential
Smooth Muscle Contraction
The “PQRST”

• P wave - Atrial
depolarization

• QRS - Ventricular
depolarization

• T wave - Ventricular
repolarization
The PR Interval

Atrial depolarization
+
delay in AV junction
(AV node/Bundle of His)

(delay allows time for the


atria to contract before
the ventricles contract)
Pacemakers of the Heart

• SA Node - Dominant pacemaker with an intrinsic


rate of 60 - 100 beats/minute.

• AV Node - Back-up pacemaker with an intrinsic


rate of 40 - 60 beats/minute.

• Ventricular cells - Back-up pacemaker with an


intrinsic rate of 20 - 45 bpm.
Brief Cardiac Anatomy
Inferior Surface of the Heart
Limb Leads of ECG
The ECG Paper
• Horizontally
– One small box - 0.04 s
– One large box - 0.20 s
• Vertically
– One large box – 1 mm
The ECG Paper (cont)

3 3
sec sec
• Every 3 seconds (15 large boxes) is marked by a
vertical line.
• This helps when calculating the heart rate.

NOTE: the strips used for this slide and the following
slides are not marked but all are 6 seconds long.
ECG Rhythm Interpretation

How to Analyze a Rhythm


Chapter Objective
• To recognize the normal rhythm of the heart -
“Normal Sinus Rhythm.”
Rhythm Analysis

• Step 1: Calculate rate.


• Step 2: Determine regularity.
• Step 3: Assess the P waves.
• Step 4: Determine PR interval.
• Step 5: Determine QRS duration.
Step 1: Calculate Rate

3 3
• Option 1 sec sec
– Count the # of R waves in a 6 second rhythm strip,
then multiply by 10.
– Reminder: all rhythm strips in the Modules are 6
seconds in length.

Interpretation?

9 x 10 = 90 bpm
Step 1: Calculate Rate

R
wave

• Option 2
– Find a R wave that lands on a bold line.
– Count the # of large boxes to the next R wave. If the
second R wave is 1 large box away the rate is 300, 2
boxes - 150, 3 boxes - 100, 4 boxes - 75, etc. (cont)
Step 1: Calculate Rate

3 1 1
0 5 0 7 6 5
0 0 0 5 0 0

• Option 2 (cont)
– Memorize the sequence:
300 - 150 - 100 - 75 - 60 - 50

Interpretation? Approx. 1 box less than


100 = 95 bpm
Step 2: Determine regularity

R R

• Look at the R-R distances (using a caliper or


markings on a pen or paper).
• Regular (are they equidistant apart)? Occasionally
irregular? Regularly irregular? Irregularly
irregular?
Interpretation? Regular
Step 3: Assess the P waves

• Are there P waves?


• Do the P waves all look alike?
• Do the P waves occur at a regular rate?
• Is there one P wave before each QRS?
Interpretation? Normal P waves with 1 P
wave for every QRS
Step 4: Determine PR interval

• Normal: 0.12 - 0.20 seconds.


(3 - 5 boxes)

Interpretation? 0.12 seconds


Step 5: QRS duration

• Normal: 0.04 - 0.12 seconds.


(1 - 3 boxes)

Interpretation? 0.08 seconds


Rhythm Summary

• Rate 90-95 bpm


• Regularity regular
• P waves normal
• PR interval 0.12 s
• QRS duration 0.08 s
Interpretation? Normal Sinus Rhythm
Normal Sinus Rhythm (NSR)

• Etiology: the electrical impulse is formed in the


SA node and conducted normally.

• This is the normal rhythm of the heart; other


rhythms that do not conduct via the typical
pathway are called arrhythmias.
NSR Parameters

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