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    Electrocardiogram (E.C.G)

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    Jamuna Patel
    The electrocardiogram (ECG or EKG) records the electrical activity of the heart. Metal electrodes placed on the skin detect the tiny electrical changes on the skin that arise from the heart muscle's electrophysiologic pattern of depolarizing and repolarizing during each heartbeat. The ECG provides important information about heart rate and rhythm, as well as evidence of any damage to heart muscle. A standard 12-lead ECG allows assessment of the heart from multiple angles. Key aspects of the ECG that are evaluated include the P, QRS, and T waves as well as intervals like PR and QT. Abnormalities in these patterns can indicate conditions like arrhythmias, conduction defects, myocardial infarction or ischemia

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    © All Rights Reserved
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    Electrocardiogram (E.C.G)

    Uploaded by

    Jamuna Patel
    50 views51 pages
    The electrocardiogram (ECG or EKG) records the electrical activity of the heart. Metal electrodes placed on the skin detect the tiny electrical changes on the skin that arise from the heart muscle's electrophysiologic pattern of depolarizing and repolarizing during each heartbeat. The ECG provides important information about heart rate and rhythm, as well as evidence of any damage to heart muscle. A standard 12-lead ECG allows assessment of the heart from multiple angles. Key aspects of the ECG that are evaluated include the P, QRS, and T waves as well as intervals like PR and QT. Abnormalities in these patterns can indicate conditions like arrhythmias, conduction defects, myocardial infarction or ischemia

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    ECG

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    The electrocardiogram (ECG or EKG) records the electrical activity of the heart. Metal electrodes placed on the skin detect the tiny electrical changes on the skin that arise from the heart muscle's electrophysiologic pattern of depolarizing and repolarizing during each heartbeat. The ECG provides important information about heart rate and rhythm, as well as evidence of any damage to heart muscle. A standard 12-lead ECG allows assessment of the heart from multiple angles. Key aspects of the ECG that are evaluated include the P, QRS, and T waves as well as intervals like PR and QT. Abnormalities in these patterns can indicate conditions like arrhythmias, conduction defects, myocardial infarction or ischemia

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    50 views51 pages

    Electrocardiogram (E.C.G)

    Uploaded by

    Jamuna Patel
    The electrocardiogram (ECG or EKG) records the electrical activity of the heart. Metal electrodes placed on the skin detect the tiny electrical changes on the skin that arise from the heart muscle's electrophysiologic pattern of depolarizing and repolarizing during each heartbeat. The ECG provides important information about heart rate and rhythm, as well as evidence of any damage to heart muscle. A standard 12-lead ECG allows assessment of the heart from multiple angles. Key aspects of the ECG that are evaluated include the P, QRS, and T waves as well as intervals like PR and QT. Abnormalities in these patterns can indicate conditions like arrhythmias, conduction defects, myocardial infarction or ischemia

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 51

    Electrocardiogram

    ( E.C.G)
    Electrocardiogram ( E.C.G)
    • A recording of the electrical activity of the
    heart .
    • The E.C.G records these cardiac electrical
    activity by means of metal electrodes.
    • Electrical activity is followed by mechanical
    event
    Metal Electrode placement.
    The ECG Paper
    • Horizontally
    – One small box - 0.04 s
    – One large box - 0.20 s
    • Vertically
    – One large box - 0.5 mV
    ECG Graph Paper

    • Runs at a paper speed of 25 mm/sec


    • Each small block of ECG paper is 1 mm2
    • At a paper speed of 25 mm/s, one small block
    equals 0.04 s
    • Five small blocks make up 1 large block which
    translates into 0.20 s (200 msec)
    • Hence, there are 5 large blocks per second
    • Voltage: 1 mm = 0.1 mV between each individual
    block vertically
    Normal Impulse Conduction
    Sinoatrial node

    AV node

    Bundle of His

    Bundle Branches

    Purkinje fibers
    Basic ECG waves
    P wave - Atrial depolarization
    QRS – Ventricular depolarization
    T wave - Ventricular repolarization
    The 12-Lead ECG

    • The 12-Lead ECG sees the heart from 12


    different views.
    • Therefore, the 12-Lead ECG helps you
    see what is happening in different
    portions of the heart.
    The 12-Leads

    The 12-leads include:


    –3 Limb leads
    (I, II, III)
    –3 Augmented leads
    (aVR, aVL, aVF)
    –6 Precordial leads
    (V1- V6)
    How waves are formed
    • When the wave of depolarisation spreads
    towards the positive pole of the lead there is
    positive deflection
    • When the wave of depolarisation spreads
    away from the positive pole of the lead there
    is negative deflection
    12-Lead ECG Strip
    Reading 12-Lead ECGs
    The best way to read 12-lead ECGs is to develop a step-by-step
    approach
    1. Calculate RATE
    2. Determine RHYTHM
    3. Determine QRS AXIS
    4. Calculate DURATION AND INTERVALS
    5. Assess for HYPERTROPHY
    6. Look for evidence of INFARCTION OR ISCHEMIA
    Heart rate
    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.
    QUICK WAY

    R wave
    Heart rate calculation

    • Calculate no. of large or small boxes between R-R


    interval
    Heart rate = no of large boxes / 300
    = no of small boxes / 1500.
    Heart rate calculation ( cont.)
    6 sec (30 large boxes)

    – Count the no of R waves in a 6 second( 30 large boxes)


    rhythm strip, then multiply by 10.
    or
    – Count the no of R waves in a 10 second rhythm strip, then
    multiply by 6 .
    Normal Sinus Rhythm (NSR)

    • Etiology: the electrical impulse is formed in


    the SA node and conducted normally.
    • For rhythm check the rhythms strip ( lead ll )
    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
    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?
    Normally 1 P wave precedes every QRS
    AXIS
    Axis refers to the mean QRS axis (or vector) during
    ventricular depolarization.
    The direction of current flows leftward and downward
    because most of the ventricular mass is in the left
    ventricle
    Position of leads
    Limb leads
    I = +0o
    II = +60o
    III = +120o

    Augmented
    leads
    avL = -30o
    avF = +90o
    avR = -150o
    Position of leads wrt Body

    LEFT
    RIGHT ARM
    ARM

    RIGHT LEFT LEG


    LEG
    Axis
    • The normal QRS axis lies
    between -30o and +100o

    QRS Complexes
    I II Axis
    + + normal

    + - left axis deviation


    • A quick way to determine right axis deviation
    - +
    the
    QRS axis is to look at the - - right superior
    QRS complexes in leads I axis deviation
    DURATION AND INTERVALS
    P wave.
    • Depolarization of both atria
    • WIDTH = 0.12 seconds ( 3 small boxes)
    • Amplitude = 2.5 mm.

    • Right atrial enlargement ----- tall p wave


    • Left atrial enlargement ------- wide and notched
    Right atrial enlargement
    – Take a look at this ECG. What do you notice about the P waves?

    The P waves are tall, especially in leads II, III and avF.
    Left atrial enlargement
    – Take a look at this ECG. What do you notice about the P waves?

    Notched

    Negative deflection

    The P waves in lead II are notched and in lead V1


    they have a deep and wide negative component.
    PR interval
    • PR interval: from onset of P wave to onset of QRS

    • Normal duration = 0.12-2.0 sec (120-200 ms)


    (3-5 small boxes)
    • Represents atria to ventricular conduction time
    (through His bundle)
    • Allows time for ventriculars to fill.
    First–degree AV node block
    • is when conduction through AV node > 0.2 sec ( 5
    small boxes)
    – Causes long P-R interval
    Second-degree AV node block
    Mobitz’s type 1 ( wenckebach) progressive prolongation of pr
    interval and then a drop

    Mobitz’s type 2 prolonged pr interval but remains constant and


    then drop
    Third-degree or complete AV node block
    • no atrial activity passes to ventricles
    – Ventricles driven slowly by bundle of His or
    Purkinjes
    QRS complex:
    • Represents ventricular depolarization
    • Normal duration = LESS THAN 100 MSECS
    • WIDE --- Ventricular rhythm , bundle
    branch block, ventricular
    tachycardia ,ventricular fibrillation
    • Tall --- ventricular hypertrophy.
    Right ventricular hypertrophy
    – Take a look at this ECG. What do you notice about the axis and QRS
    complexes over the right ventricle (V1, V2)?

    There is right axis deviation (negative in I, positive in II) and


    there are tall R waves in V1, V2.
    Left ventricular hypertrophy
    Take a look at this ECG. What do you notice about the axis and QRS
    complexes over the left ventricle (V5, V6) and right ventricle (V1, V2)?

    There is left axis deviation (positive in I, negative in II) and there are
    tall R waves in V5, V6 and deep S waves in V1, V2.
    Bundle branch blocks.

    Right axis deviation Left axis deviation


    Wide QRS complex Wide QRS complex
    ST segment and T wave:

    • Represents repolarization or recovery of ventricles


    • ST segment is isoelectric
    • Ischemia • Infarction

    • ST depression • ST elevation .

    Which Wall = which leads

    Anterior wall Lateral wall


    v1 v2 v3 v4 l avL V5 V6

    Inferior wall
    ll lll avf
    OTHER MI
    • High lateral wall • Posterior wall MI
    ONLY IN l and avL Opposite changes seen
    • Extensive anterior wall in v1 v2 .
    MI Tall R wave ,
    V1 – V6 ST depression
    • Anterior septal T wave inversion.
    V1- V2
    • Strict Anterior wall
    V3-V4
    Different ST Depression
    Stages of Infarction

    SIGNS OF
    INFARCTION

    •ST elevation
    •T wave
    inversion
    •Deep and
    wide q wave
    Anterior wall MI

    • ST elevation in v1 v2 v3 v4
    • Reciprocal changes ( ST depression in ll lll avf )
    Lateral wall MI

    • ST elevation in l avL
    • Reciprocal changes ( ST depression in ll lll avf v1 v2 v3 )
    Inferior wall MI

    • ST elevation in ll lll avf


    • Reciprocal changes ( ST depression inv1 v2 avL )
    QT Interval
    • Measured from beginning of QRS to
    the end of the T wave
    • Normal QT is usually about 0.44 sec
    • QT interval varies based on heart
    rate
    • The faster the heart beats, the faster
    the ventricles repolarize so the shorter
    the QT interval. Therefore what is a
    “normal” QT varies with the heart rate.
    For each heart rate you need to
    calculate an adjusted QT interval,
    called the “corrected QT” (QTc):
    • QTc = QT / square root of RR
    interval
    Arrhythmia Formation
    Atrial cells
    SA Node
    Premature Atrial
    Sinus Bradycardia Contractions (PACs)
    Sinus Tachycardia Atrial Flutter
    Atrial fibrillation

    Ventricular cause AV Junctional cause


    Premature Ventricular Paroxysmal Supraventricular
    Contractions (PVCs) Tachycardia
    Ventricular Fibrillation AV Junctional rhythm
    Ventricular Tachycardia
    Atrial fibrillation

    Atrial Flutter
    Atrial Premature Contraction

    Ventricular Premature Contraction


    Junctional Rhythm

    Paroxysmal Supraventricular tachycardia

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