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ECG
The Normal Electrocardiogram (ECG)
The record of potential fluctuations of
myocardial fibers at the surface of the body ELECTROCARDIOGRAM (ECG) • ECG is the surface recording of the summated electrical activity of the heart for each beat by placing surface electrodes (Leads).
• Body is a Volume conductor, electrical
activity of the Heart are conducted all over the body for each beat.
• Instrument used for recording ECG is
called Electrocardiograph, which amplifies the electrical signals. Procedure of ECG recording • Electrocardiograph: Instrument which records electrical signals on a ‘mm’ graph paper at a speed of 25 mm/sec. • 2 methods of recording, 1.‘Bipolar’ or Standard limb leads of Einthoven 2.Unipolar leads ‘Bipolar’ or Standard limb leads of Einthoven 2 active electrodes (Exploring) • Lead I: records potential bet RA–LA, • Lead II: records between RA- LF, • Lead III: records between LA- LF Unipolar recording 1. Active or Exploring electrode
Indifferent Electrode Kept at ‘Zero’
Potential
• VL – left arm, • VF – left foot & • VR- Right Arm. • Precordial Leads of Wilson: V1 to V6 • Influenced by the part of the heart nearest to the electrodes.
• V1 to V6 – Horizontal plane Precordial Chest Leads NORMAL ECG & ITS WAVES: ‘P’ WAVE • Duration: 0.1 sec, +ve wave • Amplitude:0.1 to 0.12mV • Due to Atrial Depolarization • Represents the spread of impulse from SA node to atrial muscles Start of ECG Cycle Early P Wave Later in P Wave QRS- COMPLEX ‘
• Ventricular depolarization,
• QRS- 0.08-0.12 Sec.duration
• ‘QRS’ COMPLEX; ‘
DEPOLARIZATION OF VENTRICULAR MUSCLE
•‘Q’ small –ve wave, Due to mid- portion of inter-ventricular septal depolarization.
•‘R’ wave: prominent,+ ve wave,
depolarization of major portion of ventricles.
•‘S’ wave –ve ,represents the
activation of postero-basal portion. Early QRS Later in QRS S-T segment: • Long iso -electric period from the end of ‘s’ to beginning of ‘T’. 0.08 SEC ‘. S-T Segment T’ wave: ventricular repolarization duration 0.27 sec Amplitude:0.3mv +ve wave,, end coincides with closure of semi lunar valves Early T Wave Later in T-Wave Back to where we started Electrical Activity of Myocardium 1) atrial depolarization begins 2) atrial depolarization complete (atria contracted) 3) ventricles begin to depolarize at apex; atria repolarize (atria relaxed) 4) ventricular depolarization complete (ventricles contracted) 5) ventricles begin to repolarize at apex 6) ventricular repolarization complete (ventricles relaxed) Heart block • Blockage of impulses generated by SA node • Impulses fails to reach cardiac muscle. • 2types: • Sinoatrial block • Atrioventricular block Sinoatrial block
• 40-60BEATS/MIN Atrioventricular block • Impulses are not transmitting from atria(AV node) to ventricles. • 2 TYPES: • INCOMPLETE BLOCK • COMPLETE BLOCK • INCOMPLETE BLOCK • Transmission of impulses from atria(AV node) to ventricles is slow down not blocked completely • 4types: • First degree • Second degree • Wenckebach phenomenon • Bundle branch block • COMPLETE BLOCK • Transmission of impulses from atria to ventricles is blocked completely • Ventricles beat in their own rhythm • Cause: • Disease of AV node--leads to AV nodal block • Defective conductive system
