ECG
Dr. Saba Murad
DPT, MS-CPPT, PGC(Aus)
Lecturer FUIRS
INTRODUCTION
⚫ The heart is a vital link in the oxygen transport system, pumping blood to
the pulmonary and peripheral circulation systems to supply oxygen and
other nutrients required for metabolism in all tissues.
⚫ The beating heart generates rhythmic, electrical impulses that cause
mechanical contraction, or the pumping action, of cardiac muscle. Some
of the electrical current produced by these rhythmic impulses is
detectable by electrodes that may be placed on the surface of the skin.
⚫ Current flow during the cardiac cycle is then recorded as the
characteristic waveforms of the electrocardiogram(ECG).
⚫ Mechanical events such as contraction and relaxation of the myocardium
are inferred from the waveforms produced by the ECG.
ECG
• A recording of the electrical activity of the heart over time
• Gold standard for diagnosis of cardiac arrhythmias
• Helps detect electrolyte disturbances (hyper- & hypokalemia)
• Allows for detection of conduction abnormalities
• Screening tool for ischemic heart disease during stress tests
• Helpful with non-cardiac diseases (e.g. pulmonary embolism)
Electrocardiogram (ECG/EKG)
• Is a recording of electrical activity of heart conducted thru ions in
body to surface
Normal conduction pathway:
• SA node -> atrial muscle -> AV node -> bundle of His -> Left and Right
Bundle Branches -> purkinje fibers -> Ventricular muscle
Heart Excitation Related to ECG
Electricity of the heart
• The contraction of any muscle is associated with electrical changes
called “depolarization” and these changes can be detected by the
electrodes placed on the surface of the body.
• Although heart has 4 chambers , from electrical point of view it can
be thought of as having two, why??
Wiring diagram of the heart
Rhythm of the heart
• The word “rhythm” is used to refer the part of the heart which is
controlling the activation sequence.
• The normal heart rhythm with electrical activation beginning in the SA
node is called “sinus rhythm”
Recording the ECG
12 leads include
• 3 standard leads
• 3 unipolar leads
• 6 chest or pericordial leads
• Each lead incorporates two electrodes measuring the potential or
voltage difference between them.
• The positive electrodes detects the electrical impulse while neutral
electrodes completes the circuit.
Unipolar leads
• Lead AvR attached to right arm
• Lead AvL attached to left arm
• Lead AvF attached to left leg
Standard leads
• Lead 1: the exploring electrode is attached to left arm and neutral to
the right arm
• Lead 2: exploring electrode to the left leg and the neutral electrode to
the rt arm
• Lead 3: exploring electrode to the left leg and the neutral electrode to
the left arm.
Chest leads
• V1 and V2 assess the right ventricle
• V3 and V4 interventricular septum
• V5 and V6 anterior and lateral aspect of the heart
ECG
⚫ 3 distinct waves are
produced during
cardiac cycle
⚫ P wave caused by atrial
depolarization
⚫ QRS complex caused
by ventricular
depolarization
⚫ T wave results from
ventricular
repolarization
Fig 13.24
13-
Determination of Heart Rate
Measure sinus pause?
The pause is measured by placing your caliper tips on the last R wave just prior to the pause and the R wave
immediately following the pause. Count the number of small boxes and multiply by 0.04 second .
AXIS
• Examine LEAD I and AVF for axis….
• Put ur thumb of LEFT hand on QRS’s direction in LEAD I and thumb of
RIGHT hand on QRS copmlex’s direction in LEAD AVF ……
• AXIS IS DETERMINED BY “UP THUMB”
Which axis????
Which axis????
Location of infarct combinations
I aVR V1 V4
ANT
LATERAL POST ANT
II aVL V2
SEPTAL
V5
ANT
V3 V6 LAT
III aVF
INFERIOR
ECG FINDINGS IN MYOCARDIAL ISCHEMIA AND INFARCTION
ISCHEMIA INFARCTION
• ST segment • Abnormal Q waves;
depression; T wave • ST segment elevation
inversion; or depression;
• Q waves absent • T waves inverted,
normal, or upright.
Which wall MI???
Do you think this person is having a myocardial
infarction. If so, where?
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this person is having an acute anterior wall myocardial
infarction.
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Which wall MI???
Now, where do you think this person is having a
myocardial infarction?
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Inferior Wall MI
This is an inferior MI. Note the ST elevation in leads II,
III and aVF.
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Which wall MI???
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Anterolateral MI
This person’s MI involves both the anterior wall (V2-V4)
and the lateral wall (V5-V6, I, and aVL)!
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