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Ecg Basics

The document provides an overview of ECG basics, including: 1. The conduction system of the heart consists of specialized tissues that initiate cardiac muscle contraction. 2. ECG is a graphical representation of the main electrical vector passing under an electrode, showing changes in heart electrical activity over time. 3. Key intervals and segments of the ECG include the P wave, PR interval, QRS complex, ST segment, QT interval, and RR interval.

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Kailas Nath
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76 views

Ecg Basics

The document provides an overview of ECG basics, including: 1. The conduction system of the heart consists of specialized tissues that initiate cardiac muscle contraction. 2. ECG is a graphical representation of the main electrical vector passing under an electrode, showing changes in heart electrical activity over time. 3. Key intervals and segments of the ECG include the P wave, PR interval, QRS complex, ST segment, QT interval, and RR interval.

Uploaded by

Kailas Nath
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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ECG BASICS

DR KAILAS NATH K M
AZEEZIA MEDICAL COLLEGE
What shall we discuss today?
• Introduction
• Conduction system of heart
• Electrical vector and axis
Introduction
• A line graph that shows changes
in the electrical activity of the
heart over time.

• Willem Einthoven invented the


first practical electrocardiograph
(1895)
Conduction System of Heart

The conductive system of the


heart consists of five
specialized tissues.
• 1. SA node
• 2. AV node
• 3. Bundle of His
• 4. LBB and RBB
• 5. Purkinje fibers.
Electrocardiography
• Electrical impulses generated by the
specialized tissues initiates
contraction of cardiac muscles.
• - millions of vectors in different
directions
• - The resultant vector is known as the
electrical axis of the ECG
• Hence, ECG is a graphical
representation of the electrical
movement of the main vector
passing under an electrode or a lead.
Electrical Vector
Negative Deflection Equipolar Deflection Positive Deflection
• Positive impulse moving :
• Away from the lead  -ve deflection
• Towards the lead  +ve deflection

But when the electrode is in the middle


of the vector, the ECG machine converts
it into positive deflection for the
amount of energy that is coming
towards the electrode and the negative
wave for the amount of energy that is
going away from the electrode.
ECG Leads
ECG paper X-axis  in units of time (sec or milli-sec)
Y-axis  in units of length (mm)

Small square = 0.04 seconds = 4 ms


Large square = 0.2 seconds = 20 ms

Speed of ECG = 25mm/sec  5 large box/sec

0.20 x 5 = 1 second
Intervals :

PR interval : the atrial depolarization and


physiological delay of the stimulus in the
atrioventricular (AV) node.
QT interval : total time of ventricular
depolarization.
RR interval : In sinus rhythm, this
interval should be constant.

Segments:

PR segment
ST segment : the beginning of
ventricular repolarization
Systematic Interpretation of ECG
1. Look for lead aVR 6. P-R interval
2. Rate • I. First degree heart block
• II. Second degree heart block
3. Rhythm • III. Third degree heart block
I. Regular
7. ST segment and T wave abnormality
II. Irregular • I. S-T segment elevation
4. Axis • II. S-T segment depression
I. Normal • III. T wave inversion
II. Right axis deviation 8. Hypertrophy
III. Left axis deviation • I. Left ventricular hypertrophy
• II. Right ventricular hypertrophy
5. P wave morphology
9. Bundle branch block
I. P-Mitrale
• I. Right bundle branch block
II. P-Pulmonary • II. Left bundle branch block.
1. Look for aVR lead
• All waves should be inverted in
lead aVR
• - unless limb leads are wrongly
connected
• Exception : Dextrocardia
2.Rate

• For ECG in regular rhythm,

• To be more precise,
Rate (contd.)
• The best method for measuring irregular heart rates with varying R-R
intervals is to count the number of R waves in a 6-sec (30 large
squares) strip (including extra beats such as PVCs, PACs, and PJCs) and
multiply by 10. This gives the average number of beats per minute.
3. Rhythm

• Features of sinus rhythm are: Causes of Irregular Rhythm


• Each P wave should be followed by QRS • 1. Physiological:
complex.
• Sinus arrhythmia
• P-R interval should be normal and constant.
• P wave morphology should be normal. • 2. Pathological:
• R-R interval should be equal, if it is irregular, • Atrial fibrillation
then it is called irregular rhythm. • Ventricular fibrillation
Sinus Arrhythmia
4. Cardiac Axis
4. Axis
Look at Lead I and aVF from electrical axis of the
heart. Normally, QRS complex is deflected upwards
in these leads.

In right axis deviation (RAD), there is inversion of


QRS complex in lead I

In left axis deviation (LAD), there is inversion of


QRS complex in aVF
Causes of axis deviation
RIGHT AXIS DEVIATION LEFT AXIS DEVIATION

Right ventricular Left ventricular hypertrophy


hypertrophy
Right bundle branch block Left bundle branch block

Left posterior hemiblock Left anterior hemiblock

Emphysema and cor Wolf-Parkinson-White


pulmonale syndrome
Fallot’s tetralogy Hypertrophic cardiomyopathy
5. P wave morphology
• The P wave represents the depolarization of left and right atria.
• The SA Node starts depolarization in the right atrium  so the former
part of the P-wave is contributed by right atrium and the later part by
left atrium.

• P wave morphology can vary according to the location of the area


acting as the pacemaker
P-mitrale (LA enlargement)
The width of P wave in lead II is
more than 0.12 seconds and
notched (M shaped) the gap
between the two peaks should
be greater than or equal to 0.04
seconds.

• Here, the LA is enlarged and the duration taken to depolarize the left
atria is comparatively more than the right atria
 Notched and wide P wave
P-pulmonale (RA enlargement)
• P wave is peaked
• Amplitude > 2.5mm
in Lead II

Here, there is right atrial enlargement. So the duration taken to


depolarize right atria is longer than that of left atrium.
a Tall P wave
P wave abnormalities
RIGHT ATRIAL ABNORMALITIES LEFT ATRIAL ABNORMALITIES
Bronchial Asthma Mitral stenosis
Emphysema Mitral regurgitation
Pulmonary embolism Aortic stenosis
Tetralogy of Fallot
Atrial septal defect
Pulmonary valve stenosis

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