ELECTROCARDIOGRAM (ECG)

ECG is a graphic recording of the cardiac electrical activity by means of electrodes put on the
skin of the limbs and chest wall.

How cardiac action potentials are recorded?

The body is a good conductor of electricity because tissue fluids have a high concentration of
ions that move (creating a current) in response to potential differences.
These potential differences can be detected by electrodes put on the skin surface and
amplified and recorded as a tracing on paper or on a monitor

Cardiac potentials spread along body fluids and reach the skin where they can be recorded by
special galvanometers (ECG machine).

Electrocardiograph: The apparatus used for recording the electrical activities of the heart is
called electrocardiograph or ECG. It consists of:

Recording galvanometer
Electrodes

What is ECG lead?

-Lead: The particular arrangement of each 2 electrodes.
-The standard ECG (12 lead ECG) consist of 12 different leads, record the same cardiac events
but from different views.
-Additional leads may be used in special situations.

Types of leads:

Bipolar leads: Measure the potential difference between 2 points. Include leads: I,II & III.
Unipolar leads: Measure the actual potential at certain point. Include 3 unipolar limb and 6
unipolar chest leads.

Bipolar Leads:

-Einthoven's triangle: Is an equilateral triangle, the sides of which represent the 3 bipolar leads
& the heart lies in its centre.

-Einthoven's law: The sum of voltages in leads & equals the voltage in lead .

Unipolar leads:

Augmentation of unipolar by 50% is produced by disconnecting the limb having exploring

electrode from the central terminal (zero potential).

They measure the potential at certain points on the chest facing the heart:
V1: in the 4th space at Rt. Sternal border.
V2: in the 4th space at Lt. Sternal border.
V3: midway between V3 & V4.
V4: Lt. midclavicular line in the fifth space.
V5: Lt. anterior axillary line in the fifth space.
V6: Lt. mid axillary line in the fifth space.

- VR: record the electrical potential at right arm.

- VL: record the electrical potential at left arm.
- VF: record the electrical potential at left foot.
But the deflections obtained from these leads were very low, so the circuit was modified & the
deflections were augmented by 50% & called augmented leads:
aVR: i.e. augmented voltage of right arm (50% greater than VR).
aVL: i.e. augmented voltage of Lt. arm (50% greater than VL).
aVF: i.e augmented voltage of Lt. foot (50% greater than VF).

ECG paper:

Each small square horizontally measures duration equals 0.04 seconds and each small square
vertically measures voltage equals 0.1 m.v.

Mean axes of cardiac potentials in different parts of the cardiac muscle during
impulse propagation:

ECG machine records as follows:

However when repolarization moves away from the positive electrode of any lead it records it as
a positive wave.

The record of different ECG waves usually varies in different leads depending on the position of
the exploring electrode in each lead.

Normal ECG in lead II:

The ECG consists of:

A) Waves:

The P wave: represents atrial depolarization.

The QRS complex: represents ventricular depolarization.
The T wave: represents ventricular repolarization

B) S-T segment: isoelectric

C) P-R and Q-T intervals.