CardiologyECGBasics.

Anatomy:

Function
of the heart is mainly pumping the blood, Regulate the circulation.
Valves of the heart:
A. Semilunar:
1. Aortic: between Left Ventricle and Aortic Arch.
2. Pulmonary: between Right Ventricle and Pulmonary artery.
B. A-V (Atrioventricular):
1. Mitral: between Right Atrium and Right Ventricle.
2. Tricuspid: between Left Atrium and Left Ventricle.
Heart position
is in the posterior to Mediastinum, on left side of chest.
Heart size
is Closed Fist, when opening the chest first part you see is Right
Ventricle, the Most Anterior.
1

Createdby:HawraAlEirani

 Heart Layers:
(outer to inner)
1. Pericardium.
2. Myocardium.
3. Endocardium.
Circulation of the Blood:
Deoxygenated blood flows from the body to Superior & Inferior Vena Cava
to Right Atrium to Right Ventricle to Pulmonary artery to Lung to Pulmonary
vein (Oxygenated blood) to Left Atrium to Left Ventricle to Aorta to The
Whole Body.
Cardiac Cycle Stages:

Borders of the Heart:

Right Border:
a. Superior & Inferior Vena Cava.
b. Right Atrium.
Left Border:
a. Left Atrium & Ventricle.
b. Pulmonary Artery.
c. Aortic Artery.

Inferior Surface:
a. Right Ventricle.
b. Apex (Left Ventricle).
Blood Supply
to the heart muscles is the Coronary Arteries:
1. Right Coronary Artery (RCA): Posterior Interventricular Artery (PIV) (80%).
2. Left Main Coronary Artery (LCA): Left Circumflex Artery (15%).
Controlling of Blood Flow:
Valves:
1. During Systole:
a. A-V Closed.
b. Semi Lunar Opened.
2. During Diastole:
a. A-V Opened.
b. Semi Lunar Closed.
S1 Sound occur in the Systole due to [Closure of A-V], S2 Sound occur in
Diastole due to [ Closure of Semilunar].
Myocardium cells work as Sensorium (work as one), any damage to the cardiac
tissues, cardiac biomarkers will be released (Troponin, Myosin, CK-MB).
Conduction System:
[Sinoatrial (SA) to Atrioventricular (AV) to Bundle
Branch/Purkinje fibers].
SA node (pacemaker) sends impulses to the AV, The AV node waits a while
before sending impulses (so the Ventricles can relax and get filled with blood
to contract). Then, the AV node sends the Impulses Through the Bundle
Branches then, to Purkinje fibers.

 Stroke Volume
= 70-80 ml ejected with every beat.
Abnormal Sounds (
Murmurs
):
Stenosis Sound is heard when the Valve is Open.
Regurge Sound is heard when the Valve is Closed.
1. In A-V Valves:
A. Diastole: (Mitral, Tricuspid) are Open, Stenosis occur.
B. Systole: (Mitral, Tricuspid) are Closed, Regurgitation occur.
2. In Semi Lunar Valves:
A. Diastole: (Aortic, Pulmonary) are Closed, Regurgitation occur.
B. Systole: (Aortic, Pulmonary) are Open, Stenosis occur.
Electrocardiogram (
ECG
):
Leads:

Lead 1

aVF

for Axis

Normal

Undetermined

Right Axis

Left Axis

Axis Deviation:
(Lead1 + aVF = look at QRS upwards or downwards).
1. Left Axis Deviation:

2. Right Axis Deviation:

3. Odd Axis Deviation:

Both lead 1 and lead aVF will be pointing

downwards.
Basic Normal ECG Paper:

In paper:
1 Big Square (has 25 small squares) = 0,2sec. Therefor, In 1 min =300
Big Square.

 Rhythm: (
Between R-R
)
.
1. Regular Rhythm.
2. Irregular Rhythm.
Irregular Regular.
Irregular Regular.
Heart Rate:
HR= 300/no. of big squares,
(
look at Lead 2, P-R Interval normally
takes 3-5 small squares
).
1. Tachycardia > 100 beat/min.

2. Bradycardia < 60 beat/min.

 Waves:
1. P Wave: Atrial Depolarization (Any problem with atriums will show in
this wave on ECG).
2. QRS Complex: Ventricular Depolarization, Atrial Depolarization
(Ventricular Depolarization is stronger than Atrial Repolarization).
3. T Wave: Ventricular Repolarization .
Segments: (Iso-Electric Line)
1. ST Segment: To Identify Ischemia.
2. PR Segment: For AV Activity.
3. TP Segment: For the Baseline.
Interval: (consist of Wave + Segment)
1. PR interval: P wave + PR Segment.
2. QR interval: QRS Complex + ST segment.
Conduction Abnormalities:
1. Shortness Abnormalities (Pre-excitation):
A. Wolff Parkinson White Syndrome (WPW):
I.
Wide QRS.
II.
Short P-R Interval.
III.
Delta wave (Slurring).

B. Lown Ganong Levine Syndrome (LGL): AV node sends impulses directly.

I.
Short P-R Interval.
II.
Normal QRS.
2. Prolonged Abnormalities (Heart Block):
st
I.
1
Degree:
Delayed Conduction Through AV node. (All impulse arrive
but delayed).
Prolonged P-R Interval.

II.

2Degree:

alf the impulse arrive and half don't.

H
A. Mobitz 1/ Wenckebach: Progressive prolongation of P-R Interval
until a P-wave is completely blocked. (worsen with each cycle).
nd

B. Mobitz 2: Sudden blocked beat, not preceded by a change in

duration on P-R Interval.

III.

3Degree:

rd

Complete Heart Block. (Blocked Atrial beats,No P-wave).

Ectopic Foci:
anabnormalpacemakersiteswithintheheart(outsideofthe
SA
node
)thatdisplay
automaticity
,whichcancauseadditionalbeats(observedas
prematurebeats
)ortakeoverthenormalpacemakeractivityoftheSAnode.
Theseectopicpacemakerscanleadtoeither
tachycardia
or
bradycardia
.
QRS Complex Abnormalities:
1. Left Ventricular Hypertrophy: (look at V1 = S wave and V6 = R wave).

To say a patient is hyper trophic V1+V6 = 35 and above. ( we count S big

Squares Longitudinally, and R big squares Longitudinally, each multiplied
in 5 then added together).

2.
Right Ventricular Hypertrophy:
Tall R, (look at V1 and V6).

 Bundle Branch Block (BBB):

(look at V1,V6)
1. Left Bundle Branch Block (LBBB):

2. Right Bundle Branch Block (RBBB): ( V1:R wide: has M Shape, V6:S
wide: has M shape).