2.3 Electrocardiography (Barbon)

Electrocardiography
AJRU

R wave
Electrocardiography
Apex Depolarization
-‐ Procedure used to record electrical activity of the human heart

QRS Complex

ST Segment
Ventricular
Depolarization Plateau S wave

Posterobasal
PR Interval Depolarization

Atrial Depolarization
+
AV Nodal Delay

T wave
P wave
Ventricular
Repolarization
Atrial Depolarization
Q wave
QT Interval

Interventricular Septum
Ventricular Depolarization
PR Segment Depolarization
+

Ventricular Repolarization
AV Nodal Delay
-‐ Fewer gap junctions
-‐ Smaller diameter fibers U wave

Slow repolarization of the papillary muscles. If the height of the T wave is equal

to the height of the U wave, it may indicate Hypokalemia in the patient.

Impulse Conduction

Rule #1: Depolarization following direction of impulses = Positive Deflection ^
Rule #2: Depolarization away from direction of impulses = Negative Deflection v Direction of Impulses
Rule #3: Repolarization following direction of impulses = Negative Deflection v
à Downward
à Right to Left
Rule #4: Repolarization away from direction of impulses = Positive Deflection ^

-‐ SA Node generates an impulse
o Atrial Depolarization occurs
§ P wave
§ Depolarization direction
• Downward Follows Rule #1
• Right to left
-‐ Impulse is transmitted to the AV node
o AV Nodal Delay
§ PR Segment
§ Isoelectric line (no electrical activity noted)
Electrocardiography AJRU

-‐ Atrial Repolarization occurs (Unseen in the ECG)
Atrial Muscle
o Repolarization Direction
§ Downward Follows Rule #3 The first part to Depolarize will
§ Right to left be the first part to Repolarize.
-‐ Impulse is transmitted to the Ventricular Conduction System
o Ventricular Depolarization Occurs
Ventricular Muscle
§ QRS Complex
• Q Wave The first part to Depolarize will
o Interventricular Septum Depolarization be the last part to Repolarize.
• Downward Follows Rule #2 The last part to Depolarize will
• Left to Right be the first part to Repolarize.
• R Wave

o Cardiac Apex Depolarization
§ Depolarization Direction
• Downward Follows Rule #1
• Right to Left
• S Wave
o Posterobasal Depolarization
• Upward à Follows Rule #2
-‐ Ventricular Repolarization occurs
o Q Wave
• Upward à Follows Rule #4

Automatic Cells
-‐ Sinoatrial (SA) Node
o Node of Keith and Flack
o Primary pacemaker of the heart
o Suppresses automaticity of other automatic cells
§ Overdrive suppression
-‐ Atrioventricular (AV) Node
o Node of Kent and Tawara
o AV Nodal delay
o Slow velocity of impulse conduction (0.05 m/s)
-‐ Purkinje system
o Bundle of His
o Left and Right bundle branch
o Purkinje Fibers

ECG Procedure
-‐ Types
o Resting ECG
§ Most common procedure done
§ Remove all metal items
§ Usually uses all leads
o Exercise ECG / Stress test / Treadmill test
§ Detects the heart’s electrical activity changes during activity
§ At least 3 chest electrodes are used

-‐ Application of electrode gel
-‐ Leads
o Method discovered by Dr. Einthoven
o Ground Lead
§ Eliminates non-‐cardiac electrical activities
§ Right leg (Black)
o Bipolar Limb Leads
§ Lead I
• Records electrical activities in the base of the heart
• Right Arm (Red) to Left Arm (Yellow)
§ Lead II
• Records electrical activities from the base going to the apex on right side of the heart
• Follows cardiac vector
• Right Arm (Red) to Left Leg (Green)
§ Lead III
• Records electrical activities from the base going to the apex on left side of the heart
• Left Arm (Yellow) to Left Leg (Green)
o Unipolar Limb Leads
§ aVR
• Center to the right uppermost part of the heart
§ aVL
• Center to the left uppermost part of the heart
§ aVF
• Center to the apex of the heart
o Unipolar Chest Leads
§ V1 4th Intercostal Space, Right Sternal Border
§ V2 4th Intercostal Space, Left Sternal Border
§ V3 In between V2 and V4
§ V4 5th Intercostal Space, Left Mid Clavicular Line
§ V5 5th Intercostal Space, Left Anterior Axillary Line
§ V6 5th Intercostal Space, Left Mid Axillary Line
§ V7 5th Intercostal Space, Left Posterior Axillary Line Rarely used
th
§ V8 5 Intercostal Space, Left Mid Scapular Line
o Esophageal Leads
§ Rarely used
§ Most posterior portion of the heart
§ Patient is asked to swallow the leads

-‐ Body fluids transmit conduction from heart

-‐ Einthoven’s Equation
o (Lead II) = (Lead I)+ (Lead III)
§ Lead II shows the tallest recording in the ECG


ECG Reading
-‐ Vertical Reading
5mm = 0.2 s
o Amplitude (millivolts)
-‐ Horizontal Reading
o Time (seconds)
1mm = 0.1 mv

5mm = 0.5 mv 1 Hash Mark

Equivalent to 3 seconds
(15 big boxes)

1mm = 0.04 s

-‐ Interpreting the Heart Rate
o Only for ECG readings with a regular rhythm
o Count the number of small boxes in between the RR intervals
o Multiply number of small boxes by 0.04 seconds

Heart Rate = 60 seconds
RR Interval

o Example 60 seconds .
12 x 0.04 = 0.48 = 125 bpm
0.48 seconds
1 5 10 12

Shortcut! (Only for exact RR Intervals)
-‐ 5 small boxes (1 big box) = 300 Normal Duration
-‐ 10 small boxes (2 big boxes) = 150 ECG Intervals
Common Range
-‐ 15 small boxes (3 big boxes) = 100
PR Interval 0.18 s 0.12 – 0.21 s
-‐ 25 small boxes (5 big boxes) = 60 QRS Interval 0.08 s 0.08 – 0.10 s
-‐ 30 small boxes (6 big boxes) = 50 QT Interval 0.40 s 0.40 – 0.43 s
-‐ 40 small boxes (8 big boxes) = 37 ST Interval 0.32 s 0.12 – 0.21 s


Cardiac Abnormality Detection in ECG
-‐ Arrhythmias
o Bradycardia
§ RR < 60 bpm
o Tachycardia
§ RR > 100 bpm
o Pacemaker abnormalities
o Heart Blocks
§ 1st degree
• Prolonged PR Interval
§ 2nd degree
• PQRS – P – PQRS (2:1 / 3:1)
§ 3rd degree
• P waves found in many parts
-‐ Myocardial Ischemia / Injury / Infarction
o Ischemia
§ Depressed T wave
T↓schemia (Tischemia)
o Injury
Injur↑ST (injuryST)
§ ST segment elevation
infarQtion (infarction)
o Infarction
§ Pathologic Q wave
-‐ Hyperkalemia
o T wave
-‐ Hypokalemia
o Prominent U wave
-‐ Hypocalcemia
o Narrow QRS Interval

Vectocardiography
-‐ Determination of the electrical axis of the heart
-‐ Mean cardiac vector (angle) indicates the average direction of current flow in the heart
o Normal (Local)
§ 0 to 90° Deviation from the normal axis
o Normal (Western) may indicate Cardiomegaly
§ -‐30 to +110°
o Average / Common Vector / Common Axis
§ 59°
-‐ 2 methods
o Method 1
§ Lead I and aVF
o Method 2
§ Lead I, Lead II and Lead III

2.3 Electrocardiography (Barbon)

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2.3 Electrocardiography (Barbon)

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