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    Department of Cardiology and Vascular Medicine, Padjadjaran University School of Medicine Hasan Sadikin Hospital Bandung

    Uploaded by

    Muhammad Amrie
    The document describes the basics of electrocardiography including: 1) An ECG records the electrical activity of the heart over time which can be used to diagnose medical problems like arrhythmias or damage to heart muscle. 2) The heart's electrical impulse causes the muscle to contract starting from the sinoatrial node and traveling through the atria and ventricles. 3) An ECG evaluates features like rhythm, rate, intervals, and wave morphologies to analyze the heart's function and detect any abnormalities.

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    Department of Cardiology and Vascular Medicine, Padjadjaran University School of Medicine Hasan Sadikin Hospital Bandung

    Uploaded by

    Muhammad Amrie
    30 views61 pages
    The document describes the basics of electrocardiography including: 1) An ECG records the electrical activity of the heart over time which can be used to diagnose medical problems like arrhythmias or damage to heart muscle. 2) The heart's electrical impulse causes the muscle to contract starting from the sinoatrial node and traveling through the atria and ventricles. 3) An ECG evaluates features like rhythm, rate, intervals, and wave morphologies to analyze the heart's function and detect any abnormalities.

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    EKG-skill lab.pptx

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    The document describes the basics of electrocardiography including: 1) An ECG records the electrical activity of the heart over time which can be used to diagnose medical problems like arrhythmias or damage to heart muscle. 2) The heart's electrical impulse causes the muscle to contract starting from the sinoatrial node and traveling through the atria and ventricles. 3) An ECG evaluates features like rhythm, rate, intervals, and wave morphologies to analyze the heart's function and detect any abnormalities.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    30 views61 pages

    Department of Cardiology and Vascular Medicine, Padjadjaran University School of Medicine Hasan Sadikin Hospital Bandung

    Uploaded by

    Muhammad Amrie
    The document describes the basics of electrocardiography including: 1) An ECG records the electrical activity of the heart over time which can be used to diagnose medical problems like arrhythmias or damage to heart muscle. 2) The heart's electrical impulse causes the muscle to contract starting from the sinoatrial node and traveling through the atria and ventricles. 3) An ECG evaluates features like rhythm, rate, intervals, and wave morphologies to analyze the heart's function and detect any abnormalities.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    You are on page 1of 61

    Toni Mustahsani Aprami

    Department Of Cardiology and Vascular Medicine,


    Padjadjaran University School of Medicine
    Hasan Sadikin Hospital Bandung
    LA

    RA
    (HB)
    (SAN)

    (BB)
    VV
    (AVN)

    (BB)

    HB

    SAN AVN BB

    RA
    LA
    V
    Terms describing cardiac cycle

    Systole Diastole
    Activation Recovery

    Electrical Excitation Recovery

    Depolarization Repolarization

    Shortening Lengthening

    Mechanical Contraction Relaxation

    Emptying Filling
    Cardiac Electrical Activity

    Mechanical Actiyity
    What medical problems can be
    diagnosed with an ECG?

    • Enlargement of cardiac chambers

    • Hypertrophy of cardiac muscle

    • Cardiac arrhythmias

    • Insufficient coronary blood flow

    • Death of heart muscle and its location

    • Electrolyte abnormality
    RECORDING ELECTRODES AND LEADS
    1. Bipolar limb leads:
    record the potential differences between two limbs

    2. Unipolar precordial leads:


    record the absolute electrical potential at each of
    designated torso sites

    3. Augmented unipolar limb leads:


    is designed to increase the amplitude of the output
    of limb leads
    BIPOLAR LIMBS LEADS
    Lead I Left arm
    Positive
    Lead II Left leg
    input
    Lead III Left leg
    AUGMENTED UNIPOLAR LIMBS LEADS
    aVR Right arm
    Positive
    aVL Left arm
    input
    aVF Left leg
    PRECORDIAL LEADS
    V1 Right sternal margin, 4th intercostal space
    V2 Left sternal margin, 4th intercostal space
    V3 Midway between V2 and V4
    V4 Left midclavicular line, 5th intercostal space
    V5 Left anterior axillary line

    V6 Left midaxillary line


    Paper speed

    • 25 mm/second

    • 50 mm/second
    Normal features of the electrocardiogram.
    What does an ECG actually measure?

    An ECG records voltage on its vertical axis


    against time on its horizontal axis

    • Measurement along the vertical axis indicates


    “summation” of the electrical activation of all of the
    cardiac cells

    • Measurement along the horizontal axis indicates


    heart rate, regularity, and the time intervals
    required for electrical activity to move from one
    part of the heart to another
    Systematic evaluation of the ECG
    1. Rhythm
    2. Rate and regularity
    3. Axis
    4. P-wave morphology
    5. PR interval
    6. QRS-complex morphology
    7. ST-segment morphology
    8. T-wave morphology
    9. QTc interval
    R R R

    Q S

    R R

    R’

    Q S QS S
    The normal cardiac rhythm:

    The sinus rhythm


    • The normal cardiac rhythm is called sinus rhythm
    because it is produced by electrical impulses formed
    within the SA node
    • Sinus rhythm is essentially but not absolutely regular
    • The P-wave axis of sinus rhythm is between 300 and 750
    • An abnormal P-wave axis is usually accompanied with an
    abnormally short PR interval. However, a short PR
    interval with in the presence of normal P-wave axis
    suggests an abnormal conduction pathway
    Rate and regularity
    P waves and QRS complexes are used to determine
    cardiac rate and regularity

    Over a particular interval of time, normally, there are same


    numbers of P waves and QRS complexes

    Heart rate:

    * 1500 divided by number of small squares


    between successive P waves or QRS complexes

    * 300 divided by number of large squares


    between successive P waves or QRS complexes

    Normal heart rate: 60-100 beats per minute (bpm)


    Axis of QRS Complex
    • Normal axis:
    between –30 degrees and +90 degrees

    • Right axis deviation (RAD):


    between +90 degrees and ± 180 degrees

    • Left axis deviation (LAD):


    between –30 degrees and –120 degrees
    -1200 ̶ 0
    -90
    -600

    aVR -1500
    -300 aVL

    1800 00 I

    150̶ 0 300

    1200 60̶ 0
    900
    III II
    aVF
    Negative in lead I
    Positive in lead aVF

    Right axis deviation


    (RAD)
    Positive in lead I
    Negative in lead aVF

    Left axis deviation


    (LAD)
    P-wave morphology
    1. The contour: is normally smooth and monophasic
    (entirely positive or negative) in all leads except V1 or
    occasionally V2
    2. Upright or positive P waves are normally seen in leads I,
    II, aVL, aVF, V4-V6 and downward in lead aVR. P wave
    in lead III may be either upright or downward.
    3. P-wave duration is normally less than 0.12 seconds
    4. The maximal amplitude is normally no more than 0.2 mv
    Abnormal P waves
    The PR interval
    1. The PR interval measures the time required for an
    electrical impulse to travel from the atrial myocardium
    adjacent to the SA node to the ventricular myocardium
    adjacent to the fibers of the Purkinye network
    2. The duration is normally from 0.11 to 0.20 seconds
    3. PR interval varies with the heart rate. The faster the
    heart rate, the shorter the PR interval
    Abnormal PR interval
    Morphology of the QRS complex
    1. Q waves
    • The presence of Q waves in leads V1, V2, and V3
    should be consider abnormal.
    • The absence of small Q waves in leads V5 and V6
    should be consider abnormal
    • A Q wave of any size is normal in leads III and
    avR
    • In all other leads, a “normal” Q wave would be very
    small (less than 0.04 second and its voltage is less
    than 25% of the R-wave)
    Abnormal Q waves
    Abnormal Q waves
    2. R waves
    The positive R wave normally increases in amplitude and duration
    from lead V1 to V4 or V5.
    Loss of normal R-wave progression is considered abnormal

    3. S wave
    S wave should be large in V1 and then progressively smaller to V6

    4. Ratio of R/S
    Amplitude in V1 and V2 is normally less than 1.
    R in V5 or V6 + S in V1 or V2 is not more than 35 mm
    Abnormal R wave in V1
    5. Duration of the QRS complex (QRS interval)

    It normally ranges from 0.07 second to 0.11 second (less than


    0.12 second). The QRS interval has no lower limit that indicates
    abnormality

    6. Amplitude of QRS complex

    There is no arbitrary upper limit for normal voltage of the QRS


    complex. An abnormally low QRS complex when the amplitude
    is no more than 0.5 mV in any limb leads and no more than 1.0
    mV in any of the precordial leads
    Abnormal QRS interval

    0.19 s
    Morphology of the ST
    segment
    1. The ST segment represents the period during which the
    ventricular myocardium remains in an activated or depolarized
    state

    2. ST segment normally located at the same horizontal level with


    the PR segment

    3. Normal variations:
    • Slight upsloping, downsloping, or horizontal depresion
    • Early repolarization : displacement of ST segment by as much
    as 0.1 mV in the direction of the ensuing T wave

    4. ST segment may be altered when there is prolonged QRS


    complex
    Normal ST segment
    Normal ST-segment deviation
    Morphology of the T and

    U waves
    The T wave

    • The T waves are positively directed in all leads except aVR


    (negative) and V1 (biphasic)

    • T waves do not normally exceed 0.5 mV in any limb lead or


    1.5 mV in any precordial lead

    The U wave

    U wave is either absent or present as a small wave following the


    T wave and is usually most prominent in leads V1 and V2.
    Increased prominence of the U wave indicates the possibility of
    hypokalemia
    The QTc interval
    1. The QT interval measures the duration of electrical
    activation and recovery of the ventricular myocardium

    2. The QT interval decreases as the heart rate increases


    and therefore should be corrected for cardiac rate (QTc
    interval)

    3. QTc= QT/RR interval (in seconds)


    The upper limit of QTc is 0.46 second (slightly longer in
    females)

    4. QT interval varies among different leads. The longest QT


    interval measured in multiple leads should therefore be
    considered the true QT interval
    Thank You
    Excitation of the Heart
    Excitation of the Heart
    What is an Electrocardiogram ?

    An ECG is the recording (“gram”) of the


    electrical activity (“electro”) of the cells of the
    heart (“cardio”) that reaches the body surface

    Initiates the heart muscle to contract, to


    pump blood to the tissues
    Resting cells
    + + + + + + + +
    – – – – – – – – – – – –
    + + + + + + + +
    Depolarizing cell

    + + – – – + + + +
    – – – + + + – – – – – –
    + + – – – + + + +

    Depolarized cells
    – – – – – – – – – – – –
    + + + + + + + + + + + +
    – – – – – – – – – – – –
    Depolarized cells

    – – – – – – – – – – – –
    + + + + + + + + + + + +
    – – – – – – – – – – – –
    Repolarizing cell

    – – – + + – – – – – –
    + + + – – – + + + + + +
    – – – + + – – – – – –
    Repolarized cells
    + + + + + + + +
    – – – – – – – – – – – –
    + + + + + + + +
    + + – – – + +
    – – – + + + – – –
    + + – – – + +

    +
    0
    –

    +
    –

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