ASSIGNMENT: ELECTROCARDIOGRAPHY (ECG)

NAME: SARA JAMAL

SEAT NO. H2024084
YEAR/SEMES. : 3RD YEAR/6TH SEMESTER
COURSE: CARDIOPHYSIOLOGY-552
COURSE INCHARGE: DR. LUBNA NAZ
SUBMISSION DATE: 24-OCT-2023
 ELECTROCARDIOGRAPHY
(ECG)

 Introduction to ECG (Electrocardiography):

Electrocardiography, commonly known as ECG or EKG (from the German
"Elektrokardiogramm"), is a fundamental tool in cardiology used to record and analyze the
electrical activity of the heart. It provides valuable information about the heart's rhythm,
rate, and overall electrical health. ECG plays a pivotal role in diagnosing cardiac
conditions, monitoring heart function, and assessing the effectiveness of treatments. It is a
non-invasive and widely used diagnostic procedure that has been in practice for many
decades.

 The Heart's Electrical Conduction System:

 The heart's electrical system initiates and coordinates the contraction of the heart
muscle.
 The electrical signals start in the sinoatrial (SA) node, travel through the atria, pass
through the atrioventricular (AV) node, and then spread through the ventricles.
 ECG Machine:
An ECG machine records the electrical signals generated by the heart and produces a
graphical representation of these signals on a strip of paper or digital display. The machine
consists of several components, including electrodes, amplifiers, and a recording device.

 ECG Electrodes:
 Electrodes make direct contact with the patient's skin and are responsible for capturing
the electrical impulses produced by the heart's activity.
 Electrodes can be of different types, including

1. Disposable adhesive electrode, these are the most common ECG electrodes and
are attached to the skin using an adhesive. They have a conductive gel that helps
transmit electrical signals efficiently.

2. Suction electrodes, these electrodes use a small vacuum to create a seal with the
skin, ensuring better contact and reducing the risk of artifacts.
3. Wet gel electrodes, these electrodes use a conductive gel to establish a connection
with the skin. The gel provides better conductivity and adhesion E.g; high-chloride
electrodes.

4. Dry electrodes, these electrodes eliminate the need for conductive gel and can be
applied directly to the skin, making them more convenient and less messy. E.g;
Ag/AgCl electrodes.

5. Holter Monitoring Electrodes: These are designed for continuous ECG

monitoring over an extended period. Typically lightweight and subtle.

6. Exercise ECG (Stress Test or Treadmill Test): This ECG is performed while the
patient exercises, usually on a treadmill or stationary bike. It helps assess how the
heart responds to increased workload

 The choice of electrode type depends on factors like patient comfort, the need for
conductivity gel, and the clinical situation.
 Lead Systems:
An ECG lead system refers to specific combinations of electrodes that are strategically
placed on the patient's body to capture electrical signals from various angles and
perspectives. There are different types of ECG leads including
1. Right-Sided Leads: These are used to obtain ECG readings from the right side of the
chest. They are essential for diagnosing right ventricular infarctions and other
conditions.

2. Frank Lead System: This system uses multiple electrodes to obtain a three-
dimensional view of the heart's electrical activity.

3. Lewis Lead: Used to obtain a posterior view of the heart, valuable for diagnosing
posterior myocardial infarctions.

4. Standard 12-lead ECG: The 12-lead ECG consists of 10 electrodes that are
placed on the limbs and chest. These leads include limb leads (I, II, III, aVR, aVL, aVF)
and precordial (chest) leads (V1 to V6). They are called Resting ECG leads and most
commonly used.
 Limb leads:
Use electrodes on the limbs, specifically, they use electrodes on the right arm (RA),
left arm (LA), and left leg (LL). Include six leads: I, II, III, aVR, aVL, aVF.
a. Bipolar limb leads (I, II, III) provide a frontal
plane view.
b. Unipolar Leads (aVR, aVL, aVF) offer an
augmented view.

 Chest Leads (Precordial Leads):

Chest leads, also known as precordial leads,
utilize electrodes placed on the chest wall at specific
positions. There are six chest leads, labeled V1, V2, V3, V4, V5,
and V6.
 Focus on the anterior, lateral, and posterior parts of
the heart.
 Used for diagnosing myocardial infarctions and
heart conditions.

These leads provide multiple perspectives on the heart's

electrical activity.
 Standard ECG Paper and Measurements:
 The standard ECG paper is divided into small boxes (1 mm by 1 mm) and larger boxes
(5 mm by 5 mm).
 One small box represents 0.04 seconds, and one large box represents 0.20 seconds.
 The height of waveforms is measured in millimeters and can be used to determine
voltage values.
 Normal ECG Pattern:
 A typical ECG pattern consists of a P-wave,
QRS complex, and T-wave.

 The P-wave is followed by the QRS complex,

and the T-wave follows the QRS complex

 Waveform Components:
1. P-Wave:
 Represents atrial depolarization, or the electrical activity causing the atria to
contract.
 Normal duration is typically less than 0.12 seconds.
2. QRS Complex:
 Represents ventricular depolarization, or the electrical activity causing the
ventricles to contract.
 Normal duration is less than 0.12 seconds.
  Comprises three distinct waves: Q, R, and S.

3. T-Wave:
 Represents ventricular repolarization, or the electrical activity as the ventricles
relax and recover.
 Normal T-wave is typically upright in most leads but can vary.
4. U-Wave (if visible):
 Represents a small, rounded wave that sometimes appears after the T-wave,
associated with repolarization of the His-Purkinje system.
 Not always visible and considered less clinically significant.

 ECG Segments:
1. PR Segment:
 Extends from the end of the P-wave to the beginning of the QRS complex.
 Represents the delay at the atrioventricular (AV) node, allowing time for the
ventricles to fill with blood.
2. ST Segment:
 Extends from the end of the QRS complex to the beginning of the T-wave.
 It should be at the baseline (isoelectric) in a normal ECG. Deviations indicate
myocardial ischemia or injury.
3. QT Interval:
 Represents the time from the start of the QRS complex to the end of the T-wave.
 Corrected for heart rate (QTc) to assess for the risk of arrhythmias, specifically.
4. J-Point:
 The point where the QRS complex ends and the ST segment begins.
 Clinically important for evaluating ST-segment
changes.
 Time and Voltage on the ECG:
 The horizontal axis on the ECG paper represents time, typically measured in
milliseconds.
 The vertical axis represents voltage, usually measured in millivolts.
 The paper speed (the rate at which the paper moves) determines the time intervals.

 Einthoven's Triangle:
 It is a visual representation of the three standard limb leads
in electrocardiography.

 Helps illustrate the placement and orientation of these leads,

aiding in the interpretation of the heart's electrical activity from
different angles.

 Cardiac Cycle:
 The sequence of events in an ECG represents one cardiac cycle.

 It starts with atrial depolarization (P-wave), followed by ventricular depolarization

(QRS complex), and ends with ventricular repolarization (T-wave).
 Clinical Applications:
 ECG is used to diagnose various heart conditions, including arrhythmias, ischemic
heart disease, heart attacks, and heart enlargement.
 It is essential in routine health checkups, preoperative assessments, and monitoring
patients during surgery.

 ECG Interpretation:
 Accurate ECG interpretation requires knowledge of

normal and abnormal ECG patterns.

 Abnormalities in waveforms, intervals, and

segments can signal specific cardiac problems.

 Abnormal ECG Patterns/ Heart Rate Abnormalities:

 Arrhythmias: These are irregular heart rhythms. Examples include atrial fibrillation
(chaotic atrial rhythm), ventricular tachycardia (fast, abnormal ventricular rhythm),
and bradycardia (slow heart rate).
 Conduction Disorders: Conditions like bundle branch blocks and heart blocks can
disrupt the normal electrical conduction in the heart.
 Ischemic Changes: ST-segment elevation or depression can suggest inadequate
blood supply to the heart muscle, often seen in myocardial infarctions (heart attacks).

 Bradycardia:
1. Bradycardia is characterized by a heart rate slower than the normal resting rate
(typically under 60 beats per minute).
2. Causes include sinus node dysfunction, medication side effects, or underlying heart
conditions.
3. Symptoms may include fatigue, dizziness, and fainting.

 Tachycardia:
1. Tachycardia is an abnormally fast heart rate, typically above 100 beats per minute
at rest.
2. Causes range from stress, fever, and anemia to underlying heart conditions like
atrial fibrillation.
3. Symptoms may include palpitations, chest pain, and shortness of breath.