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Santosh Dev

The document discusses the normal conduction system of the heart and how it relates to the electrocardiogram (ECG or EKG). It describes the sinoatrial node initiating the heartbeat signal, which travels through the atrioventricular node, bundle of His, bundle branches, and Purkinje fibers to contract the ventricles. It explains how each stage of the cardiac cycle - atrial depolarization, ventricular depolarization, and repolarization - appears as distinct waveforms on the ECG. Finally, it discusses how analyzing the ECG can provide insight into cardiac pathologies by identifying arrhythmias, chamber hypertrophy, electrolyte disturbances, and other conditions.

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146 views45 pages

Santosh Dev

The document discusses the normal conduction system of the heart and how it relates to the electrocardiogram (ECG or EKG). It describes the sinoatrial node initiating the heartbeat signal, which travels through the atrioventricular node, bundle of His, bundle branches, and Purkinje fibers to contract the ventricles. It explains how each stage of the cardiac cycle - atrial depolarization, ventricular depolarization, and repolarization - appears as distinct waveforms on the ECG. Finally, it discusses how analyzing the ECG can provide insight into cardiac pathologies by identifying arrhythmias, chamber hypertrophy, electrolyte disturbances, and other conditions.

Uploaded by

devdsantosh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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ECG

Santosh Dev
The Normal Conduction System
Normal Impulse Conduction
Sinoatrial node

AV node

Bundle of His

Bundle Branches

Purkinje fibers
For more presentations
www.medicalppt.blogspot.com
Impulse Conduction & the ECG
Sinoatrial node

AV node

Bundle of His

Bundle Branches

Purkinje fibers
For more presentations
www.medicalppt.blogspot.com
The “PQRST”

• P wave - Atrial
depolarization
• QRS - Ventricular
depolarization
• T wave - Ventricular
repolarization
For more presentations
www.medicalppt.blogspot.com
What is an EKG?
The electrocardiogram (EKG) is a representation
of the electrical events of the cardiac cycle.

Each event has a distinctive waveform, the study


of which can lead to greater insight into a
patient’s cardiac pathophysiology.
What types of pathology can we identify
and study from EKGs?

• Arrhythmias
• Chamber hypertrophy
• Electrolyte disturbances (i.e. hyperkalemia,
hypokalemia)
• Drug toxicity (i.e. digoxin and drugs which
prolong the QT interval)
Depolarization Waves Versus Repolarization Waves
During depolarization, the normal negative potential inside
the fibre reverses and becomes slightly positive inside and
negative outside.
Voltage & Time Calibration of the Electrocardiogram
The ECG Paper

 Horizontally
– One small box - 0.04 s
– One large box - 0.20 s
 Vertically
– One large box - 0.5 mV

For more presentations


www.medicalppt.blogspot.com
Characteristics of the Normal
Electrocardiogram
Methods for Recording Electrocardiograms
Recording Electrical
Potentials from a
Partially Depolarized
Mass of
Syncytial Cardiac
Muscle
Flow of Electrical Currents in the Chest Around the
Heart
EKG Leads

Leads are electrodes which measure the


difference in electrical potential between either:

1. Two different points on the body (bipolar leads)

2. One point on the body and a virtual reference point with


zero electrical potential, located in the center of the heart
(unipolar leads)
EKG Leads
The standard EKG has 12 leads: 3 Standard Limb Leads
3 Augmented Limb Leads
6 Precordial Leads

The axis of a particular lead represents the viewpoint from


which it looks at the heart.
Standard Limb Leads
Einthoven’s Triangle: Einthoven’s triangle, is
drawn around the area of the heart.
• This illustrates that the two arms and the left
leg form apices of a triangle surrounding the
heart.
• The two apices at the upper part of the triangle
represent the points at which the two arms
connect electrically with the fluids around the
heart, and the lower apex is the point at which
the left leg connects with the fluids
Einthoven’s Law: states that if the electrical
potentials of any two of the three bipolar limb
electrocardiographic leads are known at any given
instant, the third one can be determined
mathematically by simply summing the first two
(but note that the positive and negative signs of
the different leads must be observed when
making this summation).
Chest Leads (Precordial Leads)
Normal electrocardiograms recorded from the six standard chest leads

In leads V1 and V2, the QRS recordings of the normal heart are mainly negative
because the chest electrode in these leads is nearer to the base of the heart
than to the apex, and the base of the heart is the direction of electronegativity
during most of the ventricular depolarization process. Conversely, the QRS
complexes in leads V4,V5, and V6 are mainly positive because towards the apex
is electropositivity.
Augmented Unipolar Limb Leads
• two of the limbs are connected through
electrical resistances to the negative terminal
of the electrocardiograph, and the third limb is
connected to the positive terminal. When the
positive terminal is on the right arm, the lead
is known as the aVR lead; when on the left
arm, the aVL lead; and when on the left leg,
the aVF lead.
 The augmented limb leads aVR, aVL, and aVF bisect the angle between
standard limb leads I and II, I and III, and II and III, resp. Thus, there is a
limb lead oriented every 30 in the frontal plane, which makes it much
easier to calculate vectors.

Augmented limb leads All Limb Leads


• Principles of Vectorial Analysis of
Electrocardiograms
• “Resultant” Vector in the Heart at Any Given
Instant
Direction of a Vector Is Denoted in Terms of Degrees
 In a normal heart, the average direction of the vector during spread of the
depolarization wave through the ventricles, called the mean QRS vector, is
about +59 degrees, which is shown by vector A
Vectorial Analysis of Potentials Recorded in Different Leads:
• Determination of a projected vector B along the axis of lead I when vector A represents
the instantaneous potential in the ventricles

• Determination of projected vectors in leads I, II, and III when vector A represents the
instantaneous potential in the ventricles.
Vectorial Analysis of the Normal Electrocardiogram
• Vectors That Occur at Successive Intervals During Depolarization of the Ventricles
—The QRS Complex

0.01s after onset of ventricular depolarization 0.02 s after onset of depolarization

0.035 s after onset of depolarization 0.05 s after onset of depolarization


0.06 s after complete depolarization of the ventricles
 Electrocardiogram During Repolarization—The T
Wave:0.15s
 Depolarization of the Atria—The P Wave

 Repolarization of the Atria—The Atrial T Wave: when repolarization


begins, the region around the sinus node becomes positive with respect to the
rest of the atria. Therefore, the atrial repolarization vector is backward to the
vector of depolarization.
• the so-called atrial T wave follows about 0.15 second after the atrial P wave, but
this T wave is normally negative.
• In the normal ECG, the atrial T wave appears at about the same time that the
QRS complex of the ventricles appears. Therefore, it is almost always totally
obscured by the large ventricular QRS complex.
Mean Electrical Axisof the Ventricular QRS— And
Its Significance
Abnormal Ventricular Conditions that Cause Axis
Deviation
- averages about 59 degrees, (20 to about 100
degrees).
 Change in the Position of the Heart in the Chest.
 Hypertrophy of One Ventricle:- the axis deviates
toward the hypertrophied ventricle.
Bundle Branch Block Causes Axis Deviation:
 Left Axis Deviation in Left BundleBranch Block.
 Right Axis Deviation in Right Bundle Branch Block.

Abnormal Voltages of the QRS Complex


 Inceased voltage d/t hypertrophy of the muscle
 Decreased Voltage Caused by Cardiac Myopathies
 fluid in the pericardium: Pleural effusion & Pulmonary emphysema

Current of Injury: Many different cardiac abnormalities, especially those


that damage the heart muscle itself, often cause part of the heart to
remain partially or totally depolarized all the time. When this occurs,
current flows between the pathologically depolarized and the
normally polarized areas even between heartbeats. This is called a
current of injury
The J Point—The Zero Reference
Potential for Analyzing Current of
Injury
DISORDERS IN THE ACTIVATION SEQUENCE
Atrioventricular conduction variations
Bundle-branch block:
THANK
YOU

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