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ECGram

The document discusses the cardiovascular system block and the electrocardiogram. It defines the waves of the normal ECG, including the P wave, QRS complex, and T wave. It also describes the normal intervals in an ECG trace and different lead types including bipolar, unipolar, and chest leads.

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18 views24 pages

ECGram

The document discusses the cardiovascular system block and the electrocardiogram. It defines the waves of the normal ECG, including the P wave, QRS complex, and T wave. It also describes the normal intervals in an ECG trace and different lead types including bipolar, unipolar, and chest leads.

Uploaded by

Zied TMAR
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Cardiovascular System Block

The Electrocardiogram (ECG)

Dr. Mona Soliman, MBBS, MSc, PhD


Department of Physiology
Chair of Cardiovascular Block
College of Medicine
King Saud University
Lecture Objectives

1. Identify waves of the normal ECG and the


physiological cause of each
2. Define the normal intervals in the ECG trace
3. Determine the bipolar, unipolar and chest leads
The Normal Electrocardiogram (ECG)

The depolarization wave spread through the heart



electrical currents pass into the surrounding tissue

part of the current reaches the surface of the body

The electrical potentials generated by these


currents can be recorded from electrodes placed
on the skin opposite the heart
The Normal Electrocardiogram (ECG)
The Electrocardiogram (ECG) is a recording of
the electrical activity of the heart
The Normal Electrocardiogram (ECG)

 P wave: is caused by atrial


depolarization
 QRS complex: is caused
by depolarization of the
ventricles
 T wave: repolarization of
the ventricles
Voltage and Calibration of the ECG

The vertical calibration


lines: Voltage(millivolt)
 5 small lines = 1 mV
The horizontal calibration
lines: Time (seconds)
 1 inch(25 small lines) = 1
second
 Each inch is divided by 5
dark vertical lines
 The interval between the
dark lines= 0.2 second
 thin line=0.04 second

6
P-R interval
It is the time between
the beginning of the P
wave and the beginning
of the QRS complex
It is the interval between
the beginning of
electrical excitation of
the atria and the
beginning of excitation
of the ventricles
The P-R interval is about
0.16 second
7
Q-T interval

Contraction of the
ventricles last from the
beginning of the Q wave
to the end of the T wave
Q-T interval is the time
from the beginning of
the Q wave to the end of
the T wave
Q-T interval is about
0.35 second
Heart Rate

The heart rate is the repetition of the time


interval between two successive heartbeats
If the interval between 2 beats is 1 second , the
heart rate is 60 beats per minute
Methods for Recording Electrocardiograms
Computer-based and Pen recorder and a moving
electronic display sheet

11
Flow of Electrical current in the Heart

In normal ventricles, current


flows from negative to
positive from the base of the
heart toward the apex
The first area that
depolarizes is the ventricular
septum

12
Flow of Electrical current in the Heart

Current flows from the


electronegative inner
surface of the heart to the
electropositive outer
surface
(from the base of the heart
to the apex)
An electrode placed near
the base of the heart is
electronegative,
and near the apex is
electropositive
The ECG Leads

Lead: two wires and their electrodes to make a


complete circuit

The Bipolar Limb Leads: (I, II, III)


Chest Leads: (V1, V2, V3, V4, V5, V6)
Augmented Unipolar Limb Leads (aVR, aVL, aVF)
The Bipolar Limb Leads
Bipolar: means that the
ECG is recorded from two
electrodes
Lead I:
 The right arm : –ve
 The left arm: +ve
Lead II:
 The right arm: -ve
 The left leg: +ve
Lead III:
 The left arm: -ve
 The left leg: +ve

15
Chest Leads
Recorded from the
anterior surface of the
chest (V1, V2, V3, V4,
V5, V6)
Positive electrode on
the chest
The indifferent
electrode is the
negative electrode
connected to the right
arm, left arm, and left
leg 16
Chest Leads
V1 and V2: QRS are mainly negative because the
chest leads are nearer to the base of the heart
V3,V4 and V6 are mainly positive because the
chest electrode are nearer to the apex
Augmented Unipolar Leads
The two limbs are connected to the negative terminal of
the ECG, and the third limb is connected to the positive
When the positive terminal is on:
 The right arm (aVR)
 The left arm (aVL)
 The left leg (aVF)
All are similar to the
standard limb leads
aVR lead is inverted

18
Practical use of the ECG

Heart rate
Normal intervals
Rhythm
Regular
Single p-wave precedes
every QRS complex
P-R interval is constant
and within normal
range
Cardiac axis Axis
For further readings and diagrams:

Textbook of Medical Physiology by Guyton & Hall


Chapter 11 (The Normal Electrocardiogram)
Einthoven’s Triangle
Enthoven’s Triangle: is drawn
around the area of the heart

The two apices at the upper


part of the triangle represent
the points at which the two
arms connect electrically

The lower apex is the point at


which the left leg connects

21
Einthoven’s Law

Einthoven’s Law: if the electrical potential of any


two of the three bipolar limb leads are known, the
third one can be determined mathematically by
summing the first two (note the +ve and -ve signs)
Einthoven’s Law
Example:
The right arm= –0.2 mV
The left arm= 0.3 mV
The left leg= 1.0 mV
Lead I= 0.5 mV
(right arm = -0.2 mV and
left arm= 0.3 mV)
Lead II= 1.2 mV
(right arm= -0.2mV and
left leg= 1.0mV)
Lead III= 0.7 mV
Normal ECG Recorded from the Three Standard
Bipolar Limb Leads
All the Three Standard
Bipolar Limb Leads
record positive
The sum of the voltage in
Lead I + Lead III=
Lead II
Einthoven’s law

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