Ecg

Electrocardiogram
(ECG)
R N DATTA
ST. THOMAS COLLEGE OF ENGINEERING &
TECHNOLOGY
Electrical Activity of Heart
Cardiac Electrical Activity

Electrocardiogram ( ECG or EKG) is a graphical recording
or display of time varying voltages produced by
myocardium ( muscle tissue of heart) during cardiac cycle
Each action potential in heart originates near top of right
atrium this point is called pacemaker or sinoatrial node
Pacemaker is a group of specialized cells that
spontaneously generate action potential at a regular interval
and rate is controlled by innervation
Action potential propagates in all directions along surface
of both atria and towards junction of atria and ventricules
Wave terminates at a point near centre of heart called
Atrioventricular ( AV) node
At AV node , special fibers act as delay line to provide
proper timing between action of atria and ventricles
Cardiac Electrical Activity

Once potential is passed through delay line it rapidly
spread to all parts of both ventricles by bundle of His
The fibres of His are called Purkinje Fibres
Speed of the signal through Purkinje Fibre is 2~4 msec
His initiates action potential simultaneously in powerful
muscles of two ventricles
Wave front follows path perpendicular to surface and
moves from inside to outside of ventricular wall
Wave front terminates at the tip or apex of the heart
A wave of repolarization follows depolarization wave by
about 0.2 to 0.4 seconds and occurs at each cell
independently
ECG Waveform
ECG Waveform
P,QRS and T waves reflect the rhythmic electrical
depolarization and repolarization of the myocardium
associated with contractions of atria and ventricles
Certain disorders, like those involving valves cannot be
diagnosed from ECG
It serves timing references for other measurements
Horizontal segment of the wave form preceding P
wave is baseline or isopotential line
P-wave represents depolarization of atrial muscle
ECG
QRS complex is combined result of repolarization of
atria and depolarization of ventricle which occurs
almost simultaneously
T wave is the wave of ventricular repolarisation
U-wave , if present , is generally believed to be result
of after-potentials in the ventricular muscle
The shape and duration of each feature of the ECG
are significant
Waveforms also depends upon lead configuration used
Normal Values of ECG parameters

Amplitude :
P wave : 0.25 mv , R wave: 1.6 mv , Q wave : 25% Rwave, T wave : 0.1- 0.5mv
Duration :
P-R interval : 0.12 - .2 sec ; Q-T interval: 0.35 -0.44 sec
S-T interval : 0.05 - 0.15 sec. P interval : 0 .11 sec
QRS interval : 0.09 sec
If P-R interval is greater than 0.2 sec. then it suggest
blockage of AV node.
If one or more basic features of ECG missing , a heart
block or some sort might be indicated.
For healthy individuals ECG remains constant
Parameters Cardiologists look into
Cardiologist typically would look first at the heart rate

Normal value lies in the range 60 -100 beats per minute
Slower rate is called bradycardia - faster rate tachycardia
Then he would see if the cycles are even pcaced if not,
an arrhythmia may be indicated
If P-R interval is greater than 0.2 sec suggest a blockage
Certain disorder involving heart valves can not be
diagnosed from electrocardiogram
Cardiograph Planes
Frontal Plane
ECG Leads
Einthoven postulated that heart is near centre of an
equilateral triangle the apexes of this triangle are
right and left shoulders and crotch
This triangle is known as Einthoven Triangle
He assumed potentials at shoulder are essentially
same as wrists; potential at crotch is same as those
from any of ankles
So he let points of this triangle represent electrode
position for three limb leads
Normal electrode placement four electrodes ( RA,
LA, LL and C) are used RL is only for ground
reference
ECG Leads
Einthoven postulated that at any given instant of
cardiac cycle , frontal plane representation of
electrical axis of heart is a two dimensional vector
ECG measured from any one three basic limbs is
time variant single dimensional component
Sides of triangle represent the lines along which
three projections of ECG vectors are measured
Einthoven showed instantaneous voltage measured
from any one of three limb lead positions is equal to
algebraic sum of other two
Vector sum of projections on all three sides is equal to zero
So polarity of lead II measurement must be reversed; Rwave amplitude of lead II is sum of amp of R in I and II
Three Bipolar Limb Lead
ECG Leads
The resulting tracing of voltage difference ( at any two
points) due to electrical activity of heart is called a Lead
Bipolar Leads : Here ECG is recorded by using two
electrodes such that final trace corresponds to the difference
of potentials exists between them
Einthoven first introduced , 3 bipolar limb lead selections;
Lead I : electrodes are placed on the right and left arm
Lead II : Right arm Left Leg ( RA-LL)
Lead III : LL - LA
In all lead connections difference of voltages are measured
between two electrodes is always with reference to a third
point in body
The reference point is conveniently taken as Right leg ( RL)
Augmented Unipolar limb leads
Unipolar Chest Leads

In unipolar limb leads, two of the limb leads are tied
together and recorded with respect to the third limb
Lead AVR : right arm is recorded with respect to a
reference established by joining the left arm and left leg
electrodes
Lead AVL : left arm is recorded with respect to a reference
established by joining the right arm and left leg electrodes
Lead AVF : Left leg is recorded with respect to a reference
established by joining the left and right arm electrodes
They are also called averaging leads and resistances
inserted between the electrode-machine connections are
known as averaging resistance

Chest leads or Precordial leads : single chest
electrodes are sequentially placed at six predesignated positions to record potential
Leads are designated by the capital letter V
followed by a subscript numeral ( V1 V6) which
represents the position of the electrode on
pericardium
Modified chest lead : lead system simulates the V1
position with electrode position as follows :
Positive electrode : fourth intercostal space right sternal
border; Negative electrode : just below the outer position
of left clavicleut usually b
Ground : anywhere but usually below the right clavicle
ECG Amplifiers
In ECG differential amplifier is used
A differential amplifier can be considered as two
amplifiers with separate inputs but with a common output
Final output is the sum of two amplifier output voltages
Both amplifier has same voltage gain , but one is inverting
and other is non-inverting
If the two amplifiers inputs are connected to the same
input source resulting common mode gain will be zero
A differential amplifier is used to measure bioelectric
signal that occur as a potential difference between two
electrodes
Bioelectric signal are applied between inverting and noninverting inputs of amplifiers
ECG Amplifiers
Signal is amplified by differential gain of amplifier
For interference signal , both inputs appear as though they
are connected together with a common input source
Thus the interference signal is amplified by small common
mode gain
Input impedance is much higher than the electrode
impedance
ECG has a frequency range extending over to 100 Hz
ECG components
Usually differential amplifiers with high CMRR values are
used in ECG to amplify the weak bioelectric signals
To record ECG , a number of electrodes are fixed to body
of patient
Two leads or one lead and an interconnected group of
leads are selected and connected to inputs of amplifier
Waveform of ECG signal is very dependent on placement
of electrodes
For normal ECG examination waveforms are recorded
from a number of different leads to ensure no important
detail of waveform is missed
RL ( right leg ), LL, RA, LA(left arm , C ( chest) leads
Measurement of Bioelectric Potentials

Electrodes : Transducer for converting ionic potentials and
current into electric potentials and current
Measurement of individual action potentials is difficult
requires placement of electrode inside cells
Common form of measurement is combined effect of a
large number of action potential appears surface of body
It can be measured by inserting electrode in muscle, brain ,
nerve etc.Exact method for potentials reach surface is not
known
Several theories are available : summation of potential ,
first derivative of summation of electric potential
Regardless of these methods , these patterns of potentials
can be measured as bioelectric signals , studied , defined
Electrodes for ECG

The most common type of electrodes routinely used for
recording ECG are rectangular or circular surface electrode
The material used is german silver, nickel silver or nickel
plated steel
Applied to the surface of the body with electrode jelly
Typical value of contact impedance of these electrodes
which are normal size is nearly 2~5k, measured at 10Hz
Electrodes : Transducer for converting ionic potentials

and current into electric potentials and current
ECG Amplifier
Electrodes : Transducer for converting ionic potentials and
current into electric potentials and current
large number of action potential appears surface of body
It can be measured by inserting electrode in muscle, brain ,
nerve etc.Exact method for potentials reach surface is not
known
Several theories are available : summation of potential ,
first derivative of summation of electric potential
Regardless of these methods , these patterns of potentials
can be measured as bioelectric signals , studied , defined

A single chest electrode (exploring electrode) is sequentially
placed on each of six predesignated points on chest
These chest positions are called precordial unipolar leads
These leads are designated V1 through V6
All three active limb electrodes are used to obtain central
terminal , while a separate chest electrode is used as
exploratory electrodes
ECG recorders ( single / multi-channel)
Trade mills
Holter recording

Ecg

Uploaded by

Copyright:

Available Formats

Ecg

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ecg

Uploaded by

Copyright:

Available Formats

Electrocardiogram

Electrical Activity of Heart

Cardiac Electrical Activity

Cardiac Electrical Activity

Normal Values of ECG parameters

Parameters Cardiologists look into

Cardiologist typically would look first at the heart rate

Three Bipolar Limb Lead

Augmented Unipolar limb leads

Augmented Unipolar limb leads

Unipolar Chest Leads

Unipolar Chest Leads

Augmented Unipolar limb leads

Unipolar Chest Leads

Unipolar Chest Leads

Measurement of Bioelectric Potentials

Electrodes for ECG

Electrodes : Transducer for converting ionic potentials

Unipolar Chest Leads

You might also like