Medical Physics

Electricity within the

Human body
2020

2020

Authors base of knowledge and awareness

‫اﻟﺘﺼﻨﻴﻒ اﻟﻌﺎﻟﻤﻲ ﻟﻘﻮاﻋﺪ ﺑﻴﺎﻧﺎت اﻟﻨﺸﺮ اﻟﻌﻠﻤﻲ‬

Prof. Dr. Bassem Raafat

Prof. Dr. Ghada Nabil Dr. Wesal Bushra

Professor of Medical Physics Course Co-Ordinator Ass. Professor of Medical Physics

College of Applied Medical Sciences Professor of Medical Physics College of Applied Medical Sciences
Radiological Science Department College of Applied Medical Sciences Radiological Science Department

Radiological Science Department

2 Objectives:

By the end of this section, you will learn the following items :

1) Review of Electrical Properties

2) The nervous system and the neurons

3) Electrical potentials of nerves

4) How neurons communicate?

5) Axon structure and functions

6) How Human Nerve Cells Transmit Signals

7) Action potential, Refractory periods

8) Polarization, depolarization and repolarization

9) Electrical signals from muscles electromyogram (EMG)

10) Electrical signals from the heart electrocardiogram (ECG)

11) ECG parameters and indications

12) How to read ECG

References:

1-Basics of Medical Physics, Daniel Jirak, Institute of Medical Physics and Information. Charles University 2017

2- Medical Physics textbook by Cameron

2- Physics in Biology and Medicine, Third Edition by Paul Davidovits

3- Physics of the Human Body, by Irving P. Herman

4- "Definition of EKG by Lexico". Lexico Dictionaries. Retrieved 20 January2020.

5- Electrocardiographic Terms", AMA Manual of Style, American Medical Association Medical Physics

First Year, Level-II

3
Electrical Charge and Field

§ Electrons are negative charges and protons are positive

charges. An electron is considered the smallest quantity of negative

charge and a proton the smallest quantity of positive charge.

§ Two negative charges repel. Also, two positive charges repel. A

positive charge and a negative charge attract each other.

§ Point Charge : An accumulation of electric charges at a point (a tiny

volume in space) is called a point charge.

When an atom loses an electron, the separated electron forms a

negative charge, but the remaining that contains one less electron

or consequently one more proton becomes a positive charge. A

positive charge is not necessarily a single proton. In most cases, a

positive charge is an atom that has lost one or more electron(s).

SI Unit of Electric Charge : Coulomb

If two like point charges are separated by 1m and the repulsion force between them

is 9.0x109N, each charge is called 1 Coulomb, shown as 1C. It has been shown that it

takes 6.25x1018 electrons to form 1C of negative electricity.

Medical Physics

First Year, Level-II

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‬ ‫األلكترونات سالبة الشحنة والبروتونات موجبة الشحنة اإللكترون يعتبر اصغر كمية من الشحنات السالبة والبروتون اصغر كمية من‬
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‬ ‫الشحنات املوجبة
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‬ ‫شحنتان سالبتني تتنافر وايضا شحنتان موجبتان تتنافر والشحنه املوجبه والسالبة يتجاذبو مع بعض
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‬ ‫الشحنه النقطية تراكم الشحنات الكهربيه عند نقطه ) حجم صغير في الفراغ ( يسمي شحنه نقطيه
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‫عندما تفقد الذره الكترونا االلكترون املنفصل يشكل شحنه سالبه ولكن الباقي الذي يحتوي علي الكترون او اقل او يصبح بروتون‬
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‬ ‫اخر موجب الشحنه والشحنه املوجبه ليست بالضروره بروتونا واحدا وفي معظم الحاالت تكون الشحنه املوجبه عباره عن ذره فقدت‬
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‬ ‫الكترون او اكثر
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‬ ‫لو يوجد شحنتان متساويتان مفصولني بمسافه ‪ ١‬متر وقوه التنافر بينهم ‪٩‬في ‪ ١٠‬اس ‪ ٩‬كل شحنه منهم ‪ ١‬كولوم وتاخذ‬
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‬ ‫الكترون لتكوين ‪ ١‬كولوم‬
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4 Electrical Charge and Field

Electric field is defined as the electric force per unit

charge. The direction of the field is taken to be the

direction of the force it would exert on a positive test

charge. The electric field is radially outward from a

positive charge and radially in toward a negative point

charge.
‫املجال الكهربي هو القوه الكهربيه لوحده الشحنه اتجاه املجال ياخذ اتجاه‬

‫القوه يخرج من الشحنه املوجبه الي الشحنه السالبه‬

Coulomb’s Law :

The Constant k = 9 × 109 N-m2/ C2

Medical Physics

First Year, Level-II

5 Electric Fields Properties

‫املجال الكهربي من املوجبه بره‬

Electric field vector of a positive charges is out

Electric field vector of a negative charges is in

‫املجال الكهربي من السالبه جوه‬

Dipole moment ‫العزم اللحظي‬

It is the combination of both electric fields

comes from the interaction between two

charges and calculated as : ‫اتحاد من املجالني بني الشحنتنان‬

P = qr

P is the dipole moment, q is the charge and

Prof. Dr. Bassem Raafat

r is the distance between both charges

Medical Physics

First Year, Level-II

6 Electricity within the Human Body

Electricity is everywhere, even in the human body. Our cells are specialized to conduct

electrical currents. Electricity is required for the nervous system to send signals throughout

the body and to the brain, making it possible for us to move, think and feel.

So, how do cells control electrical currents?

§ The elements in our bodies, like sodium, potassium, calcium, and

magnesium, have a specific electrical charge. Almost all of our cells can

use these charged elements, called ions, to generate electricity.

§ The contents of the cell are protected from the outside environment by a

cell membrane. This cell membrane is made up of lipids that create a

barrier that only certain substances can cross to reach the cell interior. Not

only does the cell membrane function as a barrier to molecules, it also acts

as a way for the cell to generate electrical currents. Resting cells are

negatively charged on the inside, while the outside environment is more

positively charged. This is due to a slight imbalance between positive and

negative ions inside and outside the cell. Cells can achieve this charge

separation by allowing charged ions to flow in and out through the

membrane. The flow of charges across the cell membrane is what

generates electrical currents.

Medical Physics

First Year, Level-II

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‫الكهربيه في كل مكان حتي في جسم االنسان الخاليا بتاعتنا مخصصه في توصيل التيارات الكهربيه‬
‫والكهربيه ضروريه للجهاز العصبي في توصيل االشارات للجسم او للمخ
‬

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‫كيف تتحكم الخاليا في التيارات الكهربيه ؟
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‫العناصر املوجوده في اجسامنا زي الصوديوم والبوتاسيوم والكالسيوم واملغنيسيوم لها شحنه محدده يمكن للخاليا‬
‫استخدام هذه العناصر املشحونه التي تسمي االيونات النتاج الكهرباء
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‫محتويات الخليه محميه من البيئه الخارجيه بواسطه غشاء الخليه يتكون غشاء الخليه من الدهون التي تخلق‬
‫حاجزا ال يمكن لبعض املواد املرور للدخول داخل الخليه
‬
‫والغشاء ليس حاجز امام الجزيئات فقط بل يعمل ايضا كطريقة للخليه لتوليد التيار الكهربي يتم شحن الخاليا‬
‫اثناء الراحه من الداخل بالسالب ويكون فالخارج موجب بسبب اختالف بسيط بني االيونات املوجبه والسالبة داخل‬
‫وخارج الخليه
‬

‫يمكن للخليه الفصل بني الشحنات عن طريق السماح لاليونات بالتدفق داخل وخارج الغشاء وتدفق الشحنات‬
‫هذا الذي يولد التيارات الكهربيه
‬

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7 Electrical Field Communication Unit

AXON, Neurons

An axon, or nerve fiber, is a long slender

projection of a nerve cell, or neuron, that

conducts electrical impulses away from the

neuron's cell body or soma. Axons are in effect

the primary transmission lines of the nervous

system, and as bundles they help make up

nerves.

Neurons or Axons are the longest cell in

the human body is the neuron. Neurons are

cells of the nervous system that process and

transmit information throughout the body

The longest neuron in the human body has a

single threadlike projection (the axon), a few

micrometers in diameter, that reaches from the

base of the spine to the foot, a distance of up to

Medical Physics

one meter." First Year, Level-II

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‫االلياف العصبيه االكسون هو اسقاط طويل ونحيف للخليه العصبيه او النيرون يرسل‬
‫النبضات الكهربيه بعيدا عن جسم الخليه او السوما واالكسون تعتبر خطوط النقل‬
‫االساسيه للجهاز العصبي وكحزم تساعد في تكوين االعصاب
‬

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‫الخاليا العصبيه او املحاور هي اطول خليه في جسم االنسان والخاليا العصبيه هي‬
‫التي تعالج وتنقل املعلومات في جميع انحاء الجسم
‬

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‫اطول خليه في جسم االنسان ولها اسقاط واحد يشبه الخيط )املحور العصبي (
‬

‫يبلغ قطره بضعه ميكروميترات ويمتد من قاعده العمود الفقري الي القدم علي مسافه تصل‬
‫الي واحد متر
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8 Nerve cell Structure ‫التشعبات قصيره ومتفرعه غير مايلني جزء من الخليه العصبيه‬

1-Dendrites: Short, branched & unmyelinated

‫مخصص في استقبال االشارات الكهربيه من املحفز او من خليه‬
‫عصبيه اخري نحو جسم الخليه وسطحها مخصص لالتصال مع‬

part of the neurons specialized for receiving ‫الخاليا العصبيه االخري‬

electrical messages (signals) from stimuli or

from other neurons towards the cell body. Its

surfaces is specialized for contact with other

neurons.

2-Soma (Cell body): Surrounded by cell

membrane, it receives electrical messages

(signals) from other neurons through body. If

the stimulus (such as touch, sound, light, and

so on), is strong enough, the neuron will

transmit an electrical signal outwards along a

fiber called an axon.

‫السوما او جسم الخليه محاط بغشاء الخليه يستقبل االشارات الكهربيه من الخاليا العصبيه‬
‫االخري عبر الجسم اذا كان هناك محفز مثل الصود والصوت واللمس وهكذا قوي بدرجه كبيره‬

‫فالعصب هينقل االشارات الكهربيه خالل ليل عصبي يسمي االكسون‬

Medical Physics

First Year, Level-II



‫االكسون او الليف العصبي ينشر االشارات الكهربيه بعيدا عن‬

‫ متر ويوجد منه‬١ ‫جسم الخليه الي نهايه االعصاب وتقريبا‬

9 Nerve cell Structure ‫نوعان مايلني وغير مايلني‬

3- Axon (nerve fiber): Carries (propagates)

and conveys electrical messages (signals)

away from the cell body into the nerve

terminals. Axons are ≈ 1 mm long. There

are two types of nerve fibers (myelinated

and unmyelinated nerve fibers).

4- Axon terminals: Transmit electrical

messages (information) from the neuron to
muscles, glands or other neurons. Synaptic

end bulbs: contain vesicles filled with

neurotransmitters.

‫نهايه االكسون تنقل االشارات الكهربيه من العصب الي عضله‬

‫غده او عصب اخر وليها حويصالت تحتوي علي ناقالت عصبيه‬

Medical Physics

First Year, Level-II


‫مخ االنسان يتكون من باليني الخاليا العصبيه متصله مع‬

‫بعضها من خالل توصيالت تسمي الساينبس تقع علي‬

10 Neurons Communication ‫التشعبات او جسم الخليه وعلي كل ساينابس يوجد ناقالت‬

‫كيميائيه تخرج من خليه وتستتقبل فالخليه االخري‬

The human brain is composed of billions of nerve cells which communicate through
specialized connections called synapses (located on the dendrites or on the cell body). At

each synapse, a chemical neurotransmitter is released from one cell and binds to receptors
on the second cell. This chemical transmission generates electrical and biochemical signals

in the second cell that are then passed along to a network of nerve cells. Thus, a synapse
is the basic unit of communication in the brain. Building the correct network of synapses is

essential for brain development and understanding how those synapses go is key to many
neurological disorders. ‫النقل الكيميائي يولد اشارات كهربيه وبايوكيميائيه في الخليه االخري ويمر خالل شبكه من الخاليا العصبيه لذلك‬

‫الساينبس هو وحده االتصال االساسيه فاملخ وبناء شبكه سليمه من الساينبس ضروري لتطوير املخ والساينبس هو‬

‫املفتاح للعديد من االضطرابات العصبيه‬

Prof. Dr. Bassem Raafat

Medical Physics

First Year, Level-II


‫جزيئات النيرو تخرج من الحويصله وترتبط باملستقبالت في الخليه اللي‬

‫بعدها لتوليد اشارات كهربيه وبايوكيميائيه في الخليه التانيه وبعد ذلك تمر‬

11 Neurotransmitters ‫خالل شبكه من الخاليا العصبيه‬

Neurotransmitters molecules are

released from the synaptic vesicles to

bind with the receptors sites in the

next cell in order to generate electrical

and biochemical signals in the second

cell that are then passed along to a

network of nerve cells.

Prof. Dr. Bassem Raafat

Medical Physics

First Year, Level-II


‫سطح كل العصب يوجد جهد كهربي نتيجه وجود توزيع شحنات غير‬

‫متوازن داخل وخارج الغشاء فتكون سالب فالداخل اكتر من الخارج‬

12 Cell Electrical Potentials ‫بسبب ان الشحنات املوجبه فالخارج اكثر من الداخل‬

Across the surface or membrane of every neuron is an electrical potential (voltage) difference due to
the presence of unbalanced charges distribution inside and outside the membrane. It looks like more

negative inside than that outside because the positive charges outside is much more than that
inside.

Resting potential

Polarization

Cell membranes surround neurons just as any

other cell in the body has a membrane. When

a neuron is not stimulated. It’s just sitting with

no impulse to carry or transmit its membrane

is polarized and its potential difference in this

case called Resting potential

Medical Physics

First Year, Level-II


‫عندما املحفز يصل عصب في حاله راحه بوابات االيونات تفتح‬
‫فجاه وتسمح اليونات الصوديوم فالخارج تدخل داخل الخليه‬

‫والعصب يصبح من بلوريزيد الي ديبولوريزيد‬

13 Cell Electrical Potentials

Action potential

De-polarization

When a stimulus reaches a resting neuron,

the gated ion channels on the resting

neuron’s membrane open suddenly and

allow the Na+ that was on the outside of the

membrane to go rushing into the cell. As this

happens, the neuron goes from being

polarized to being depolarized.

Remember that when the neuron was

polarized, the outside of the membrane was

positive, and the inside of the membrane

was negative. Well, after more positive ions

go charging inside the membrane, the

inside becomes positive, as well;

polarization is removed and the threshold is

reached. ‫عندما يكون العصب بوالريزيد خارج الغشاء موجب‬

‫والداخل سالب وبعد دخول شحنات موجبه داخل الغشاء‬ Medical Physics

‫الداخل يصبح موجب ويصل الي حد التحفيز‬ First Year, Level-II



14 Cell Electrical Potentials

Resting potential again

Re-polarization

After the inside of the cell becomes flooded

with Na+, the gated ion channels on the

inside of the membrane open to allow the

K+ to move to the outside of the membrane.

With K+ moving to the outside, the

membrane’s repolarization restores

electrical balance, although it’s opposite of

the initial polarized membrane that had Na+

on the outside and K+ on the inside.

‫بعد ما داخل الخليه يمأل بايونات الصوديوم بوابه االيونات تفتح‬

‫وتسمح للبوتاسيوم بالتحرك للخارج‬

‫ويكون عكس البوالريزيد االبتدائي وهو الصوديوم بره والبوتاسيوم‬

‫جوه‬

Medical Physics

First Year, Level-II



‫قيمه التحفيز‬

‫هو حدوث الجهد الفعلي في اغلب العصب قيمه‬

15 Cell Electrical Potentials ٦٥ ‫ الي‬٥٥ ‫التحفيز يكون من‬

Threshold Potential

Threshold of excitation(threshold): The

level that a depolarization must reach for

an action potential to occur. In most

neurons the threshold is around -55mV to -

65mV.

Medical Physics

First Year, Level-II


‫البوابات تعتبر الطريقه الوحيده اليونات الصوديوم والبوتاسيوم‬

‫لالنتشار خالل الخليه العصبيه ويوجد شحنات موجبه كثير‬

16 Sodium and Potassium gates ‫بوتاسيوم فالداخل وفالخارج العديد من الصوديوم والبوتاسيوم‬

These gates represent the only way that sodium and potassium ions can diffuse through a

nerve cell membrane. There are lots of positively charged potassium ions just inside the

membrane and lots of positively charged sodium ions PLUS some potassium ions on the
outside.

This means that there are more positive charges outside than ‫هذا يعني ان الشحنات املوجبه بره اكتر من جوه وهذا‬

inside, this way inside can be described as negative side. ‫يعني انه سالب‬

Prof. Dr. Bassem Raafat

Medical Physics

First Year, Level-II



‫قانون الكل او ال كل‬

‫ان العصب او الياف العضالت استجابتهم للمحفز مستقل عن شده‬

17 All or NON law ‫التحفيز لو التحفيز وصل جهد التحفيز يعطي استجابه كامله والعكس‬
‫ال يعطي استجابه‬

The all-or-none law is the principle that the strength by which

a nerve or muscle fiber responds to a stimulus is independent

of the strength of the stimulus. If that stimulus exceeds the

threshold potential, the nerve or muscle fiber will give a

complete response; otherwise, there is no response.

‫ال يوجد شي‬

In other words
‫اسمه جهد‬
‫جزئي او‬

There's NO such thing as a

‫ضعيف‬

partial or weak action

potential.

Importance of ALL or NON law

Each fiber within a motor unit contracts according to the all

or none law. This principle states that when a motor unit
‫كل ليف داخل وحده محرك تنقبض وفقا لقانون الكل او ال‬

‫كل‬

receives a stimulus of sufficient intensity to bring forth a ‫وينص املبدا علي ان عندما تتلقي الوحده محفزا بكثافة‬
response, all the muscle fibers within the unit will contract at

the same time, and to the maximum possible extent.

‫عاليه لحدوث االستجابه فان جميع االلياف تنقبض في‬
‫نفس الوقازوباقصي حد ممكن‬ Medical Physics

First Year, Level-II


‫الغشاء لبعض االكسونات مغطي بطبقه دهنيه عازله تسمي املايلني لها فراغات صغيره غير مايلني تسمي العقد الرنفيه حيث االكشن‬

‫بوتينشال اسرع في املايلني عن النانميلني واالكسون الذي ليس له طبقه مايلني يسمي ان مايلني‬

18 Myelinated and Un-myelinated Nerves

Membrane of some axons are covered with a fatty insulating layer

called Myelin that has small un-insulated (un-myelinated, constricted)

gaps called Nodes of Ranvier every few millimeters these nerves are
referred to as myelinated nerves which conduct actions potentials

much faster than unmyelinated nerves. While, axons of other nerves

which have no myelin sheath are called unmyelinated nerves.

Prof. Dr. Bassem Raafat

Medical Physics

First Year, Level-II



‫سرعه التوصيل‬
‫ متر لكل ثانيه وسرعه‬١٢٠ ‫ الي‬١ ‫النبضه تنتقل من اليسار لليمني بسرعه من‬

‫التوصيل التوصيل تتاثر ب‬
19 Conduction Velocity

‫قطر العصب ووجود وغياب الطبقه املايلني‬

Impulses typically travel along neurons from left to right side at a speed of anywhere
from 1 to 120 m/sec. This speed of conduction can be influenced by:

1- Diameter of a nerve fiber.

2- Presence or absence of myelin sheath.

‫العصب الذي قطره اكبر يوصل الكهربيه اسرع من القطر الصغير‬

ü Nerves with larger diameter conduct electricity

faster than those with small diameter

ü Myelinated nerves conduct velocity faster than

unmyelinated nerves
‫االعصاب املايلني سرعتها اعلي من الغير مايلني‬

Prof. Dr. Bassem Raafat

Electrical Resistance across the axon’s

membrane decrease as the diameter of the

axon increases so an axon with a large

diameter will have higher velocity of

propagation than an axon with a small

diameter.
‫املقاومه الكهربيه خالل غشاء االكسون تقل لو القطر زاد حيث ان االكسون الذي قطره سرعته‬ Medical Physics

‫اعلي من القطر الصغير‬ First Year, Level-II



20 Normal Conduction Velocity NCV

§ A nerve conduction velocity between 50 and 60 meters per second is generally considered
in the normal range. However, any result has to be examined along with other information.

Your doctor will compare the results of your test against a standard, or norm, of

conduction velocities.‫ متر لكل ثانيه تكون فالرينج الطبيعي ورغم ذلك يجب فحص النتيجه مع معلومات‬٦٠‫ و‬٥٠ ‫سرعه التوصيل تكون بني‬
‫تانيه ويقارن طبيبك نتائج اختبارك مع السرعات العاديه والقياسية‬

§ The nerve conduction velocity (speed) is then calculated by measuring the distance
between electrodes and the time it takes for electrical impulses to travel between

electrodes. A related procedure that may be performed is electromyography (EMG).

‫يتم حساب سرعه التوصيل عن طريق قياس املسافه بني االقطاب والوقت التي تستغرقه النبضات لالنتقال بني االقطاب والعمليه املتعلقه اسمها تخطيط العضل‬

§ The reference values for nerve conduction velocity (NCV) and late responses for different
nerves considerably vary in different group and type of population. Physiological factors such

as age, temperature, height, and gender affect the NCV.

‫االرقام املرجعيه لسرعه توصيل العصب واالستجابه املتاخره لألعصاب تختلف اختالفا كبيرا في مجموعه مختلفه‬

‫وتؤثر العوامل الفيزيائيه مثل العمر ودرجه الحراره والطول والجنس علي سرعه التوصيل‬

Medical Physics

First Year, Level-II



21 Electro-Myo-Gram (EMG)

Electrical signals from muscles

• Electromyography (EMG) is a diagnostic

procedure to assess the health of muscles and the

nerve cells that control them

neurons). EMG results can reveal nerve
(motor

dysfunction, muscle dysfunction or problems with

nerve-to-muscle signal transmission.

• Nerve conduction studies measure how well and how fast

the nerves can send electrical signals. Nerves control the

muscles in the body by electrical signals (impulses), and

these impulses make the muscles react in specific ways.

Prof. Dr. Bassem Raafat

• Nerve and muscle disorders cause the muscles to react in

abnormal ways. Measuring the electrical activity in

muscles and nerves can help find diseases that damage

muscle tissue or nerves.

Medical Physics

First Year, Level-II

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‫جهاز ‪ Emg‬اجراء تشخيصي لتقييم صحه العضالت والخاليا‬
‫العصبيه املتحكمه في ذلك الخاليا العصبيه الحركيه ‪.‬ونتيجه الجهاز‬
‫يكشف الخلل الوظيفي او خلل فالعضالت او املشاكل في نقل‬
‫االشارات من العصب الي العضالت
‬

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‫دراسه توصيل العصبي لالعصاب يمكن ان تقيس جوده وسرعه ارسال‬
‫االعصاب لالشارات الكهربيه وتتحكم االعصاب في العضالت عن طريق‬
‫النبضات وهذه النبضات تجعل العضالت تتفاعل بطرق معينه
‬

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‫اضطرابات العضالت واالعصاب تؤدي الي‬
‫تفاعل العضالت بشكل مو طبيعي وقياس‬
‫النشاط الكهربي لالعصابل والعضالت يساعد‬
‫في العثور علي االمراض اللي تتلف االنسجه‬
‫العضليه واالعصاب
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Electro-Myo-Gram (EMG)

22
Electrical signals from muscles

EMG and nerve conduction study

§ A nerve conduction study (NCS) is a medical

diagnostic test commonly used to evaluate the function,
especially the ability of electrical conduction, of the

motor and sensory nerves of the human body.

‫دراسه التوصيل العصبي هي اختبار طبي تشخيص معروف لتقييم الوظيفه وخصوصا قدره التوصيل‬
‫الكهربي لالعصاب الحركيه والحريه لجسم االنسان‬

SO, the difference is :

EMG test looks at the electrical signals your muscles

make when they are at rest and when they are being
used. A nerve conduction study measures how fast and
how well the body's electrical signals travel down

your nerves
‫ ينظر الي االشارات الكهربيه التي تصنعها عضالتك عندما تكون في راحه وعندما‬emg ‫لذلك الفرق هو‬
‫تستخدمها تقيس دراسه التوصيل العصبي مدي سرعه وجوده انتقال االشارات الكهربيه عبر اعصابك‬ Medical Physics
First Year, Level-II

‫الكمون يعرف انه الفتره بني عرض التحفيز واالستجابه الواضحه‬
Electro-Myo-Gram (EMG)
‫له مثل انقباض العضالت‬

23
Electrical signals from muscles ‫وهو ايضا الخمول بني وقت التحفيز ولحظه حدوث االستجابه‬

Latency ‫الكمون‬

Latency or latent period is defined as the period

(interval, delay) elapsed between the

presentation of a stimulus and the obvious
response such as the contraction of a muscle.

And it is also, the apparent inactivity between

the time the stimulus is applied and the moment
a response occurs.

An abnormal EMG result means there is a

Prof. Dr. Bassem Raafat

problem in an area of muscle activity—turning

on and off, when it is active, how much it is ‫ غير طبيعيه تعني ان هناك مشكله في‬emg ‫نتيجه‬
active, if it is more or less active, and fatigue. ‫منطقه النشاط العضلي يتم تشغيله وايقافه وعندما‬
This can offer a clue in diagnosing various ‫يكون نشطا ومقدار نشاطه اذا كان اكثر او اقل‬

nerve and muscle conditions. Learn more in 10

Conditions Diagnosed With an EMG.
‫فالنشاط‬

Medical Physics
First Year, Level-II


Electro-Cardio-Gram ECG or EKG

24
Electrical signals from the heart

An electrocardiogram (ECG) is a simple test that can be used to

check your heart's rhythm and electrical activity in rest.

• With each beat, an electrical impulse (or “wave”) travels through the
heart. This wave causes the muscle to squeeze and pump blood from

the heart. A normal heartbeat on ECG will show the timing of the top
and lower chambers.

• Normal ECG. A normal ECG means that the heart is beating in a regular electrical activity within the

normal range which is 60 - 100 beats per minute (specifically 82 bpm). Normal ECG also means that all
the important intervals on this recording are within normal ranges.

Prof. Dr. Bassem Raafat

• An abnormal EKG can mean many things. Sometimes an EKG abnormality is a normal variation of
a heart's rhythm, which does not affect your health. Other times, an abnormal EKG can signal a

medical emergency, such as a myocardial infarction (heart attack) or a dangerous arrhythmia.

Medical Physics
First Year, Level-II
 ‫مخطط القلب هو اختبار بسيط يستخدم للتحقق من ايقاع القلب‬
‫ونشاطه اثناء الراحه
‬

‫مع كل نبضه النبضه الكهربيه تنتقل عبر القلب وتؤدي هذه املوجه‬
‫الي ضغط العضالت وضخ الدم من القلب ونبض القلب الطبيعي‬
‫سيظهر في مخطط القلب توقيت الغرفتان اللي فوق واللي تحت
‬

‫تخطيط القلب الطبيعي يعني ان القلب في نشاط منتظم ضمن‬

‫النطاق الطبيعي وهو ‪ ٦٠‬ل ‪ ١٠٠‬نبضه فالدقيقة اي ‪ ٨٢‬نبضه‬
‫في الدقيقه وتخطيط القلب يعني ايضا ان جميع الفواصل‬
‫الزمنيه املهمه في التسجيل تقع في النطاق العادي
‬

‫رسم القلب الغير طبيعي يعني اشياء كثيره في بعض االحيان‬

‫يكون تباين طبيعي في ايقاع القلب والذي ال يؤثر علي صحتك‬
‫في اوقات اخري‪ .‬يمكن ان يشير مخطط القلب الغير طبيعي الي‬
‫حاله طبيه طارئه مثل نوبه القلب او عدم انتظام ضربات القلب‬
‫الخطير
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25 Electro-Cardio-Gram ECG or EKG

Electrical signals from the heart

How do you read ECG results?

Check the date and time that the ECG was

performed.

1. Step 1 – Heart rate.

2. Step 2 – Heart rhythm.

3. Step 4 – P waves.
4. Step 5 – PR interval.
5. Step 6 – QRS complex.

6. Step 7 – ST segment.
7. Step 8 – T waves.

SO

We have to learn firstly more

about the heart

Structure
Beats
Cycles

Valves
Conductivity
Medical Physics
First Year, Level-II


26 Electro-Cardio-Gram ECG or EKG

Electrical signals from the heart

Cardiac Cycle

• The cardiac cycle is the performance of heart from the ending of one heartbeat to the beginning of
the next. It consists of two periods. one during which the heart muscle relaxes and refills with

blood, called diastole, following a period of robust contraction and pumping of blood,
dubbed systole. After emptying, the heart immediately relaxes and expands to receive another

influx of blood returning from the lungs and other systems of the body, before again contracting
to pump blood to the lungs and those systems. A normally performing heart must be fully

expanded before it can efficiently pump again.

• Rhythmical action of the heart is defined as“ The ability of the heart to

beat regularly and initiate its own regular repetitive beats independent
on nerve supply”. This rhythmical action is controlled by an electrical
signal initiated by spontaneous stimulation of special muscle cells

located in the right atrium. These muscle cells make up the sinoatrial
(SA) nodes or Heart Pacemaker (Initiate cardiac impulses).

• Electrical signals from SA node initiates the depolarization of the

nerves and muscles of both left and right atrium, causing the atria to

contract and pump blood into the ventricles. Repolarization of the atria
then follows. Medical Physics
First Year, Level-II
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‫الدوره القلبيه هي اداء القلب من نهايه نبضه قلب واحده الي بدايه اللي بعدها‬
‫يكون من فترتني واحده تسترخي من خاللها عضله القلب وتمتلئ بالدم الدايستول‬
‫وبعد فتره من االنقباض القوي وضخ الدم تسمي السيستول وبعد التفريغ يرتاح‬
‫القلب فورا ويتمدد الستقبال تدفق الدم العائد من الرئتني وانظمه الجسم االخري‬
‫قبل ان يتقلص مره اخري لضخ الدم الي الرئتني يجب ان يتم توسيع القلب الذي‬
‫يعمل بشكل طبيعي بشكل كامل قبل ان يتم الضخ مره اخري
‬

‫
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‫الفعل املتوازن للقلب هو قدره القلب علي الخفقان بانتظام وبدء دقاته املتكرره‬
‫املنتظمة بشكل مستقل عن امداد العصب يتم التحكم بواسطه اشاراه كهربائيه تبدا‬
‫بالتحفيز التاقائي لخاليا عضليه خاصه موجوده في االذين االيمن تشكل هذه‬
‫الخاليا العضليه العقد الجيبني االذنينيه او منظم ضربات القلب
‬

‫تبدا االشارات الكهربيه من العقد الجبينيه االذينيه ازاله استقطاب االعصاب‬

‫وعضالت االذين االيمن وااليسر مما يتسبب في انقباض االذينني وضخ الدم الي‬
‫البطينني ثم استقطاب االذينني
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27 Electro-Cardio-Gram ECG or EKG

Electrical signals from the heart

Cardiac Cycle

Diastole : Systole :
§ The RA receives venous blood from the § Both left and right ventricles received

body through the superior vena cava blood from left and right atria, respectively.

(SVC) and inferior vena cava (IVC). The

LA receives oxygenated blood from lungs § Both Atrioventricular valves are closed so

through four pulmonary veins that enter

the LA.
no blood can return back to atria

§ Both atria are contracted and both

§ Both aortic and pulmonary valves opened
to permit blood to go out

Ventricles are relaxed

§ Blood is ejected into aorta and pulmonary

Prof. Dr. Bassem Raafat

§ Atria become smaller in size while artery
ventricles become larger in size

§ Blood move through the atrioventricular

valves to ventricles from RA to RV and

from LA to LV respectively.

Medical Physics
First Year, Level-II


28 Electro-Cardio-Gram ECG or EKG

Electrical signals from the heart

Electricity within the heart

• An electrical stimulus is generated by the sinus node (also

called the sinoatrial node, or SA node). This is a small mass

of specialized tissue located in the right upper chamber

(atria) of the heart. The sinus node generates

an electrical stimulus regularly, 60 to 100 times per minute

•
under normal conditions.
Electrical signal then passes into the atrioventricular

(AV) node via His bundle and the Purkinje fibers to

the ventricles which, initiates the depolarization of

the right and left ventricles causing them to contract

and force blood into the pulmonary and general

Prof. Dr. Bassem Raafat

circulation. The ventricle nerves and muscles then
repolarize and the sequence begin again.

• Nerves and muscles of the heart can be regarded as

source of electricity enclosed in an electrical

conductor (torso).

Medical Physics
First Year, Level-II
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‫املحفز الكهربي ينشا بواسطه العقد الجبيبه ‪ sa‬وهذه كتله صغيره من االنسجه‬
‫املتخصصه املوجوده في الحجر العلويه اليمني )االذينني ( من ‪ ٦٠‬ل ‪ ١٠٠‬مره‬
‫فالدقيقه في ظل الظروف العاديه
‬

‫االشارات الكهربيه تنتقل الي العقد االذينيه البطينيه خالل الحزمه الخاصه به‬
‫والياف بركنجي الي البطينني مما يؤدي الي ازاله استقطاب البطني االيمن وااليسر‬
‫مما يؤدي الي انقباضهما واجبار الدم الي الدخول الي الدوره الدمويه الرؤيه ثم‬
‫تستقطب لعصاب وعضالت البطني ويبدا مره اخري
‬

‫يمكن اعتبار اعصاب وعضالت القلب‪ .‬مصدرا للكهرباء محاطا بموصل كهربائي
‬

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29 Electro-Cardio-Gram ECG or EKG

Electrical signals from the heart

Heart has four main valves :

1- Right atrioventricular valve :

controls flow between the right atrium and right

ventricle it is also called the tricuspid valve.

2- Left atrioventricular valve :

controls flow from the left atrium to the left ventricle.

It has two flaps and is therefore also called the

bicuspid valve. Another name for this valve is the

mitral valve, because it looks like a miter.

3- The pulmonary semilunar valve :

Prof. Dr. Bassem Raafat

controls blood flow from the right ventricle to the left
and right pulmonary arteries.

4- The aortic semilunar valve :

controls flow from the left ventricle to the aorta.

Medical Physics
First Year, Level-II


30 Electro-Cardio-Gram ECG or EKG

Electrical signals from the heart

ECG Test

The ECG electrodes. Electrical activity going through the heart can

be measured by external (skin)electrodes. The electrocardiogram

(ECG) registers these activities from electrodes which have been

attached onto different places on the body. In total, twelve leads are
calculated using ten electrodes.

Electrodes for obtaining ECG are located on the left arm

(LA), right arm (RA) and left leg (LL).

§ Lead I : Measurement of potential between RA and LA

§ Lead II : measure the potential between RA and LL

Prof. Dr. Bassem Raafat

§ Lead III : measure the potential between LA and LL

Two types of ECG are known : The three leads (LI + LII +
LIII) are called standard

1. Resting ECG while the patient is lying down on his bed

2. Stress ECG while the patient making effort as bile or treadmill
limb leads.

Medical Physics
First Year, Level-II
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‫توصيالت مخطط القلب يمكن قياس النشاط الكهربي بواسطه اقطاب خارجيه‬
‫جلديه يسجل ‪ ecg‬هذه االنشطه من خالل اقطاب كهربيه مثبته في اماكن مختلفه‬
‫من الجسم كلهم ‪ ١٢‬خيطا باستخدام ‪ ١٠‬اقطاب
‬

‫
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‫االقطاب توجد للحصول علي مخطط القلب علي الذراع االيمن وااليسر والرجل‬
‫اليسري
‬

‫
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‫يوجد نوعان من تخطيط القلب
‬

‫االول ملا املريض نايم في سريره والتاني اثناء بذل املريض جهد مثل العصاره الصفراويه‬
‫او جهاز املشي
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31 Electro-Cardio-Gram ECG or EKG

Electrical signals from the heart

ECG Test

Hear cycle can be considered as group of muscle contraction and

relaxations.
On other words, heart muscles are always in one of three cases :

1. polarization
2. depolarization

3. repolarization

• As the heart is working regularly with no rest time, it can be

considered as the main two phases of the heart muscle are

depolarization and repolarization in repeated manner.

Prof. Dr. Bassem Raafat

‫القلب يعمل بانتظام بدون راحه والعمليتان االساسيتان لعضلة القلب هما ازاله االستقطاب وعوده االستقطاب‬
‫بطريقه متكرره‬
• SO, ECG can shown as a test to find out the ability of the muscle
to contract and relax in a regular and right time intervals

‫ كاختبار ملعرفه قدره العضالت علي االنقباض واالسترخاء في فترات زمنيه منتظمه‬ECG ‫يظهر جهار‬
‫وصحيحه‬• Repetition, regularity and timing of the process are very sensitive
in diagnosis of the normal and abnormal ECG pattern Medical Physics
First Year, Level-II
‫تكرار وانتظام العمليه وتوقيتها‬
32 Electro-Cardio-Gram ECG or EKG
Electrical signals from the heart
Depolarization
ECG reading parameters of the
ventricles

Time interval from atrial

Repolarization
depolarization to
of the
ventricular
ventricles
depolarization.

Depolarization
of the atria

Prof. Dr. Bassem Raafat

Time interval from
ventricles depolarization
to ventricular
depolarization.

Medical Physics
First Year, Level-II
33 Electro-Cardio-Gram ECG or EKG
Electrical signals from the heart

ECG reading parameters

P- wave Depolarization (contraction) of the right and left atria

PR Time interval from atrial depolarization to ventricular
depolarization.
QRS Depolarization of the right and left ventricular
QT Duration of ventricular depolarization and
repolarization.
ST ventricular repolarization (relaxation)

Medical Physics
First Year, Level-II