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    Ecg 1

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    1. The document discusses the basics of electrocardiography including cardiac electrophysiology, the electrical vector, lead positions, normal ECG waveforms and intervals. 2. Key points covered include the generation of the electrical vector, the positions of frontal plane and precordial leads, identification of the P wave, PR interval, QRS complex, ST segment, T wave, and calculation of heart rate and electrical axis. 3. The objectives are to review basic cardiac electrophysiology, understand how the electrical vector is recorded, know lead positions and locations, and be able to identify normal ECG deflections, intervals, and calculate heart rate and axis.

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    Ecg 1

    Uploaded by

    api-3757039
    964 views43 pages
    1. The document discusses the basics of electrocardiography including cardiac electrophysiology, the electrical vector, lead positions, normal ECG waveforms and intervals. 2. Key points covered include the generation of the electrical vector, the positions of frontal plane and precordial leads, identification of the P wave, PR interval, QRS complex, ST segment, T wave, and calculation of heart rate and electrical axis. 3. The objectives are to review basic cardiac electrophysiology, understand how the electrical vector is recorded, know lead positions and locations, and be able to identify normal ECG deflections, intervals, and calculate heart rate and axis.

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    ECG-1

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    1. The document discusses the basics of electrocardiography including cardiac electrophysiology, the electrical vector, lead positions, normal ECG waveforms and intervals. 2. Key points covered include the generation of the electrical vector, the positions of frontal plane and precordial leads, identification of the P wave, PR interval, QRS complex, ST segment, T wave, and calculation of heart rate and electrical axis. 3. The objectives are to review basic cardiac electrophysiology, understand how the electrical vector is recorded, know lead positions and locations, and be able to identify normal ECG deflections, intervals, and calculate heart rate and axis.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    964 views43 pages

    Ecg 1

    Uploaded by

    api-3757039
    1. The document discusses the basics of electrocardiography including cardiac electrophysiology, the electrical vector, lead positions, normal ECG waveforms and intervals. 2. Key points covered include the generation of the electrical vector, the positions of frontal plane and precordial leads, identification of the P wave, PR interval, QRS complex, ST segment, T wave, and calculation of heart rate and electrical axis. 3. The objectives are to review basic cardiac electrophysiology, understand how the electrical vector is recorded, know lead positions and locations, and be able to identify normal ECG deflections, intervals, and calculate heart rate and axis.

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    E.C.G.

    Course – I
    The Normal E.C.G
    Dr. Michael Kassirer
    ”Dept. Internal Medicine ”D
    Tel-Aviv Medical center
    Objective
    By the end of lesson 1 the student will:

     Be able to review basic cardiac electro-physiology


     Understand how the electrical vector is formed and
    recorded.
     Know the position of the conventional frontal and
    axial leads, and the location of right precordial and
    posterior leads.
     Be able to identify the different deflections and
    intervals of the E.C.G, know their normal values,
    and explain what they represent.
     Know how to calculate the heart rate and electrical
    axis.
    Stand on the shoulders
    of giants
    The E.C.G - Preface
     The E.C.G = Electro-Cardio-Graph is a
    graphic recording of the electric potentials
    generated by the heart.
     Advantages:
    ►Immediate availability.
    ►Non-invasive, Non-expensive
    ►highly versatile
    ►Diagnostic tool and therapeutic aid.
    Conductive system
    • Pacemaker cells
    • Conduction tissue
    • myocardium
    Conductive system
    • Sinus-Atrial Node
    • AV Node
    • Bundle of Hiss
    • Right Bundle Brunch
    • Left Bundle Branch:
    - Anterior fascicle
    - Posterior fascicle
    • Purkinje fibers
    Cardiac electro-
    physiology 1
     Membrane Potential: Rest: - 90mV
    Action: + 20mV

     Depolarization: - 90mV +20mV


    (Na+ In)
     Re-polarization: +20mV - 90mV
    (K+ Out)
    Cardiac electro-
    physiology 2
    20mV+

    90mV-
    Electrical current

    - - - - - - + + + + +
    -- - - - - + + + + + ++
    -- - - - - + + + + + +
    +
    - - - - - - + + + + +
    :The problem

    How to Record 4D
    vector (3dD +
    Voltage) in 3D
    ??recording system
    Electrical vector
    Electrical Vector
    2 4 6 8 10 12 14 16
    0

    2
    4
    6
    8
    10
    12
    E.C.G leads – frontal
    plane
    Bi-polar Leads:

    Uni-polar
    leads:
    E.C.G leads – frontal
    plane
    Bi-polar Leads:

    Uni-polar
    leads:
    Frontal plane - summery
    Electrode position – horizontal
    plane
    Electrode position:
     Frontal Plane
     Horizontal (precordial)
    plane
    E.C.G – Waveforms and
    intervals
    E.C.G – Waveforms and
    intervals
    E.C.G paper/strip

    1mV

    Paper speed = 25mm/sec.


    Cube = 0.04 sec.
    5 Cubes (large) = 0.2 sec
    The P wave

    )P wave = P wave )RA) + P wave )LA


    Normal Values: W < 0.12 sec. )3 mm)
    H < 2.5 mm
    Best seen - L2 )+)
    - V1 )+ or iso-electric)
    The PR interval

    PR interval = AV delay
    Normal Values: 0.1 – 0.2 sec
    The QRS complex – V.
    depolarization

    V1
    V1 V6

    L3
    L3 L2
    The QRS complex – V.
    depolarization

    V1 V6

    L3 L2
    The QRS complex – V.
    depolarization

    V1
    V1 V6

    L3 L2
    The QRS complex – V.
    depolarization

    V1
    V1 V6

    L3 L2
    The QRS complex – V.
    depolarization

    V1
    V1 V6

    L3
    L3 L2
    The QRS complex – V.
    depolarization

    V1
    V1 V6

    L3
    L3 L2
    The QRS complex – V.
    depolarization

    V1
    V1 V6

    L3
    L3 L2
    The QRS complex – V.
    depolarization

    V1
    V1
    V1 V6

    L3
    L3 L2
    The QRS complex – V.
    depolarization

    V1
    V1
    V1 V6

    L3
    L3 L2
    The QRS complex - 1

    QRS complex = Ventricular depolarization


    Q wave = septum - Normal in V1, aVR
    - L3 )disappear in inspiration).
    Normal Q < 0.04 sec, < 4mm
    Q/R ratio < 15% )V4-6), < 25% )L2, 3, aVF)
    The QRS complex - 2

    )R wave = R )RV) + R )LV


    Normal Values: W < 0.1 sec
    Voltage ≈ size / distance, but R )V5) < 25mm
    )R < S in V1 )rS or rSr’ pattern
    R > S in V5,6 - Transition zone in V3,4
    How to find the heart
    ?rate
    HR = 300 / No. of large
    cubes
    RR Ex. = 300 / 5 = 60
    interval

    HR = 6 * (No of QRS in 6
    sec.)
    RR
    interv
    al Ex = 6 * 18 = 108
    How to find the Electrical
    axis
    How to find the Electrical
    axis
    ((method 1

    QRS in L1
    L1
    L1
    QRS in aVF

    aVF

    L3
    aVF
    How to find the Electrical
    axis
    ((method 2

    1. Find the isoelectric QRS


    2. The axis is 90º to it.
    L1

    L3 30º+
    L1
    )120º+)
    aVF

    L
    3 L3
    aVF
    Electrical axis
     Normal Axis:
    - 30º - +110

     Right Axis
    deviation:
    > + 100

     Left Axis
    deviation:
    < - 30º
    The ST-T segment

    ST segment = Ventricular repolarization


    Normal – Horizontal, Isoelectric
    )Normal ST elevation – High take-off )V1-3
    early repolarization -
    Concave , After deep S, or with↑↑.T
    The T wave

    Vector – same direction as QRS complex


    .ex. Rt. Precordial leads
    always + in I, II, aVL, V3-6 -
    always – in aVR -
    The QT interval

    Normal Value - QTc ≥ 0.40msec

    QTc = QT/√RR
    QTc calculation

    QT =0.64

    RR RR = 1.24

    QT √ RR = 1.114

    QTc = QT/√ RR =
    0.57
    Normal E.C.G - summery

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