Umyu Ecg Workshop

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BASIC ECG ASSESSMENT

& INTERPRETATION

DR. BASHEER ISAH WAZIRI (M.B.B.S, M.Sc, Ph.D)


DEPARTMENT OF HUMAN PHYSIOLOGY, FACULTY OF BASIC
MEDICAL SCIENCES, UMYU.
Outline

 Meaning of ECG
 Uses of ECG & its Principle
 Conducting System of the Heart
 ECG LEADS
 ECG Waves & Intervals
 Calculation of Voltages & Time Interval Durations
 Rhythm Interpretation and Heart rate Estimation
 Summary
Learning Outcomes
 At the end of the presentation, Participants are expected to be able to:

1. Know the meaning of ECG and its uses

2. Be able to explain the basis and principle of ECG

3. Discuss the conducting system of the heart

4. Classify ECG LEADS and explain the basis of the classification

5. State ECG WAVES and intervals including what they represent

6. Calculate Voltages and time interval of a given ECG reading

7. Follow 6 steps of rhythm interpretation

8. Estimate heart rate in both regular and irregular rhythm


Let The Journey Begins
What is ECG

 ECG (Electrocardiogram) is simply the recording of electrical activity of


the heart.

 It records change in voltages (depolarizing & repolarizing) that occur


during cardiac action potential.

 The changes in voltages are presented in form of deflection (waves).


Uses of ECG

 Diagnosis of Diseases
 Monitoring & Evaluation of Treatment
 Fitness Check up
 Research Purposes
Bundle of His
Polarized
0 mV Na+
-90 mV
Na+
K +
K+ Single myocardial cell during resting phase (between beats)

Bundle of His
Depolarization
Na+
+ 5 mV

K + Na+

K+
Bundle of His
Repolarization
0 mV
-90 mV

K Na
+ +
K+
Bundle of His
Mechanism of Auto-rhythmicity
 Leakage of Na+

 slow rise in the resting membrane potential →


reaches threshold (-40 mV)

 Ca2+ channels activated → action potential


generated

 Ca2+ channels become inactivated as K+


channels open → return to resting membrane
potential

 K+ channels remain open for another few


tenths of a second → hyperpolarization →
 progressive closing of K+ channels 
permeability to Na+ and Ca2+ → new cycle
ECG LEADS
(Arrows below point to the positive pole of each lead)

Einthoven's Law states that I + (−II) + III = 0. It is written this way (instead of I − II + III = 0)
because Einthoven reversed the polarity of lead II because he liked to view upright QRS
complexes. The equation can also be written I + III = II.
Limb Leads
Lead I Lead II Lead III

─ RA LA + ─ RA LA RA LA ─

RL LL RL LL + RL LL +

Lead aVR Lead aVL Lead aVF

+ RA LA RA LA + RA ─ LA

─ ─

RL LL RL LL RL LL
+
Bipolar Limb Leads
Lead I = voltage between LA - RA
Bipolar Limb Leads
Lead II = voltage between RA - LL
Bipolar Limb Leads
Lead III = voltage between LA - LL
Precordial Mid-clavicular line
Anterior axillary line
Leads Angle of Louis Mid-axillary line

V1: 4th intercostal space at


right sternal border

V2: 4th intercostal space at


left sternal border

V3: Halfway between V2 & V4

V4: 5th intercostal space at


midclavicular line

V5: Same horizontal line as V4


at anterior axillary line

V6: Same horizontal line as V4


at mid-axillary line
ECG PROCEDURE

 Inform patient & Obtain Consent


 Secure a calm environment with some Privacy
 Checking & Standardization of Machine
 Patient preparation
 Recording
 Precautions
ECG Waves
P wave
Atrial
Depolarization
P wave
Atrial
Depolarization

Atrial
Repolarization
TP wave

Ventricular
Depolarization QRS
complex
P wave
Atrial
Depolarization

Atrial
Repolarization
TP wave

Ventricular
Depolarization QRS
complex

QRS
T Ventricular
P
Repolarization T wave
ECG waveforms & time intervals
R Positive wave of the QRS complex

PR ST segment
segment
Considered

T
isoelectric
line

P
U

J point = junction of end of QRS & beginning of ST


Negative wave preceding R wave Q
PR interval QRS interval QT interval
(0.12-0.20 sec) (0.07-0.11 (depends upon HR & gender)
sec)S Negative wave following R wave
ECG WAVES & INTERVALS
QT interval 0.35 – 0.44
-

V
+
-

+
V
-

V
V

+
Lead II = R-wave: positive deflection
aVR = R-wave: negative deflection in normal
conditions
ECG LEADS Cont’d
Interpretation: Calculation of Wave
Voltages & Interval Durations
Standard 12-Lead ECG

II

Voltage
Amplitude

1 mm 5 mm 1mm = 0.1mv

UCSF
Exercise

Estimate the Voltages of P-wave, QRS Complex and T-wave in this Strip

P Wave = 0.1mv
QRS = 0.7mv
T Wave = 0.2mv
Standard 12-Lead ECG

Time

0.20 sec
0.04 sec

40 ms 200 ms

UCSF
Time Interval Estimation
EXERCISE

o What is the P-R interval ?


o is it Normal?  P-R = 0.12 sec, Normal
Six Steps for Rhythm Interpretation

1. Is there any Electrical activity?


2. What is the Heart rate?
3. Is it Regular?
4. What is the QRS Duration?
5. Is there Normal Atrial Activity?
6. What is the P-R interval?
ECG Reading
Heart Rate Estimation
 Hear rate estimation
 Estimate the duration of cardiac cycle: R-R interval X 0.04
 Divide 60 seconds (1 minute) by the duration of Cardiac cycle
obtained.

 Alternatively
 Divide 1500 by the number of small squares between R – R interval
 Or divide 300 by the number of big squares between R – R interval
Heart Rate Estimation

 R-R interval = 20 small squares

 Cardiac cycle = 20 X 0.04 sec = 0.8 sec

 HR = 60/0.8 = 75b/min
Estimation of Heart rate Cont’d
Estimation of Heart rate Cont’d
Estimation of Heart Rate in irregular Rhythm
???
???
???
Features of Abnormal Myocardial Blood
Supply on ECG

ST segment elevation
Features of Abnormal Myocardial Blood Supply on
ECG

 S-T Depression: Myocardial Ischemia


ST Elevation: Myocardial Infarction
What is this?
Any Idea?
Summary
Ladies & Gentlemen, We have reached the end of
this Session
I ho
pe t
he J
was ourne
inte very y
resti
ng

ECG Workshop
Session 1
Thank You Very Much for Your Participation

DR. BASHEER I. WAZIRI (M.B.B.S, M.Sc, Ph.D)


You Can Connect With me Through the Following for More Educational
Activities.

biwaziri.pys@buk.edu.ng

@WAZIRI-BI

@Dr. Basheer Isah Waziri

@Bashwaz Waziri

@wazbash80

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