Practical physiology 2020-2021 Lab:-
Electrocardiography ECG
The ECG is the measurement of the electrical activity generated by the heart, as the
heart undergoes depolarization and repolarization. This electrical current that are
generated spread not only within the heart, but also throughout the body and can be
measured by an array of electrodes placed on the body surface
Objectives:-
1- To record and study the electrical activity of the heart
2- To test the irregularities in how the heart functions gain (assessment of the
pathophysiology of heart disease).
Principle: - ECG recorded by a 12 electrodes, six electrodes are placed on each arm
and leg, and the other six electrodes are placed at a specific location on the chest.
These electrode leads are connected to a device that measures potential differences
between selected electrodes to produce the characteristic ECG tracings
Normally, when an ECG is recorded, all leads are recorded simultaneously, giving rise
to what is called a 12-lead ECG.
Material and methods:- The ECG machine is made up from the following
parts
1-The leads. 2- The amplifier. 3-The recorder .
Type of leads:-
1-Bipolar limb leads (lead I, II, and III). bipolar leads (standard limb leads) that utilize
a single positive and a single negative electrode between which electrical potentials
are measured.
Lead I: right arm (RA) and left arm (LA)
Lead II: right arm (RA) and left leg (LL)
Lead III: left arm (LA) and left leg (LA)
Practical
physiology
2020-2021 Lab:-
2-Unipolar limb leads (Augmented), they are three leads ( aVR , aVL, aVF)
3-The horizontal plane unipolar leads (Chest leads) V1- V6
Typical ECG waves:-
P wave is due to arterial Depolarization
QRS complex is due to ventricular Depolarization
T wave is due to ventricular Repolarization
Analyzing the waves:-
The ECG is recorded at a speed of 25 mm/sec, and the voltages are calibrated, so that
1 mV = 10 mm in the vertical direction. Therefore, each small 1-mm square represents
0.04 sec (40 m sec) in time and 0.1 mV in voltage. Because the recording speed is
standardized, we can calculate the heart rate from the intervals between different
waves.
Practical physiology 2020-2021 Lab:-
Feature Description Pathology Duration
P wave The P wave The P wave is typically upright in <80 ms
represents most leads except for aVR; an
depolarization of the unusual P wave axis (inverted in
atria. Atrial other leads) can indicate an
depolarization ectopic atrial pacemaker. If the
spreads from the SA P wave is of unusually long
node towards the duration, it may represent atrial
AV node, and from enlargement. Typically a large
the right atrium to right atrium gives a tall, peaked
the left atrium. P wave while a large left atrium
gives a two-humped bifid P
wave.
PR interval The PR interval is A PR interval shorter than 120 120 to
measured from the ms suggests that the electrical 200 ms
beginning of the P impulse is bypassing the AV
wave to the node, as in
beginning of the Wolf-Parkinson-White
QRS complex. This syndrome. A PR interval
interval reflects the consistently longer than 200 ms
time the electrical diagnoses first degree
impulse takes to atrioventricular block. The PR
travel
Practical physiology 2020-2021 Lab:-
from the sinus node segment (the portion of the
through the AV tracing after the P wave and
node. before the QRS complex) is
typically completely flat, but may
be depressed in pericarditis.
QRS complex The QRS complex If the QRS complex is wide 80 to
represents the rapid (longer than 120 ms) it suggests 100
depolarization of the disruption of the heart's ms
right and left conduction system, such as in
ventricles. The LBBB, RBBB, or ventricular
ventricles have a rhythms such as ventricular
large muscle mass tachycardia. Metabolic issues
compared to the such as severe hyperkalemia,
atria, so the QRS or tricyclic antidepressant
complex usually overdose can also widen the
has a much QRS complex. An unusually tall
larger amplitude QRS complex may represent
than the P wave. left ventricular hypertrophy while
a very low amplitude QRS
complex may represent a
pericardial effusion or infiltrative
myocardial disease.
ST segment The ST segment It is usually isoelectric, but may 80-
connects the QRS be depressed or elevated with 120ms
complex and the T myocardial infarction or
wave; it represents ischemia. ST depression can
the period when the also be caused by LVH or
ventricles are digoxin. ST elevation can also
depolarized. be caused by pericarditis,
Brugada syndrome, or can be a
normal variant (J-point
elevation).
T wave The T wave Inverted T waves can be a sign 160 ms
represents the of myocardial ischemia, left
repolarization of the ventricular hypertrophy, high
ventricles. It is intracranial pressure, or
generally upright in metabolic abnormalities. Peaked
all leads except T waves can be a sign of
aVR and lead V1. hyperkalemia or very early
myocardial infarction.
Corrected The QT interval is A prolonged QTc interval is a risk <440 ms
QT interval measured from the factor for ventricular
(QTc) beginning of the tachyarrhythmias and sudden
QRS complex to death. Long QT can arise as a
the end of the T genetic syndrome, or as a side
wave. Acceptable effect of certain medications. An
ranges
Practical physiology 2020-2021 Lab:-
vary with heart rate, unusually short QTc can be seen
so it must be in severe hypercalcemia.
corrected to the
QTc by dividing by
the square root of
the RR interval.
Heart Rate Calcula on
Practical physiology 2020-2021 Lab:-
Practical physiology 2020-2021 Lab:- Normal values
of intervals and waves :-
Heart rate 60-100 bpm
PR interval 120-200 m s
QRS interval 80-100 ms
QT interval 420 ms
S T interval 320 ms
P wave amplitude in lead II 3 mv (mm)
P wave terminal negative 1 mv (mm)
deflection in lead v1).
P wave 80 ms
Q wave 0.04 s(1mm)and <1/3 of
Rwave amplitude in the
Same lead.
T wave 160 ms
