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Understanding ECG Waveforms and Leads

This document discusses the electrocardiogram (ECG) and its use in evaluating cardiac electrical activity. It begins by outlining the learning objectives which are to explain ECG wave generation and components, recognize different waves and intervals, identify the 12-lead ECG, and explain ECG applications. It then provides background on how the heart's dipole generates currents during depolarization and repolarization that can be recorded via surface electrodes. Examples are given of various arrhythmias and myocardial infarctions that can be identified on ECG based on changes in waves and intervals.

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Salah Salah 201-901-341
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96 views21 pages

Understanding ECG Waveforms and Leads

This document discusses the electrocardiogram (ECG) and its use in evaluating cardiac electrical activity. It begins by outlining the learning objectives which are to explain ECG wave generation and components, recognize different waves and intervals, identify the 12-lead ECG, and explain ECG applications. It then provides background on how the heart's dipole generates currents during depolarization and repolarization that can be recorded via surface electrodes. Examples are given of various arrhythmias and myocardial infarctions that can be identified on ECG based on changes in waves and intervals.

Uploaded by

Salah Salah 201-901-341
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Electrocardiogram

Dr. Yasser El-Wazir


Professor of Medical Physiology
Learning outcomes
By the end of this lecture, student will be able to:
• Explain the ECG wave form generation
• Recognize the different ECG waves, segments and
intervals
• Identify the conventional 12 leads ECG
• Explain examples of ECG applications
Reference
Guyton & Hall Textbook of Medical Physiology
13th edition (2016):
• Chapter 11: The Normal ECG. Pages 133-136
Cardiac dipole generated during
depolarization & repolarization
During active depolarization &
repolarizations phases, parts
of outer surface of the cardiac
muscle has different polarities.
This creates a dipole which
drives current flow.
When the cardiac muscle is
completely depolarized or
completely repolarized, there
will be no potential difference
and current flow
Surface recording of cardiac
electric activity
It is possible to record the
cardiac electrical activity
via electrodes placed on
the body surface because
the body acts as a
conductor of the electrical
currents generated by the
heart.
ECG waves reflect sequential
cardiac electrical activity

9
ECG waves, segments & intervals
Temporal Relationship between
Cardiac AP and Surface ECG
ECG Leads
ECG paper

Small 0.04 second 0.2 second Big square


square

The standard paper speed is 25 mm/second; thus, the duration of the large
square is 0.2 second & the small square is 0.04 second
Limb Leads
Bipolar
• I : LA - RA
• II : LL - RA
• III : LL - LA
Unipolar
• aVR: RA - V
• aVL: LA - V
• aVF: LF - V
Orientation of the Limb Leads in
the frontal plane
Orientation of the chest (precordial)
leads in the horizontal plane

4th
5th
EXAMPLES OF ECG APPLICATIONS
Premature ventricular beats
AV junctional rhythm

Indiscernible P wave
Ventricular rhythm
Atrio-ventricular block
Abnormal delay in the AV node
First degree AV block

Prolonged PR interval > 0.2 second

Second degree AV block


The AV node allows every other
sinus beat to pass to the
ventricles

Third degree AV block


Third degree AV block
Regions of the Myocardium

Lateral
I, AVL,
V5-V6

Anterior /
Inferior Septal
II, III, aVF V1-V4
Acute antero-lateral infarction

Elevated ST segment in V2 – V5, LI, aVL


Acute inferior infarction

Elevated ST segment in II, III, aVF

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