EXPERIMENT 2: Laboratory #1: ECG, HEART SOUNDS & EINTHOVENS
TRIANGLE
THE MATERIAL FROM THIS CLASS MUST BE HANDED IN AS A STRUCTURED
LABORATORY SUBMISSION
In the practical class we examine human cardiac activity by electrocardiography and using heart
sounds (detected with a stethoscope and with a microphone plus chart recorder – i.e. by
phonocardiography).
Note
- all students should wear clothing that will allow ECG electrodes and the microphone to be
placed directly on the skin of the arms, legs, and thorax.
Introduction
Heart muscle is capable of spontaneous contractions. However, the presence of a pacemaker and
elaborate conducting system ensures that there is a coordinated pattern of contraction and
relaxation. Although the depolarisations produce only small electrical charges, the large masses of
cardiac muscle involved, and the good conductivity of skin, means that the potential differences
can be recorded with surface electrodes with respect to time. This produces an electrocardiogram
that provides useful information about the electrical activity of the heart. The three main potential
changes recorded during one cardiac cycle are:
P wave atrial excitation
QRS complex ventricular excitation
T wave ventricular repolarisation
The coordinated contraction of heart muscle is designed to move blood through the heart and
around the body. To ensure that this process occurs in only one direction, a series of valves prevent
blood from flowing back in the opposite direction. At the onset of systole, the bicuspid and
tricuspid valves close when ventricular pressure exceeds atrial pressure. The sudden change in
blood flow and turbulence causes the 1st heart sound. Best heard at the apex of the heart, the
sound tends to be louder, longer and more resonant (LUBB) than the 2nd heart sound, which is a
short, sharp sound (DUP). The 2nd heart sound occurs when the semi-lunar valves snap shut as
ventricular pressure falls below aortic/pulmonary arterial pressure at the onset of diastole.
At the end of these exercises, students should be able to define and have an understanding of the
following concepts:
- the basis of different ECG waves determined by the different orientation of recording leads
- the timing of the ECG in relation to the cardiac cycle
- timing of the PCG in relation to the cardiac cycle
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Getting Started
Double click on the icon HumanECG
Click OK and name your experiment file by selecting Save As from the File menu.
Type in your Name
You will be using the PowerLab application Chart, which functions as a chart recorder to display
the recorded signals produced by biological tissues. The PowerLab chart application has been
preset for the requirements of this experiment. The screen that appears shows the recording
windows in the centre and the control panels marked “ECG” and “PCG” on the right.
Measuring Human ECG
There many possible geometric arrangements of recording leads that will produce useful
information about the electrical activity in the heart. The most widely used arrangement was
established by Einthoven in 1913. ‘Einthoven’s triangle’ consists of three reference points; one at
each shoulder and one in the lower abdominal region (see figure). These represent the points
between which voltages are compared.
right left
_
I +
_
_
II III
+ +
The precise locations of the recording electrodes is not important since, at any instant of the cardiac
cycle:
- each shoulder and its associated arm are at approximately the same potential
- the lower abdomen and both legs are all at approximately the same potential.
In practice, recording is usually at the two wrists and the left ankle.
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Procedure
Check that the 3 lead wires are connected to the appropriate sockets in the patient cable, and that
the patient cable is connected to the Bio Amp.
Stick the 4 disposable electrodes on each wrist and each ankle.
With the patient relaxed and seated on a chair, attach the leads to measure Einthoven’s lead I
i.e. +ve lead to left arm
-ve lead to right arm
Note
The lead going to the right ankle is the earth lead and remains there at all time.
- Start the chart and record about 5 cycles of the ECG
- Stop the chart
Identify the P wave, QRS complex and T wave on your ECG.
Measure the time courses of the following events:
- heart rate (beats/min)
- A-V conduction time (approximated to the time between commencement of
atrial excitation and commencement of ventricular excitation (msec)
- time taken for action potential spread over the entire ventricular myocardium
(msec)
- time between commencement of ventricular excitation and the end of
ventricular repolarisation (msec)
How do these times compare with the values given in your textbook?
DOES ANYTHING LOOK ABNORMAL?
Note
Individual ECG recordings will not all look like the typical text book representations, because of
individual variations in the position of the heart in the thorax.
Measuring the ECG after exercise
Objectives
To measure the ECG in a volunteer at intervals after exercise, to analyse the resultant signals, and
to compare them with the same volunteer’s resting ECG.
Procedure
1. Connect the ECG leads in a different volunteer.
2. Measure several cycles of the ECG at rest
3. Disconnect the Bio Amp cable from the PowerLab/410 unit. Check that the ECG leads
are not tangled; the volunteer should gather them up and hold them.
4. The volunteer should now exercise: try two minutes of rigorous step-up exercise or
bike riding
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Note:
Remember that the ECG leads are still attached to the electrodes, so the volunteer should exercise
carefully (so as not to break the leads), but vigorously enough to elevate heart rate.
5. Immediately after exercise, reconnect the Bio Amp cable to the PowerLab while the
volunteer sits down and relaxes.
6. Click the Start button, and record until the heart and breathing rate have returned to
normal; record for at least two minutes. During this time type ‘Recovery from exercise’
and press the Add button or Enter key to enter the comment.
7. Click the Stop button to stop Chart recording.
8. Choose Save from the File menu to save the recording.
Analysis
You should now have recordings in the one file of a volunteer both resting and recovering from
exercise. For each of the two recordings:
1. Select a short part of the resting ECG trace, containing two or three cardiac cycles.
2. Select the Zoom Window command from the Windows menu.
3. Use the Marker and Waveform Cursor to make the following time
measurements from the displayed waveform:
(i) P–R time interval
(ii) QRS duration
(iii) S–T time interval
(iv) T–P time interval
(v) R–R time interval
(vi) Calculate the heart rate from the R–R interval
FILL IN THE TABLE ON THE FOLLOWING PAGE
Note: the P–R interval is the time from the start of the P wave to the start of the QRS complex.
A more logical name would be ‘P–Q’ interval, but P–R is traditional.
4. Repeat the above measurements using the first ‘good’ ECG traces immediately after,
30 seconds after, and 60 seconds after exercise
5. Record your data in Table 1
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TABLE 1
Measurement ECG While Resting ECG After Exercise
0 seconds 30 seconds 60 seconds
P–R interval
QRS duration
S–T interval
T–P interval
R–R interval
Heart rate
Questions
1. What happened to the R–R interval and the heart rate after exercise?
2. Which of the intervals become shorter when the heart rate is raised?
Briefly explain why the differences exist.
Measuring Human PCG
The heart sounds can be converted to electric potential oscillations with a microphone and
displayed on the recorder
Procedure
Place the stethoscope (the flat head (the diaphragm) is best for listening to heart sounds) over the
second or 5th left intercostal space to the left of the sternum. Move the stethoscope around until
you can clearly hear the 2 heart sounds
With the chart turned OFF, attach the microphone directly to the GP Amp.
Place the microphone firmly over the bare chest wall at the position that the heart sounds were
easiest to hear.
Note
Since the microphone is sensitive to vibrations make sure the subject is as relaxed as possible
and try and use a jumper to keep the microphone in position and isolated from other sounds.
- Start the chart and record several cycles of the PCG
- Stop the chart
Identify the 1st and 2nd heart sounds on you PCG. Decide at which area you get the best separation
of clearly recorded first and second heart sounds. Use this area later when associating the heart
sounds with the ECG.
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Measure the time course of:
- the time between the commencements of the 1st and 2nd heart sounds (msec)
Superimposition of PCG on the ECG
Procedure
Select an Einthoven lead system that will give you a recording showing all phases of the ECG
clearly. Connect the plugs to the appropriate electrodes.
Place the microphone at the spot previously selected as most suitable for monitoring heart sounds.
- Start the chart and record a few cycles of the ECG and the PCG. The ECG will be visible in
channel 1 and the PCG in channel 2
- Stop the chart
Using the Zoom window, highlight a single ECG and superimpose the heart sounds onto your
ECG.
What parts of the ECG correspond to the heart sounds.
Note
- please SAVE your file before quitting the program
EINTHOVEN’S TRIANGLE
Introduction
While the ECG is a measure of the electrical activity of the heart, analyzing the ECG using
different configurations of the 3-lead system (as performed in experiment 2) can provide
information regarding the shape, size and orientation of the heart, its health and the effects of drugs
or electrolyte imbalances.
At the end of these exercises, students should be able to:
- have an understanding of the basis of different ECG waves determined by the different
orientation of recording leads
- use the three orientations of Einthoven’s triangle to estimate the orientation of the heart
- compare the ECG’s from two people and make comment about the relative size and position
of their hearts
Einthoven’s Triangle
There many possible geometric arrangements of recording leads that will produce useful
information about the electrical activity in the heart. The most widely used arrangement was
established by Einthoven in 1913. ‘Einthoven’s triangle’ consists of three reference points; one at
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each shoulder and one in the lower abdominal region (see figure). These represent the points
between which voltages are compared.
right left
_
I +
_
_
II III
+ +
Getting Started
Double click on the icon HumanECG
Click OK and name your experiment file by selecting Save As from the File menu.
Type in your Name
The screen that appears shows the recording windows in the centre and the control panels marked
“ECG” and “PCG” on the right.
Close the window that is labeled “PCG” using the pop-down menu.
Hide this recording window so that the “ECG” fills the entire recording window
Procedure
Check that the 3 lead wires are connected to the appropriate sockets in the patient cable, and that
the patient cable is connected to the Bio Amp.
Stick the 4 disposable electrodes on each wrist and each ankle.
With the patient relaxed and seated on a chair, attach the leads to measure Einthoven’s lead I
i.e. +ve lead to left arm
-ve lead to right arm
Note:
The lead going to the right ankle is the earth lead and remains there at all time.
- Start the chart and record about several cycles of the ECG
- Stop the chart
Make sure the peak of the QRS complex fills about 2/3 of the recording window. If not, adjust
the settings and repeat until satisfactory.
Alter connections to give Einthoven II configuration
i.e. +ve lead to left foot
-ve lead to right arm
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- Start the chart and record about several cycles of the ECG
- Stop the chart
Alter connections to give Einthoven III configuration
i.e. +ve lead to left foot
-ve lead to left arm
- Start the chart and record about several cycles of the ECG
- Stop the chart
Note:
Please ensure that you insert a comment to label which orientation of Einthoven’s triangle is being
performed.
Note
- please SAVE your file before quitting the program
Using the three leads, we have recorded potential changes occurring in a frontal plane, measured
at different angles to the vertical.
Measure the height of the QRS complex in each configuration of Einthoven’s
triangle and include in a table.
WORK OUT THE AXIS OF THE HEART.
IS THE ORIENTATION NORMAL?
Now repeat the three lead configurations of Einthoven’s triangle on another subject from your
group.
Compare the heights of the QRS complexes. Are the orientations the same? Which
subject has the largest heart? Can you tell?
Is there any evidence that the subject has left ventricular hypertrophy? If not, what would
this look like?
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College of Health and Biomedicine
Risk Management (Bioscience)
Section A: Practical Details
Practical No. Title
Course Code Subject
Year Level Subject Co-ordinator
Date prepared Prepared by
Submitted by Accepted by
Level of Hazard_____________________________________(refer to Section F)
Legend.
Lab coats and safety glasses must be worn in the laboratory at all times.
Control Measure
G Gloves N Nitrile gloves F Fumehood
D Dust mask T Tongs S Face shield
A Aseptic technique L Laminar flow C Caution students
O Other N See notes
Disposal of Waste
W Water dilution and sink NH Non halogenated HM Heavy metal waste
B Alkaline waste H Halogenated SW Solid waste container
A Acid waste D Disinfectant vessel WW Wet waste bag
BB Biohazard bin/ bag BG Broken glassware bin SB Sharps container
SR Scalpel remover O Other N See notes
Section B: Biological hazards
Hazard Control Measure Waste Disposal
Human blood
Horse blood
Saliva
Urine samples
Serum
Cadaver
Animal dissection
Bacteria pathogenic
Bacteria non pathogenic
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Bacteria potentially pathogenic
Fungi
Yeast
Tissue samples
Other:
Section C Sharps
Hazard Control Measure Waste Disposal
Glassware
Lancets
Razor blades
Scalpel blades
Other:
Section D General
Hazard Control Waste Disposal
Measure
Hotplate
Water bath
Microscopes
Centrifuge
Electrophoresis equipment
Other
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Section E Chemical Hazards
Chemical Conc. Designated hazardous Alternative ? Control Waste MSDS
substance measures disposal cited
Section F: Risk Analysis Matrix
Consequence Likelihood Hierarchy of risk control
Frequent Probable Occasional Remote
Catastrophic High High High High Is elimination possible?
Fatal High High High Medium Substitution- is there something less
hazardous that can be used
Critical High High Medium Low Can engineering controls be used (fume
(Severe injury) hoods)
Marginal High Medium Low Low Is there an alternative method
(Medical treatment)
Negligible (First aid) Medium Low Low Low Personal Protective Equipment
Using the above table decide on the level of risk of a practical class. If one area of a practical were considered high then the whole practical would be
rated as high unless the chemical/ method could be changed and the risk lowered.
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