THE ELECTROCARDIOGRAM: ECG
By Gaurishi Agarwal, 32
ECG : An
Electrocardiogram is a
simple test that can be used
to check the heart’s rhythm
and electrical activities.
The electrodes attached to
the skin are used to detect
the electrical signals
produced by the heart each
time it beats.
Willem Einthoven invented the
first practical
Electrocardiograph (ECG or
EKG) in 1895’
The first ECG machine
consisted of a ‘capillary
electrometer’.
With this instrument, Einthoven was able to
measure the changes of electrical potential caused
by the contractions of the heart muscles and
record them graphically.
BASIS OF ECG
Body is a ‘Volume Conductor’ , ie body fluids are
good conductors of electricity because it contains lay
quantities of electrolytes.
Therefore, electrical changes occurring in the heart
with each heart beat are conducted all over the body
and can be picked up from the body surface.
The record of these electrical fluctuations during
cardiac cycle is called Electrocardiogram (ECG).
DEPOLARIZATION AND
REPOLARIZATION WAVES
Depolarization Wave : The wave that results due to the
spread of depolarization along the muscle fiber
membrane.
Repolarisation Wave : The wave that results due to the
spread of repolarization along the muscle fiber membrane.
The negative or positive deflection on the graph depends
upon the direction of dipole vector.
The bigger the dipole, the bigger the deflection in
respective direction.
STANDARD ECG
A Standard ECG consists of 10 Electrodes which are used
to make 12 leads.
The leads are of 3 types:
• 3 Limb Leads
• 3 Augmented Leads
• 6 Chest Leads
The Electrodes are used to record the heart’s electrical
activity from the body surface, with the help of AgCl gel.
LIMB LEADS
The Limb leads or Einthoven leads are 3 in number
They are denoted as – Lead I, Lead II, Lead III.
Lead I : the negative terminal is connected to the right arm and
the positive terminal to the left arm.
Lead II : the negative terminal is connected to the right arm and
the positive terminal to the left leg.
Lead III : the negative terminal is connected to the left arm and
the positive terminal to the left leg.
The right foot is grounded.
EINTHOVEN’S TRIANGLE : The triangle in the following figure,
called Einthoven Triangle, is drawn around the area of heart.
This illustrates that two arms and the left leg
form apices of a triangles surrounding the
heart.
EINTHOVEN’S LAW : It states that if the
electrical potential of any two bipolar limb
leads is known than the potential of the
remaining lead can be calculated by a
simple mathematical equation.
Lead II = Lead I + Lead III
AUGMENTED LEADS
The Augmented leads are unipolar limb leads with slight
modification in the recording technique.
They are 3 in number.
They are denoted as – aVR , aVL , aVF
The augmented limb leads are the recording between one
limb connected to positive terminal and the rest two at the
negative terminal of the ECG machine.
This arrangement increases the potential by 50%.
Vector of augmented limb lead =
3/2 Vector of unaugmented limb lead
CHEST LEADS (PRECORDIAL LEADS)
These are 6 in number. They are as follows, along with
their respective positions.
V1 : 4th intercoastal space to the right of the sternum.
V2 : 4th intercoastal space to the left of the sternum.
V3 : midway between V2 and V4 .
V4 : 5th left intercoastal space in mid clavicular line.
V5 : 5th left intercoastal space in anterior axillary line.
V6 : 5th left intercoastal space in mid-axillary line.
Usually 6 standard chest leads are
recorded one at a time, from the
anterior chest wall, via a single
electrode placed at the specified
positions one at a time.
NORMAL ECG
Headings:-
P wave
P-R Segment
QRS Complex
S-T Segment
J-point
T wave
U wave
NORMAL ELECTROCARDIOGRAM
‘P’-Wave
• 1st wave of ECG, duration 0.1 sec.
• Due to Atrial depolarization, represents the spread of
impulse from SAN to atrial muscles.
• Peak represents excitation of AVN
• Height is upto 0.5mV
P-R Segment
• It is a brief Isoelectric period of 0.04s after the P wave.
QRS Complex
• Represents Ventricular depolarization
• Completed just before opening of Semilunar valves
• Atrial repolarization activity merges with QRS complex
‘Q’ Wave
• Represents excitation of mid portion of the interventricular
septum.
‘R’ Wave
• Prominent pointed positive wave
• Represents onset of ventricular systole
• Its height is directly proportional to functional activity of
ventricles, does not exceed 2.5mV in normal individuals.
‘S’ Wave
• Negative pointed deflection
• Represents excitation of more basal parts of ventricles
‘T’ Wave
• Rounded positive deflection, duration of 0.27s
• Represents Ventricular repolarization
• End of t wave coincides with closure of semilunar valves
• Flat T wave indicates insufficient oxygen supply to heart
muscle
‘U’ Wave
• Rarely seen , positive small rounded wave
• It is due to slow repolarization of Capillary muscles.
P-R Interval
• Represents Atrial depolarization plus conduction time through
Bundle of HIS
• Normal duration 0.12 to 0.16s at a HR of 72/min
• Duration decreases with increase of HR
• If duration is more than 0.2 s, indicates delayed conduction of
bundle of HIS
• If duration is less than 0.12s, indicates impulse has probably
arisen in AVN
S-T Interval
• Represents ventricular repolarization, 0.32s duration
J- point
• A point of no electrical activity at the end of S Wave
• Important in assessing S-T segment elevation or depression
Thank You!
