K.
SUDARAHAN (PT)
MPT CARDIO PULMONARY
ECG
ECG-Electrical activity of the myocardial muscle fibres
developed during each heart beat recorded from the
surface of the body.
Simple test and fastest test used to evaluate the hearts
rhythm and electrical activity.
BIOPHYSICAL BASIS: The electrical events of the heart rate are
conducted throughout the body in all directions .
Body fluids act as a volume conductor.
These electrical events can be picked by placing
appropriate electrodes over the surface of the body
Action potentials decreases by the time they reach
surface (at the heart 100-110mv and at the skin 3mv)
The recording obtained is an algebraic
sum of action potentials occurring .
The individual potentials cannot be
recorded from the surface.
The potentials are not interfered by the
brain and muscle potentials as they are in
microvolts.
ECG LEADS
A lead is connection between any 2 selected points on
the surface of the body and electro cardiograph.
There are 12 different leads are used, divided into two
types
1.Bipolar leads: There are 3 different leads.
These are L I ,L II, and L III each lead consists of 2
electrodes one +ve and other –ve.
Lead I measures the potential difference between right
–ve and left +ve arms.
Lead II measures the PD between Lt .foot +ve and
right arm-ve.
Lead III measure PD between the left foot +ve left arm
-ve
Unipolar leads: Unipolar leads are of two types
UNIPOLAR CHEST LEADS
V1 and V2 –Mainly right ventricular
activity is recorded
V3 and V4- Mainly inter ventricular
septal activity is recorded
V5 and V6-Mainly left ventricular activity
is recorded.
UNIPOLAR LEADS
They are of two types 1)Augumented limb leads
These are 1)aVR,
2)aVL and
3)aVF
aVR =PD between rt arm and lt arm+lt foot
aVL =PD between lt arm and rt arm+lt foot
aVF =PD between lt foot and rt arm+lt arm
AUGUMENTED LIMB LEADS
Enithovens law: States that sum of
electrical potentials at three peripheral
points of an equilateral triangle with the
current source in the centre is zero.
For example: If you had an ECG in which the Lead I R
wave has 7mm tall and S wave 2mm tall ,subtract the S from
the R, and you would have 5mm
On the corresponding complex in lead III the R wave
measures 1mm and the S has negative deflection of 16mm
subtracting R from the S gives -15mm
In Lead II using the method as before ,you get a
measurement of -10mm
Using these measurements with Einthovens law you get
II=5+-15=-10
So these leads are electrically equilateral. Hence
LI+LIII=LII or
LI+LIII-LII=0
ECG PAPER
It is milli meter graph paper. In every 5mm there
is thick line .
Y axis represents voltage 1 mv =10mm.
X axis represents the time 1 mm =0.04 sec.
Normal speed of the paper movement is
25mm/sec.
Each beat of the heart will result in a complex of
waves called PQRST complex.
The base line is called isoelectric line or
isopotential line.
P wave is the first positive wave above the
isoelectric line
Q wave is the small –ve wave and first negative
wave
R wave is the +ve wave after P wave S wave is
the –ve deflection after R.
T wave is positve wave after S .wave
P wave
It represents atrial depolarization.
Normal duration is 0.08 to 0.12 sec.
Normal voltage is 0.1 to 0.3 mv
It undergoes changes with the diseases of the
atria.
Atrial hypertrophy-P wave becomes larger or
Atrial flutter -abnormal p wave called F wave
Atrial fibrillation - “ “ f wave
Atrial tachycardia – inverted p wave
QRS COPLEX
This represents ventricular depolarization.
Normal duration is 0.08 to 0.12 seconds.
Normal voltage is 1 to 3 mv
Q wave – it represents septal depolarization. This is present in
all bipolar leads
R wave- it is due to potential travelling to the apex of the
ventricle.
S wave- it is due to potential travelling to the base of the
ventricles.
QRS Abnormalities-1)ventricular hypertrophy
2) myocardial infarction
3)complete av block
4)bundle branch block
5)ventricular ectopics
T Wave
T wave represents ventricular repolarization
Normal duration is 0.27 seconds
Normal voltage is 0.2 to 1 mv
It is normally positive wave except in LIII.
U Wave
It is due to delayed repolarization of intra
ventricular conduction system
It is seen in V2 to V4 leads
Myocardial infarction
Myocardial ischaemia
Thank you.
