ECG Basics
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ECG BasicsECG Basics
By :Dr Harith Abdulkadir sh. Mohamoud
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What is the ECG What is the ECG
An electrocardiogram (ECG or EKG) is a recording of the electrical activity of the heart over time produced by an electrocardiograph,
A noninvasive machine recording via skin electrodes.
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First, First,
consider depolarization and consider depolarization and
repolarization of a repolarization of a singlesingle cellcell
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Single Cell
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The “PQRST”The “PQRST”
P wave - Atrial depolarization
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• T wave - Ventricular repolarization
• QRS - Ventricular depolarization
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ECG shapeECG shape
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Chest (Precordial) LeadsChest (Precordial) Leads
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Chest (Precordial) LeadsChest (Precordial) Leads
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The hexaxial reference systemThe hexaxial reference system
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Arrangement of Leads on the EKGArrangement of Leads on the EKG
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Principles of heart ECG recordingPrinciples of heart ECG recording
(1) An electrical force directed twoards the (+) pole of a lead results in an upward deflection on the EKG recording of that lead
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Toward Toward
- + =
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(2) forces that head away from the (+) electrode result in a downward deflection
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Head awayHead away
- + =
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(3) an elcterical forces directed perpendicular to ECG lead does not register any activity by that lead, or it can be bi-phasic ( equi-phasic )
( a “ flat line on the recording )
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Perpendicular Perpendicular
- + =
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(4) The magnitude of the deflection either upward or downward , reflects how parallel the electrical forces is to the axis of the lead being examined .
The more parallel to the lead the greater the magnitude of the deflection
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The electrical impulse actuallyproceeds by radial spread.
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Normal conduction.leads aVL and aVF
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Sequence of conduction,Precordial leads
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Always memorize Always memorize V1 + v2 = Sr = S>R
v3+ v4 = SR or S=R
v5 + v6 = Rs or R>S
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Varieties of QRS complexesVarieties of QRS complexes
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ECG interpretation ECG interpretation
1. Heart rhythm 2. Heart rate 3. Intervals ( PR , QT , ST )4. Mean QRS axis 5. P wave abnormalities 6. Abnormalities of QRS 7. ST and T wave abnormalities
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1) Heart rhythm 1) Heart rhythm Sinus rhythm every P wave is
followed by a QRS every QRS is
preceded by a P wave
P wave is upward in lead I , II , III
if not Arrhythmia
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The ECG PaperThe ECG PaperHorizontally
◦ One small box - 0.04 s◦ One large box - 0.20 s
Vertically◦ One large box - 0.5 mV
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2) Heart rate 2) Heart rate Heart rate = 25mm/sec times 60sec/min No of mm b/w beats
If the distances are regular, count the number of "little boxes" from the beginning of one QRS to the beginning of the next QRS complex.
Divide the number of "little boxes" (which each represent 0.04 seconds) into 1500 to obtain the heart rate in beats per minute.
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Heart Rate =
1500
No. small boxes
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Rule of 300Rule of 300
Take the number of “big boxes” between neighboring QRS complexes, and divide this into 300.
The result will be approximately equal to the rate
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Rule of 300Rule of 300
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Rule Rule 66 Seconds Seconds
Every 3 seconds (15 large boxes) is marked by a vertical line.
9 * 10 = 90 beat /min
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3 sec 3 sec
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3) Intervals 3) Intervals
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(Learn the normal PR, QRS and QT intervals)
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4) Mean QRS Axis4) Mean QRS Axis
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5) Abnormalities of P wave5) Abnormalities of P wave
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6) Abnormalities of QRS complex 6) Abnormalities of QRS complex
Ventricular hypertrophy Bundle branch block
Myocardial Infarction
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Memorize these principles Memorize these principles In right ventricular hypertrophy
there is always inversion of the normal
In the left ventricular hypertrophy there is exaggeration of the normal
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Bundle branch block Bundle branch block Right bundle
branch block ( RBBB)
Left bundle branch block ( LBBB )
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RBBBRBBB
RBBB RBBB
RBBB is seen in :- Occasional normal
subjects Pulmonary embolus Coronary artery
disease ASD Active carditis RV diastolic
overload.
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LBBBLBBBLBBB is seen in :-
Always indicative of organic heart disease
Found in ischaemic heart disease
Found in hypertension
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Bundle branchblocks
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Myocardial infarction Myocardial infarction
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Lateral MI, Recorded in aVL
2
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Transmural and Non-transmural Transmural and Non-transmural
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ECG evolution of MI
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MI locations: II, III, aVF = Inf MIV1-2 = Septal MIV4-5 = Ant MI
I, aVL, V5-6 = Lateral MIV1-6 = Extensive Ant MI
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Localization of MIs
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7) ST segment and T Wave 7) ST segment and T Wave Abnormalities Abnormalities Drug effects Electrolyte disturbance Myocardial ischemiapericarditis Infarction Transmural MI ST deviate to upward Nontransmural MI ST deviate downward
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Repolarizationabnormalities
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Thank you all for listeningThank you all for listening
THE END
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