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Normal Characteristics of Ecg
Normal Characteristics of Ecg
NORNAL ECG
ACTION
POTENTIAL
HOW DOES AN
ELECTRICAL
IMPULSE MAKE
OUR HEART
BEAT?
CELL
CELL
MEMBRANE
Na
Ca
Na
Na CHANNEL CLOSE
Ca
K
Ca
K
Na K Pump
Na
Na
K
Physiologic Characteristics of
the cardiac muscle
AUTOMATICITY- ABILITY TO
INITIATE AN ELECTRICAL IMPULSE
Physiologic Characteristics of
the cardiac muscle
AUTOMATICITY- ABILITY TO
INITIATE AN ELECTRICAL IMPULSE
EXCITABILITY- ABILITY TO
RESPOND TO AN ELECTRICAL
IMPULSE
Physiologic Characteristics of
the cardiac muscle
AUTOMATICITY- ABILITY TO
INITIATE AN ELECTRICAL IMPULSE
EXCITABILITY- ABILITY TO RESPOND
TO AN ELECTRICAL IMPULSE
CONDUCTIVITY- ABILITY TO
TRANSMIT AN ELECTRICAL IMPULSE
FROM ONE CELL TO ANOTHER
Physiologic Characteristics of
the cardiac muscle
AUTOMATICITY- ABILITY TO INITIATE AN
ELECTRICAL IMPULSE
EXCITABILITY- ABILITY TO RESPOND TO
AN ELECTRICAL IMPULSE
SA
AV
SA
AV
SA
AV
BUNDLE OF HIS
SA
AV
BUNDLE OF HIS
RBB
LBB
SA
AV
BUNDLE OF HIS
RBB
LBB
PURKINJE FIBERS
MULTI CHANNEL
MULTI CHANNEL
12 lead ECG
6 chest leads ( V1-V6 )
3 limb leads unipolar ( AVF,AVL, AVF )
3 limb leads bipolar ( I, II, III )
V3 inbetween V2 and V4
V5 mid-axillary line
V6 mid-axillary line
P WAVE
P WAVE
Is the first component of a
normal ECG
P WAVE
Is the first component of a
normal ECG
Denotes electrical activity in atria
P WAVE
Is the first component of a normal
ECG
Denotes electrical activity in atria
represents atrial depolarization
which initiates atrial contraction
P WAVE
Is the first component of a
normal ECG
Denotes electrical activity in atria
represents atrial depolarization
which initiates atrial contraction
Is small rounded
P WAVE AMPLITUDE
P WAVE DURATION
PR
INTERVAL
PR INTERVAL
PR INTERVAL
This represents activity from the
beginning of atrial depolarization to
the beginning of venticular
depolarization which initiates
ventricular contraction.
PR INTERVAL
This represents activity from the
beginning of atrial depolarization to
the beginning of venticular
depolarization which initiates
ventricular contraction.
Located from the beginning of P
wave to the beginning of QRS
PR INTERVAL
Varies with age and heart rate. As the
persons ages, their heart rate decreases
and the PR interval subsequently
lengthens. The limit that you look for is:
< 3 years
3-16 years
>16 years
0.08 seconds
0.10 seconds
0.12 seconds
QRS
COMPLEX
QRS
COMPLEX
QRS COMPLEX
represents ventricular depolarization
follows the PR interval
consists of 3 waves
1. q wave 1st negative deflection
2. r wave the positive deflection
3. s wave negative deflection after r wave
NB: do NOT always see all 3 waves
Can deflect either way depending on lead
0.04 seconds
0.05 seconds
0.06 seconds
0.07 seconds
< 0.08 seconds
QRS AMPLITUDE
Amplitude is the most important criteria
for the diagnosis for ventricular
hypertrophy.
Q WAVE
The average Q wave duration is
0.02 seconds and does not
normally exceed 0.03 seconds.
ST SEGMENT
ST SEGMENT
ST SEGMENT
REPRESENTS THE END OF
VENTRICULAR DEPOLARIZATION
AND THE BEGINNING OF
VENTRICULAR REPOLAZATION
ST SEGMENT
REPRESENTS THE END OF
VENTRICULAR DEPOLARIZATION
AND THE BEGINNING OF
VENTRICULAR REPOLAZATION
EXTENDS FROM THE S WAVE TO
THE BEGINNING OF THE T WAVE
ST SEGMENT
REPRESENTS THE END OF
VENTRICULAR DEPOLARIZATION
AND THE BEGINNING OF
VENTRICULAR REPOLARIZATION
EXTENDS FROM THE S WAVE TO THE
BEGINNING OF THE T WAVE
ISOELECTRIC- DEFLECTION ONLY
SLIGTHLY 0.1 mV
T WAVE
T WAVE
T WAVE
REPRESENTS VENTRICULAR
REPOLARIZATION
T WAVE
REPRESENTS VENTRICULAR
REPOLARIZATION
FOLLOWS THE S WAVE
T WAVE
REPRESENTS VENTRICULAR
REPOLARIZATION
FOLLOWS THE S WAVE
TYPICALLY ROUNDED AND SMOOTH
T WAVE
REPRESENTS VENTRICULAR
REPOLARIZATION
FOLLOWS THE S WAVE
TYPICALLY ROUNDED AND SMOOTH
NB: CELLS MOST VULMERABLE TO
STIMULI AT THIS TIME
QT
INTERVAL
QT INTERVAL
VARIES WITH HEART RATE, BUT NOT AGE,
EXECPT IN THE INFANCY.QT MUST BE
THEREFOREMEASURED IN RELATION TO
THE HEART RATE. TO MEASURE THIS YOU
MAY USE; A COMMERCIALLY PRODUCED
RULER, TABLES OF AVERAGES OR
BAZETTS RULE.
ECG
PAPER
ECG PAPER
TO MEASURE THE DURATION
ECG PAPER
TO MEASURE THE DURATION
1 SMALL BOX = 0.04 SEC.
ECG PAPER
TO MEASURE THE DURATION
1 SMALL BOX = 0.04 SEC.
1 LARGE BOX= 0.20 SEC.
ECG PAPER
MEASURE THE DURATION
MEASURE THE AMPLITUDE
ECG
AMPLITUDE
1 SMALL BOX=1MM
1 LARGE BOX= 5MM
CARDIAC RATE
6 SECONDS STRIP
CARDIAC RATE
6 SECONDS STRIP
WHEN THE RHYTHM IS IRREGULAR,
CARDIAC RATE CAN BE DETERMINED BY
COUNTING THE R WAVES IN A 6 SECONDS
STRIP AND MULTIFLY IT BY 10 FRO THE
VENTRICULAR RATE.
FOR THE ATRIAL RATE COUNT THE
P WAVE.
6 SECONDS STRIP
6 X 10 = 60 BEATS PER MINUTE
TRIPLICATE
300,
TRIPLICATE
300, 150
TRIPLICATE
300,150, 100
TRIPLICATE
300,150, 100
75,
TRIPLICATE
300,150, 100
75, 60
TRIPLICATE
300,150, 100
75, 60,50
TRIPLICATE
___,150, 100
75, 60, 50
TRIPLICATE
___,___, 100
75, 60, 50
TRIPLICATE
___,___, ___
75, 60, 50
TRIPLICATE
___,___, ___
___, 60, 50
TRIPLICATE
___,___, ___
___, __, 50
TRIPLICATE
___,___, ___
___, ___, ___
COMPUTING THE CR
LOOK FOR THE R WAVE THAT
FALLS ON A HEAVY DARK
LINE AND LOK FOR THE
FOLLOWING R WAVE AND
APPLY THE TRIPLICATE
VALUE ON THE LINE IN
BETWEEN THE TWO R WAVE.
COMPUTATION USING
LARGE BOX
COMPUTATION USING
SMALL BOX
LEVEL
INHERENT RATE
ATRIA
60-80/ Min.
AV JUNCTION 40-60/ Min>
LEVEL
INHERENT RATE
ATRIA
60-80/ Min.
AV JUNCTION 40-60/ Min>
LEVEL
INHERENT RATE
ATRIA
60-80/ Min.
AV JUNCTION 40-60/ Min>
LEVEL
INHERENT RATE
ATRIA
60-80/ Min.
LEVEL
INHERENT RATE
ATRIA
60-80/ Min.
AV JUNCTION 40-60/ Min>
LEVEL
INHERENT RATE
ATRIA
60-80/ Min.
AV JUNCTION 40-60/ Min.
VENTRICLES 20-40/ Min.
Pacing Rate
Of Ectopic Foci
20
40
60
80
I Ventricular I Junctional I Atrial I
INHERENT RATE
NEW BOR
2 YRS
4 YRS
6 YRS
>6 YRS
SA
11O-150
85-125
75-115
65-100
60-100
Atria
110-120
85-100
75-92
65-80
80-80
A V Junction
73-90
56-75
50-69
43-60
40-60
Ventricles
37-60
29-50
25-38
22-40
20-40