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Exercise 31A (modified)

Electrocardiogram (ECG), Heart Sounds, and Exercise Activity 1. PURPOSE To perform an ECG recording in a human subject, identify and interpret the waveforms in terms of depolarization and repolarization. Calculate ECG parameters such as QRS interval, PR and QT segments, and analyze their significance Experimentally correlate heart sounds to electrical conduction in the heart and phases of cardiac cycle. Compare and analyze ECG recordings in rest and after exercise.

2. INTRODUCTION The ability of the cardiac muscle to contract is intrinsic, e.g. it does not depend on the nervous system to initiate its contraction, and it continues even if all connections are severed. Two systems exert their effects on heart activity: one is the autonomic nervous system, and the other is the instrinsic conduction system or nodal system of the heart. This consists of autorhytmic non-contractile cells specialized to initiate impulses throughout the heart. This way, the heart depolarizes and contracts in an orderly sequential manner, and beats as a coordinated unit. See Figure 31.1 of your lab manual for the components of the intrinsic conduction system. The electrical currents generated and transmitted through the heart spread throughout the body and can be recorded with an electrocardiograph. A graphic record of that activity is called an electrocardiogram (ECG). For analysis, the ECG is divided into segments and intervals (Fig.1) Review your textbook for a detailed description of the waveforms. While ECG is a record of voltage and time, it reflects electrical events happening in relatively large amount of muscle, so it does not reflect the activity of nodal tissue only. We can infer that muscle contraction will follow the excitation of muscle tissue, this is something that is not recorded in an ECG. The main goal of this exercise is for students to become familiar with recording and interpreting different cardiovascular parameters. Electrocardiograms (ECGs) reflect the electric activity of the heart. Cardiac parameters involve different ECG intervals, as well as the R-wave amplitude (expressing the force of ventricular contraction) and the heart rate. The characteristic heart sounds correspond to the closing of the AV and semilunar valves. In the first part of the experiment students will relate phases of the ECG profile with the heart sounds. In the second part, students will compare the ECG parameters recorded in rest and after aerobic exercise. In the first part of this lab activity you will record the electrocardiogram (ECG) of a group member while listening to the characteristic lub-dub heart sounds at rest. The lub sound occurs during the early phase of ventricular contraction and is produced by closing of the atrioventricular valves, which prevents blood flow into the atria. When the ventricles relax, the blood pressure drops below what is in the artery and the semilunar valves close, producing the dub sound. In the second part, you will only record ECG at rest and immediately after a short aerobic exercise. Two different subjects should be recorded for the first and the second part.

EXPERIMENTAL SET-UP
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See Figure 2 for the different sensors/instruments to be used in this lab. Double-Click iWorx/LabScribe Software on Desktop to start the program Click Settings -> Select AP_2 ECG Exercises Open ECG_heartsound settings Remove all jewelry, watches, etc. from wrists. Use alcohol swabs to clean and scrub the 3 regions on the inside of the subjects forearm s where the electrodes will be placed. 7. Remove the plastic disk from a disposable electrode and snap lead wires onto the disposable electrodes 8. Attach the disposable electrodes on the regions describes below. RED (+1) LEAD is attached to the right wrist. BLACK (-1) LEAD is attached to the electrode connected to the left wrist. GREEN (C) LEAD (the ground) is attached to the electrode on the right leg (inside ankle). Make sure that both stethoscope and the event marker are ready to be used (Figure 2). Figure 1 . The normal electrocardiogram: P wave Figure 2 Sensors and instruments used in corresponds to atrial depolarization, the QRS exercises 31 and 33. complex to ventricular depolarization, and the Ta) Stethoscope wave to the ventricular depolarization. In a b) Event Marker normal heart, the size, deflection, and timing of c) Pulse Plethysmograph waves tends to be consistent. d) ECG cable & Electrode lead wires

1. 2. 3. 4. 5. 6.

3. PROCEDURES PART 1 - Recording of ECG and Heart Sounds (at rest) 1. The experimental subject (Subject) should sit quietly with both hands on their laps in supine position.
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***If you group member moves, the ECG trace will move off the top or bottom of the screen. If he or she moves any muscles in the arms or upper body, electromyograms (EMGs) from the muscles will appear on the ECG recording as noise. *** 2. A second person (Recorder) in your group should begin listening the heart sounds placing the stethoscope on the left region of the subject chest (Figure 3). When the person can clearly hear the lub and dub sound pattern, he or she should be ready for recording with event marker. ***Heart sounds can also be heard by placing the stethoscope over the arteries in the neck. *** 3. A third person (Operator) will use the computer. Operator will click on Record button on the top right side of the Main window of Labsribe software. Operator will also click on Autoscale button on the upper margin of each channel whenever the recording shifts out of the screen. 4. When the Subject and Recorder are ready, Operator will start the recording by clicking on the Record button. 5. During the recording, Recorder will press and hold the event marker button when he or she hears the lub (first) sound and releases the button when hears the dub (second) sound. Pressing the button will result in vertical line (from baseline to peak) in Heart Sound channel Holding the button will result in a horizontal line in Heart Sound channel Releasing the button will result in a vertical line (from peak to baseline) in Heart Sound channel 6. The Operator should record for 1 minute, and the recording should have a good, noise free, portion for at least 15 seconds in length so that an easier data analysis can be performed (Figure 4). 7. While recording, the Operator should pay attention and perform the followings if necessary; When any of the recordings shifts out of screen, click on the Autoscale button on its channel. When any of the recordings looks inverted, right click on and select Invert on its channel. When the recording moves fast and the time scale (on X axis) is too short, click on double display time (may require couple of clicks) icon on the upper toolbar (Figure 5). Note the average resting heart rate (V2 V1 = .bpm) on Heat Rate channel 8. When the recording is completed Operator will; click on Stop to halt the recording. Save the file as GroupName_ecgHeartSound on the Desktop of your computer. Make sure to designate the file type as *.iwxdata.

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Figure 3. Experimental student with electrodes properly attached, while another student listens to the heart sounds using the stethoscope and recording with the event marker.

Figure 4 ECG and event marker recordings displayed in the Analysis window. Lines and labels were added to figure to indicate the locations where cursors should be placed to measure the time intervals between the R wave and the lub and the T wave and the dub.

PART 2 - Recording of ECG at Rest. 1. The Subject of this part should be a different student. Note that some aerobic exercise is required. 2. The recording will be as described in Part 1, from #1 through #7, but excluding the heart sounds. The heart sounds channel may be minimized. 3. Operator will continue recording for 3 min. 4. Operator will also type and enter the followings next to the Mark box to the right of Mark button; Type 0 second and press Enter key on keyboard when begin to record. Type 60 seconds and press Enter key on keyboard when 1 minute is passed while recording. Type 120 seconds and press Enter key on keyboard when 2 minutes is passed while recording. 5. When the recording is completed Operator will; click on Stop to halt the recording. Save the file as GroupName_ecgRest on the Desktop of your computer. Make sure to designate the file type as *.iwxdata. PART 3 - Recording of ECG after short aerobic exercise 1. First, the ECG wires will be unplugged from the electrodes, but electrodes will be left intact on Subjects skin.

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2. Then, the subject will perform some aerobic exercises such as running/jogging in the hallway outside the classroom or around the parking lot for 3 to 5 minutes, or jumping for a couple of minutes. For optimal results, try to get the heart rate elevated (over 100 bpm). 3. Recording will be performed as described in Part 1, from #1 through #7, but excluding the heart sounds. 4. When the Subject comes back from exercise, the wires will be attached, and the Operator immediately will begin recording. 5. Operator will continue recording for 3 minutes or until the Subjects heart rate returns to normal, as it was recorded during the resting period. 6. Operator will also type and enter the followings next to the Mark box to the right of Mark button; Type 0 second and press Enter key on keyboard when begin to record. Type 60 seconds and press Enter key on keyboard when 1 minute is passed while recording. Type 120 seconds and press Enter key on keyboard when 2 minutes is passed while recording. 2. When the recording is completed Operator will; click on Stop to halt the recording. Save the file as GroupName_ecgExercise on the Desktop of your computer. Make sure to designate the file type as *.iwxdata. Figure 5 Shortcut buttons on LabScribe software

4. DATA ANALYSIS Use Table 1 for calculations Table 1 Guide to Measurements of EKG Components Component (Value to be How to Measure Measured) Place one cursor on the peak of R wave on ECG channel. R wave to Place the second cursor on the onset (top of first vertical lub interval line) of event marker on Heart Sounds channel. Place one cursor on the peak of T wave on ECG channel. Place the second cursor on the offset (top of second vertical line) of event marker on Heart Sounds channel. Place one cursor at the beginning of P wave and the second cursor at the end of the P wave on ECG channel.

Value to be Recorded

T2 - T1 on either ECG or Heart Sounds channel

T wave to dub interval P wave

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T2 - T1 on either ECG or Heart Sounds channel T2 - T1 on ECG channel only

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QRS Complex

R wave Amplitude

Place one cursor at the beginning of QRS complex and the second cursor at the end of the QRS complex on ECG channel. Place one cursor on the peak of Q wave before R wave and the second cursor on the peak of the R wave on ECG channel. Place one cursor at the beginning of P wave and the second cursor at the beginning of QRS complex on ECG channel. Place one cursor at the end of P wave and the second cursor at the beginning of QRS complex on ECG channel. Place one cursor at the end of the QRS Complex and place the second cursor at the beginning of the following T wave on ECG channel. Place one cursor at the beginning of QRS complex and the second cursor at the end T wave on ECG channel. Place one cursor at the end of the T wave and place the second cursor at the beginning of the following P wave on ECG channel. Place one cursor on the peak of R wave and the second cursor on the peak of adjacent R wave to its right on the ECG channel.

T2 - T1 on ECG channel only V2 - V1 on ECG channel only T2 - T1 on ECG channel only T2 - T1 on ECG channel only T2 - T1 on ECG channel only T2 - T1 on ECG channel only T2 - T1 on ECG channel only

P R Interval

P-R Segment

S-T Segment

Q - T Interval

T - P Interval

Beat Period (R R Interval)

T2 - T1 on ECG channel only

PART 1 Analysis of Recorded Data of ECG and Heart Sounds (at rest) 1. Scroll through the recording and find a section of data with four to six good ECG cycles in succession. 2. Four complete ECG cycles can be selected by; i. Placing the cursors on either side of a group of four complete ECG cycles ii. Clicking the Zoom between Cursors button (Figure 5) on the toolbar to expand that segment to the width of Main window. 3. Click on the Analysis window icon in the toolbar (Figure 5). You will see the mathematical functions above the uppermost channel. Values for V2-V1 (y-axis, vertical), T2-T1 (x-axis, time), and Mean (average between two cursors) from each channel can be seen across the top margin of each channel. 4. For this Part, calculate the average R-lub and T-dub interval ONLY. Use Table 1 as a guide; place the two cursors on specified positions to determine the values on data tables. When the cursors are in correct positions, the data can be obtained from the numbers below V2-V1, T2T1, and the Mean functions for the channel desired. *** Data can be input on Excel file, AP2_HeartSounds_ECG_Tables_v1.xls or can be written down on the printed data tables. ***
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5. Analyze the data of 3 different cycles. 6. Record your data in the following table: Table 2. Heart Sound parameters Interval (msec) Cycle 1 Cycle 2 R-lub T-dub PART 2 Analysis of Recorded Data of ECG at rest

Cycle 3

Average

1. Perform the analysis as described above in Part 1. Refer to Table 1, but do not analyze R wave

to lub and R wave to dub intervals. 2. Analyze the data of three different cycles. 3. For each component record and fill out the data Table 3, ECG Measurements at rest. Analyze 3 cycles, record the values, and then write down the average PART 3 Analysis of ECG data after aerobic exercise 1. Perform the analysis as described above in Part 1. Refer to Table 1, but do not analyze R wave to lub and R wave to dub intervals. 2. Analyze the data at 0 sec, 60 sec, and 120 sec. at the marked portions of your recording. 3. For each component record and fill out the data Table 4, ECG Measurements after Exercise for for three different ECG cycles. 4. Compare the average values of the different parameters at rest and after exercise in Table 5. 5. QUESTIONS Table 3. Parameters calculated for ECG recording at Rest Measured at Rest Mean Values R wave Amp P wave P R Interval P- R Segment QRS wave Q T Interval S -T segment T P Interval T-wave Cycle 1 Cycle 2 Cycle 3 Average

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Beat Period (T to T Interval) Table 4. ECG parameters after exercise. ECG parameters after Exercise Mean Values R wave Amp P wave PR Interval P- R Segment QRS wave QT Interval S -T segment TP Interval T-wave Beat Period (T to T Interval) 0 min (3 values) 0 min Average After 60 min (3 values) After 60 min Average After 120 min (3 values) After 120 min Average

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Table 5. Comparison of ECG parameters at Rest and after Exercise Normal values (sec) Measured at Rest At 0 sec At 0 sec Measured After Exercise

Mean Values R wave Amp P wave PR Interval P- R Segment QRS wave QT Interval S -T segment TP Interval T-wave

After 60 sec

After 120 sec

0.060.11 0.12-0.2 0.08 0.12< 0.310.41 0.12 varies 0.16

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QUESTIONS 1. (consult your textbook if necessary) Heart What Electrical event in the Sound provokes it atria/ventricle Lub sound Dub sound

Phase of cardiac cycle

2. Using the formula below, calculate the average heart rate of the subject and write down on the table below. Heart Rate (beats/min) = At Rest At 0 sec. Mean Heart Rate When was the subjects HR the most elevated?
( )

Measured After Exercise At 0 sec At 60 sec. At 120 sec

2. In relationship with Table 5: which parameters changed the most during exercise and why? Discuss your results in relationship to the events of the cardiac cycle.

3. Recovery Heart Rate refers to the hearts ability to return to normal values after physical (aerobic) activity. It is measured two minutes after exercise and is the most common measurement in determining cardiovascular fitness. It is calculated by subtracting the two min (120 sec) HR from the HR at 0 sec. The bigger the value (quicker the HR returns the resting value) indicates a healthier heart and the smaller the value indicates a less healthy heart.

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Assume that two healthy subjects with similar physical conditions (age, gender, height, weight, etc) performed Leg Exercises (under same conditions and time frame) and their mean HRs are determined from EKG recordings on the table below; HR (at Rest) 72 80 HR (0 sec after Exercise) 115 125 HR (120 sec after Exercise) 80 115

Subject A Subject B

a) Which subject has the highest recovery HR and a healthier heart?

b) Give some possible explanations as to why one may have a healthier heart.

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