Electrocardiogram

Introduction
Electrocardiogram refers to the recording of electrical
changes that occurs in heart during a cardiac cycle. It
may be abbreviated as ECG or EKG.
What is an ECG?
An ECG is simply a representation of the electrical activity
of the heart muscle as it changes with time, usually

printed on paper for easier analysis. Like other muscles,

cardiac muscle contracts in response to electrical
depolarisation of the muscle cells. It is the sum of this
electrical activity, when amplified and recorded for just a
few seconds that we know as an ECG.
Working principle of electrocardiograph
• It works on the principle that a contracting muscle
generates a small electric current that can be detected and
measured through electrodes suitably placed on the body.
• For a resting electrocardiogram, a person is made to lie in
the resting position and electrodes are placed on arms,

legs and at six places on the chest over the area of the
heart. The electrodes are attached to the person’s skin
with the help of a special jelly.( nomenclature (RA = right
arm; LA = left arm; RL = right leg; LL = left leg)
• The electrode picks up the current and transmit them to
an amplifier inside the electrocardiograph. Then
electrocardiograph amplifies the current and records them
on a paper as a wavy line.
 • In an electrocardiograph, a sensitive lever traces the
changes in current on a moving sheet of paper.
• A modern electrocardiograph may also be connected to an
oscilloscope, an instrument that display the current on a
screen.

An essential feature of the ECG is that the electrical activity of

the heart is shown as it varies with time. In other words we can
think of the ECG as a graph, plotting electrical activity on the
vertical axis against time on the horizontal axis. Standard ECG
paper moves at 25 mm per second during real-time recording.
This means that when looking at the printed ECG a distance of
25 mm along the horizontal axis represents 1 second in time.

ECG paper is marked with a grid of small and large squares.

Each small square represents 40 milliseconds (ms) in time along
the horizontal axis and each larger square contains 5 small
squares, thus representing 200 ms. Standard paper speeds and
square markings allow easy measurement of cardiac timing
intervals. This enables calculation of heart rates and
identification of abnormal electrical conduction within the
heart
Normal ECG
Anormal ECG makes a specific pattern of three
recognizable waves in a cardiac cycle. These
wave are- P wave, QRS wave and T-wave, P-R
interval, S-T segment

P-wave:

It is a small upward wave that appears first

It indicates atrial depolarization (systole),
during which excitation spreads from SA node
to all over atrium
About 0.1 second after P-wave begins, atria
contracts. Hence P-wave represents atrial
systole

QRS wave:
It is the second wave that begins as a little
downward wave but continues as a large
upright triangular wave and ends as downward
wave
It represents the ventricular depolarization
(systole)
Just after QRS wave begins, ventricles starts to
contracts. Hence QRS wave represents
ventricular systole

t- wave:

It is third small wave in the form of a dome-

shaped upward deflection.
It indicates ventricular repolarization (diastole)
It also represents the beginning of ventricular
diastole
** ATRIAL DIASTOLE MERGES WITH QRS-WAVE

P-R interval:
It represents the time required for an impulse
to travel through the atria, AV node and bundle
of his to reach ventricles.

S-T segment:

It is measured from the end of S to the

beginning of T- wave
It represents the time when ventricular fibres
are fully depolarized.
Application of ECG:
it indicates the rate and rhythm or pattern of contraction of
heart
it gives a clue about the condition of heart muscle and is used
to diagnose heart disorders
it helps the doctors to determine whether the heart is normal,
enlarged or if its certain regions are damaged
it can also reveal irregularities in heart’s rhythm known as
‘arrhythmia’
it is used by doctors to diagnose heart damage in conditions
like high blood pressure, rheumatic fever and birth defects
an ECG also helps to determine the location and amount of
injury caused by heart attack and later helps to assess the
extent of recovery
Sinus tachycardia
(also colloquially known as sinus tach or sinus tachy) is an
elevated sinus rhythm characterized by an increase in the rate
of electrical impulses arising from the sinoatrial node. In adults,
sinus tachycardia is defined as a heart rate greater than 100
beats/min (bpm).

Sinus bradycardia
is a type of slow heartbeat. A special group of cells begin the
signal to start your heartbeat. These cells are in the sinoatrial
(SA) node. Normally, the SA node fires the signal at about 60 to
100 times per minute at rest. In sinus bradycardia, the node
fires less than 60 times per minute.
A sinus arrhythmia
is an irregular heartbeat that's either too fast or too slow. One
type of sinus arrhythmia, called respiratory sinus arrhythmia, is
when the heartbeat changes pace when you inhale and exhale.
In other words, your heartbeat cycles with your breath. When
you breathe in, your heart rate increases.

Done by Dr.Asawer Zain alabdean