Heart Structure & Function

Video #4
 Heart Structure & Function

The ECG and Impulse Conduction in the heart

ELECTROCARDIOGRAM
 Heart Structure & Function

To accurately measure a wave of depolarization passing across a tissue or

organ, we could simply place electrodes on the surface of the organ.

Can do this to study the ELECTRICAL ACTIVITY OF THE HEART.

Intact heart in situ Isolated heart in vitro

 Heart Structure & Function

As a wave of electrical excitation passes over the heart

surface - it could be detected by the changes in potential
difference between the two electrodes.
 Heart Structure & Function

Measuring the heart’s electrical activity directly.

Easy to do in a laboratory setting.

 Heart Structure & Function

In certain cases, this is not practical (i.e., in HUMANS!)

Necessary to use a NON-INVASIVE METHOD.

 Heart Structure & Function

In the case of measuring a human ECG - we cannot place

electrodes on the heart without major surgery.
 Heart Structure & Function

Methods used are less precise than direct electrode placement on the
heart - but they provide GLOBAL INFORMATION about how the activities
of various portions of the heart are INTEGRATED INTO A CO-ORDINATED
and COHERENT BEAT.

To understand the basics of an ELECTROCARDIOGRAM or ECG - consider

the simple case if two electrodes were place on the surface of the heart.
 Heart Structure & Function
Deflections caused by depolarization waves traveling in different directions.
 Heart Structure & Function
But just how close do the electrodes have to be???
The human heart is LARGE, and is surrounded by body fluids that
CONTAIN IONS and CONDUCT ELECTRICITY.
Remember the Interstitial Fluid (ISF) that surrounds and bathes all the
body’s cells

Great Movie
Electric chair!
 Recording an ECG
Thus, electrodes placed on the BODY SURFACE
can record the electrical activities of the heart -
as long as they make good contact with the
body fluids.
The conventional
placements for measuring
a human ECG are the arms
and the legs - electrodes
are normally placed on the
wrists and ankles for
convenience.
Electrodes: A, A’, B, B’, C, C’
 Recording an ECG
Willem Einthoven (1860-1927) was a Dutch doctor and physiologist. He
invented the first practical electrocardiogram (ECG) in 1903 and received the
Nobel Prize in Medicine in 1924 for it.
 Recording an ECG
Early ECG Equipment
The Cambridge Simpliscribe
popular in the 1950s – 1960s
(Vacuum tube technology)

The Cambridge VS4

popular in the 1970s – 1980s
(Solid state technology)
 Recording an ECG
ECG Equipment Today

Portable ECG monitor

www.cnamedical.com/fx-2111.jpg

http://www.hightechlabs.com.au

http://www.supplierlist.com
 Recording an ECG
ECG Electrode Placement

Most common placement is

the right wrist and left ankle
 Recording an ECG
Conductive Gels: A variety of biomedical uses
 Recording an ECG
A typical ECG represents the SUM of all the ACTION POTENTIALS of all the
CARDIAC MUSCLE CELLS during ONE BEAT.

Remember:
(1) The recording is made some distance from the heart.

(2) Various heart cells are orientated in different directions.

(3) Heart cells are excited at different times during the beat
cycle.
(4) The cells recover at various times during the beat cycle.
 Recording an ECG
MRI of a human heart showing the myocardial fiber directions
 Recording an ECG

Deflections caused by depolarization waves traveling in different directions.

All adds up to this =

 Recording an ECG
Thus, as "seen" by a surface electrode, the electrical signal from one cell,
may AUGMENT or DETRACT from that of another.

The COMPOSITE ECG bears NO RESEMBLANCE to the action potential of a

single cell.
ECG AP

NOT THE SAME

 Recording an ECG
However, years of careful observations and correlations have
established a BASIS FOR INTERPRETING ECGs.
 Recording an ECG
The KEY FEATURES on a typical ECG recording are designated by
the letters:

P QRS T
 Recording an ECG
Normal ECG
recorded from
a human heart

http://www.vanth.org/vibes/images/normalECG2.PNG
 Recording an ECG
An ECG Trace

http://www.cvphysiology.com/
 Recording an ECG
The ECG
 Recording an ECG

P WAVE: Signals the START of the heartbeat. It

corresponds to the SPREAD OF EXCITATION OVER
BOTH ATRIA.
 Recording an ECG
The ECG
 Recording an ECG

P-R INTERVAL: The time from the beginning of

the P WAVE to the beginning of the R WAVE, or it is
the time taken for IMPULSE CONDUCTION FROM THE
ATRIA to the VENTRICLES.
 Recording an ECG
P-R INTERVAL cont:
(1) Although the heart APPEARS to be electrically "SILENT" during PART of
this time - a WAVE OF DEPOLARIZATION IS STILL PROPAGATED.
(2) This time includes PASSAGE OF THE IMPULSE TO THE AV NODE.

(3) The DELAY imposed by the AV NODE.

(4) Passage through the AV BUNDLE, the BUNDLE OF HIS, BUNDLE

BRANCHES, and into the PURKINJE NETWORK.
(5) Disturbances of AV Conduction induced by INFLAMMATION, POOR
CIRCULATION, DRUGS or NERVOUS MECHANISMS are often revealed by an
ABNORMAL PROLONGATION of the P-R INTERVAL.
 Recording an ECG
The ECG
 Recording an ECG

QRS COMPLEX: This corresponds to the

INVASION of the VENTRICULAR MUSCULATURE by
EXCITORY IMPULSES.

(1) It is recorded as a bigger deflection than the P WAVE because the

VENTRICULAR MASS is MUCH LARGER than the ATRIAL MASS.

(2) The duration of the QRS Complex is shorter than the P WAVE
because impulse conduction through the ventricles (partly via the
PURKINJE NETWORK) is VERY RAPID.
 Recording an ECG
QRS has a BIGGER deflection and a FASTER conduction due to:

1. Thick walled ventricles give 2. Purkinjie System leads to rapid

GREATER ventricular mass conduction
 Recording an ECG
The ECG
 Recording an ECG
The ECG Atrial Repolarization hidden by QRS complex
 Recording an ECG
S-T SEGMENT: During the interval between S and T, the
ECG registers ZERO - all of the ventricular muscle is in the same
DEPOLARIZED STATE (recall the long plateau of the action
potential of ventricular fibers) - as a result, THERE ARE NO
DIFFERENCES TO RECORD.

T WAVE: This results from ventricular REPOLARIZATION as

different parts of the ventricle REPOLARIZE AT DIFFERENT TIMES.

These are only the BARE RUDIMENTS of the information buried in an ECG.
 Recording an ECG
The ECG
Recording an ECG
 Recording an ECG
An ECG Trace

http://www.cvphysiology.com/
 Recording an ECG
Animation of normal ECG wave

http://upload.wikimedia.org
 Recording an ECG
Remember – VERY Important !
The ECG trace that you record DOES NOT represent the electrical activity
of a SINGLE CELL.

It represents the electrical activity of the WHOLE HEART, i.e., many

thousands of cells. These lie in different orientations and are active at
different times.

Thus, the ECG shows the ‘BIG PICTURE’ of the heart’s electrical activity.
 Recording an ECG

End of Video #4