Electrocardiogram (ECG)

Elektrokardiogramm (EKG)
⼼電図（しんでんず）

Cardiology
Yoshiyasu Aizawa MD
 Part 2
2限⽬

•The basics of ECG

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The “P” Wave､P波（は）

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Biphasic P wave (V1)
 The “Q” Wave、Q波（は）
• The Q Wave is the first downward stroke of the QRS
Complex, and it is often not present.
• The upward R Wave is followed by a downward S Wave.
• This total QRS Complex represents the electrical activity
of ventricular depolarization.

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qRs
Mean QRS vector
QRS Patterns - ECG
 ST Segment

initial phase of Ventricular Repolarization

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ST Segment
• The ST Segment should be flat and level with the
baseline.
• If the ST Segment is elevated or depressed beyond the
baseline, it is a sign of serious problems. (eg. Acute
myocardial infarction)

ST Normal ST Elevation
 T Wave、T波（は）

Ventricular repolarization
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T Wave、T波（は）

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 QT Interval
QT間隔（かんかく）、QT時間（じかん）

Duration of ventricular repolarization

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The Cardiac Cycle

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 The Cardiac Cycle
P Wave = atrial depolarization (contraction).

PR Segment = pause at the AV Node.

QRS Complex = ventricular depolarization (contraction).

ST Segment = initial phase of ventricular repolarization.

T Wave = final, rapid phase of ventricular repolarization.

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Basic ECG Theory
 EKG Leads
心電図誘導（しんでんずゆうどう）

• The standard EKG is composed of 12 leads that are

attached to electrodes.

• There are 6 limb leads recorded by using arm and

leg electrodes.

• There are 6 chest leads obtained by placing

electrodes at different positions on the chest.

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 Einthoven's triangle
Limb leads

Augmented limb leads

 EKG Leads
心電図誘導（しんでんずゆうどう）
Limb Leads
I
II
III
AVR
AVL
AVF

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 EKG Leads
心電図誘導（しんでんずゆうどう）
Chest Leads
V1
V2
V3
V4
V5
V6

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Limb leads: View from a vertical plane

Chest leads: View from a horizontal plane

Correlation between Heart Walls and EKG leads
 Heart Rate

• When examining an EKG, you should first consider

the rate.
• The rate is read as cycles per minute.

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 Heart Rate
• The SA Node is the heart’s dominant pacemaker,
generating a sinus rhythm.
• The SA Node paces at a resting rate range of 60 to 100
per minute.

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 Heart Rate
• Sinus Bradycardia
• HR<60bpm

• Sinus Tachycardia
• HR>100bpm

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 Heart Rate
• Other potential pacemakers, known as ectopic foci
have the ability to pace the heart (at a slower rate), if
the normal SA Node pacemaking fails.
• These foci are located in the :
-Atrial Foci – rate of 60-80 per minute
-Junctional Foci – rate of 40-60 per minute
-Ventricular Foci – rate of 20-40 per minute
*Rapid pacemaking activity suppresses slower activity

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ECG paper
 Determining the Heart Rate from an EKG

• Step 1:
-Find a specific R Wave
that peaks on a heavy
black line (this will be
the start line)

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 Determining the Heart Rate from an EKG

• Step 2:
-Count off “300, 150,
100” for every thick
black line that follows
the start line, naming
each line as shown…

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 Determining the Heart Rate from an EKG

• Step 3:
-Count off the next
three lines after “300,
150, 100” as “75, 60,
50.”

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 Determining the Heart Rate from an EKG

• Step 4:
-Where the next R
Wave falls, determines
the heart rate.
-It’s that simple!

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Determining the Heart Rate from an EKG

What is this patient’s Heart Rate?

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Determining the rhythm on an EKG

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 Test
H

I
A G E

F B
D
 Question
Determine the following Heart Rates

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