Special Diagnostic Procedures

SPDX WEEK 4 : ELECTROCARDIOGRAPHY

ELECTROCARDIOGRAPHY ECG/EKG  Detects your heart's electrical rhythm and
 Measures the heart’s electrical activity produces what's known as a tracing.
 ECG / EKG  This tracing consists of representations of
BRIEF HISTORY several waves that recur with each
heartbeat.
1. 1786 Dr. Luigi Galvani first noted that
electrical current could be recorded  The wave pattern should have a consistent
from skeletal muscles. shape. If your waves are not consistent, or if
2. 1887 The first ‘electrogram’ (ECG) from the they do not appear as standard waves, this is
intact human heart was recorded with indicative of heart disease.
a mercury capillary electrometer
by Augustus D Waller at St. Mary’s Cardiac Cycle
Hospital, London.  Is the sequence of events – electrical or
3. 1895 Einthoven, using an improved mechanical events taking place in the heart
electrometer and a correction
from the beginning of one heartbeat initiated
formula developed independently.
by an impulse from the sinoatrial (SA) node to
He labeled the corrected derived
deflections PQRS and T. the beginning of the next heart beat also
4. 1900 First article source using the term initiated by an impulse from the SA node.
“Elektrokardiogramm” (EKG) by
Willem Einthoven Electrical events
5. 1902 Einthoven publishes the first  Depolarization, repolarization of the atria and
electrocardiogram recorded on a depolarization and repolarization of the
string galvanometer. ventricle.
6. 2018 Apple smart watch: Over 400,000
people enroll in a study being Mechanical events
conducted by researchers at Stanford  Contraction or relaxation of the atria and
and Apple to determine whether a ventricles
wearable technology can identify
irregular heart rhythms suggestive
Normal Electrical Conduction Pathway
of atrial fibrillation.
 Consists of the following components:
Important diagnostic tool in the evaluation of 1.Sinoatrial  located on the right
node / SA atrium near the
CVD:
entrance of the
• Abnormal heart rhythm (arrhythmias) superior vena cava
 too slow / fast  this is the natural
• Myocardial ischemia/infarction peace maker of the
 inadequate supply of oxygen heart
• Chamber enlargement  initiates all the
• Electrolyte abnormalities heartbeat and
 specifically the potassium or calcium that determines
being utilized by the heart heartbreak(?)
2.Atrioventricul  located on the other
Purpose of ECG ar node / AV side of the right
atrium near the AV
valve

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 serves as the
electrical gateway to
the ventricles and;
 delays the passage of
the electrical
impulses to the
ventricles
This delay is to ensure the atria
have ejected all the blood into
the ventricles before the
ventricles contract
 the AV node receives
signals from the SA
node and passes them
into the AV bundle
3.AV bundle /  This bundle is then
(bundle of His) divided into right and
left bundle branches
which conduct the
impulses toward the
apex of the heart
 The signals are then
passed onto purkinje
fibers
4.Purkinje  Turning upward and
fibers spreading
throughout the
ventricular
myocardium
 The electrical activity of the heart can be
recorded in the form of electrocardiogram
 The ECG is a compulsive recording of all
the action potential produce by the node
and the cells of the myocardium. Each way
for segments of the ECG corresponds to a
certain event of the cardiac electrical
cycle
 When the atria is full of blood, the SA node
fires electrical signals spread throughout
the atria and caused them to depolarize,
this is represented by the P-wave on the
ECG
 Atrial contraction starts about a
100millisecond after the P-wave begins
 The PQ-segment represents the time
distance travelled from the SA nodeto the
AV node
 The QRS complex marks the firing of the
AV node and represents ventricular
depolarization
 Q wave corresponds to the depolarization
of the intraventricular ??
 R wave is produced by the depolarization
of the main mass of the ventricles
 S wave represents the last phase of the
ventricular depolarization at the base of
the heart
 Atrial repolarization also occurs during
this time but the signal is obscured by the
large QRS complex
 The ST segment reflects the plateu in the
myocardial action potential, this is when
the ventricle contracts and pumps blood
 The T wave represents the repolarization
immediately before the ventricular
relaxation
 The cycle repeats on every heart beat
ECG SETUP
Types of ECG
 Resting ECG Tracing
 Exercise/Stress ECG Tracing
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 Holter Monito
ECG Leads
 Bipolar Limb Leads
 Lead 1 – right arm and left arm (+)
 Lead 2 – right arm and left leg (+)
 Lead 3 – left arm and left leg (+)
 V4 – 5th intercostal space, left
midclavicular line
(usually located below the nipple)
 V5 – left anterior axillary line, at the
same level as V4
 V6 – same level as V4 and V5 but
located at the mid
axillary line
 Lead V4R - same level as V4 but
located on the right
 Lead V3R - between V1 and V4R
ECG WAVES

 Unipolar Limb Leads
 ECG machine usually augments the
potential by 1.5 than the original
potential
 Comes from a central terminal
 Lead aVR - towards right arm
 Lead aVL - towards left arm
 Lead aVF - towards left foot
ECG Leads
 Landmark: Angle of Louis
 Chest leads represent the horizontal
plane of the heart
 Position of chest leads
 V1 – attached at the 4th intercostal
space, left
parasternal border
 V2 – 4th intercostal space, right
parasternal border
 V3 – located between V2 and V4
1.P wave
 Represents atrial depolarization
2.QRS wave
 Ventricular depolarization
 Corresponds to phase 0
 Q-wave interventricular septum
depolarization
 R-wave apical depolarization
 S wave — depolarization of the base of
the ventricle
3.T wave
 Ventricular repolarization
 Corresponds to phase 3 of repolarization
4.U wave
 Uncommon wa at is believed to be due to
the slow
 repolarization of papillary muscles
5.ST segment
 Starts at the end of S to the beginning of
T
 Represents phase 2 of ventricular
repolarization
6.ST interval
 Starts at the end of S to the end of T
 Measures the whole period of latent
repolar

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 The lead wires will be attached to the
electrodes.

 Once the leads are attached, the

technician may enter identifying
information about you into
the machine's computer.
The ECG will be started. It will take only a
short time for the tracing to be completed.
Once the tracing is completed, the
technician will disconnect the leads and
remove the skin
electrodes.

ECG RULES

POST-EXAMINATION
 You should be able to go back to your
normal diet and activities, unless your
doctor tells you differently.
Generally, there is no special care after an
electrocardiogram (ECG).
Tell your doctor if you develop any signs or
symptoms you had before the ECG
Examination Protocol (for example, chest pain, shortness of
breath, dizziness, or fainting).
• Remove any jewelry or other objects that may
interfere with the test.  When reading the ECG, look at the: NAME
• *Depending on the reason for your ECG, your / AGE/ DATE/ STANDARDIZATION
doctor may ask you to stop taking some of your INTERPRETING THE RESULTS
medications. The Tracing
EXAMINATION  A tracing consists of repeated waves that
 Remove clothing from the waist up. have a standard shape.
 Lie flat on a table or bed for the test.  The waves have sections named the P
 If your chest, arms, or legs are very hairy, wave, QRS complex, ST
the technician may shave or clip small segment, and T wave.
patches of hair, as needed, so that the  There is also a PR interval between the P wave
electrodes will stick closely to the skin. and the QRS
 Electrodes will be attached to your chest, complex, and a QT interval between the QRS
complex and the T
arms, and legs. wave.

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STANDARD

INTERPRETING THE RESULTS

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