GULU UNIVERSITY

FACULTY OF MEDICINE

DEPARTMENT OF PHYSIOLOGY

COURSE UNIT: PHYSIOLOGY (PHYS 1011)

EXPERIMENT: EXAMINATION OF BLOOD

DATE OF PRACTICAL: 16/10/2023

DATE OF SUBMISSION: 27TH NOVEMBER 2023

STUDENT’S NAME REGISTRATION SIGNATURE

NUMBER
1. OJAMBO JOSHUA HAMIRIE 23/U/3962/GUM/PS
2. ASINDE JENIPHER 23/U/3287/GUM
3. BWAMBALE EMMANUEL 23/U/0020/GUM
4. OKELLO DENISH 23/U/3295/GUM
5. MUNDUA GLORIA 23/U/3312/GUM
6. KOBUGABE EDGAR 23/U/3309/GUM
7. MUYINDA KIIRYA DAVID 23/U/0061/GUM
8. ALUMA DAN HENRY 23/U/3978/GUM
9. OWEKA INNOCENT 23/U/0096/GUM

SUPERVISOR: Dr. Muzaale Francis

TECHNICIAN: Mr. Okello Joseph

OBJECTIVE
  Determine Hear rate
 Determine the rhythm
 Determine the Cardiac Axis
 Determine the waves

BACKGROUND

The electrocardiogram is a graphic record of electrical activity of the heart generated during each
cardiac cycle and is recorded by an electrocardiography.

The electrical activation of the heart muscle cell leads to action potentials, which consists of
depolarization and repolarisation process. The ECG records the depolarization and repolarization
potentials generated by the working atria and ventricular myocardial fibres. This sets up an
electrical current which is detected by surface electrodes, amplified and displayed on a monitor
as the ECG.

The convectional ECG is recorded using 12 leads applied to arms, legs and chest. These leads
represent the difference in electrical potentials in frontal and horizontal planes of the body.

The 12-lead ECG is generated from chest and limb electrodes. These are 4 limb electrodes and 6
chest leads V1-V6 from electrodes placed on the anterior and lateral side of over the heart. The
electrode are fixed on the skin with jelly.

The Lead system

A lead is a pair of electrodes consisting of exploring electrodes and an indifferent electrode. The
potential difference between these 2 electrodes is recorded. The average vector of ventricular
depolarisation is known as cardiac axis. Normal axis is between -30 and +90.

There are three types of lead system i.e.

1. Standard bipolar limb leads

2. Augmented/Unipolar limb leads
3. Precordial leads/Unipolar chest leads)

Standard bipolar limb leads

These measure potential differences between 2 limbs

 Exploring electrode is the positive lead

 Indifferent electrode is the negative lead

The position is as follows

 Lead I: Left arm (+ve) Right arm (-ve)

 Lead II: Left leg (+ve), Right arm (-ve)
 Lead III: Left leg (+ve), Left arm (-ve)

These three leads record electrical activity along three different axes in the frontal plane.

The right leg electrode acts as an earthing electrode

The Einthoven’s Triangle: This is an imaginary formation of three limb leads in a triangle used
in the electrocardiography, formed by the two shoulders and pubis. The shape forms an inverted
equilateral triangle with the heart at the centre. It was named after Willem Einthoven who
theorized its existence.

Einthoven law states that the voltage in lead I plus the voltage in lead III is equal to the voltage
in lead II.
Unipolar Limb leads

Unipolar limb leads VR, VL and VF denotes the position of exploring electrodes when placed on
right arm, left arm or left foot respectively. They produce low amplitude potentials which are
augmented by suitable mechanism and termed as aVR aVL and aVF. Record electrical activity
between limb electrode and modified central terminal.

For example;

 Lead aVL records signals between left arm and central negative terminal formed by
connecting right arm and left leg electrodes. These leads also record electrical activity in
frontal plane.
 Lead aVR records signals between left arm and central negative terminal formed by
connecting left arm and left leg electrodes
 Lead aVF records signals between left arm and central negative terminal formed by
connecting right arm and left arm electrodes

Precordial Leads (Unipolar Chest leads)

Indifferent electrode is connected to the central terminal while exploring electrode is placed at
various points on chest wall. These are: V1-V6

 V1: 4TH intercostal space near the right sternal border

 V2: 4th intercostal space near the left sternal border
 V3: Between V2 and V4
 V4: 5th intercostal space midclavicular line
 V5: 5th intercostal space at anterior axillary line
 V6: 5TH intercostal space at mid axillary line

Lead V1 and V2 lie over the right ventricle

Lead V3 and V4 lie over the interventricular septum

Lead V5 and V6 lie over the left ventricle

Because of the 3 bipolar leads, 3 augmented unipolar leads and 6 precordial unipolar leads, a
term 12 lead ECG is obtained.
Normal ECG waves

 P Wave- Electrical depolarization of both the atria (best seen in LI and V1)
 Q Wave- Excitation of interventricular septum-beginning of ventricular depolarization
 R Wave- Displays spreading of excitation of right and left ventricular myocardium
 S Wave-Completion of ventricular depolarisation-excitation of base of the
interventricular septum
 QRS complex- Ventricular depolarization
 T Wave- Repolarization of ventricles
Clinical significance of P wave
Variation in the duration, amplitude and morphology of ‘P’ wave helps in the diagnosis of
several cardiac problems such as:
 Right atrial hypertrophy: ‘P’ wave is tall (more than 2.5 mm) in lead II. It is usually
pointed
 Left atrial dilatation or hypertrophy: It is tall and broad based or M shaped
 Atrial extra systole: Small and shapeless ‘P’ wave, followed by a small compensatory
pause
 Hyperkalemia: ‘P’ wave is absent or small
 Atrial fibrillation: ‘P’ wave is absent
 Middle AV nodal rhythm: ‘P’ wave is absent
 Sinoatrial block: ‘P’ wave is inverted or absent
 Atrial paroxysmal tachycardia: ‘P’ wave is inverted
 Lower AV nodal rhythm: ‘P’ wave appears after QRS complex.
Clinical significance of PR interval
Variation in the duration of ‘P-R’ intervals helps in the diagnosis of several cardiac problems
such as:
 It is prolonged in bradycardia and first degree heart block
 It is shortened in tachycardia, Wolf-Parkinson-White syndrome, Lown-Ganong-Levine
syndrome, Duchenne muscular dystrophy and type II glycogen storage disease
Clinical Significance of QRS complex
Variation in the duration, amplitude and morphology of ‘QRS’ complex helps in the diagnosis of
several cardiac problems such as:
 Bundle branch block: QRS is prolonged or deformed
 Hyperkalemia: QRS is prolonged.
Clinical Significance of QT interval
 ‘Q-T’ interval is prolonged in long ‘Q-T’ syndrome, myocardial infarction, myocarditis,
hypocalcemia and hypothyroidism
 ‘Q-T’ interval is shortened in short ‘Q-T’ syndrome and hypercalcemia

Clinical Significance of ST segment

 Elevation of ‘S-T’ segment occurs in anterior or inferior myocardial infarction, left bundle branch
block and acute pericarditis. In athletes, ‘S-T’ segment is usually elevated
 Depression of ‘S-T’ segment occurs in acute myocardial ischemia, posterior myocardial
infarction, ventricular hypertrophy and hypokalemia
 S-T’ segment is prolonged in hypocalcemia
 S-T’ segment is shortened in hypercalcemia

R-R’ INTERVAL
‘R-R’ interval is the time interval between two consecutive ‘R’ waves.
‘R-R’ interval signifies the duration of one cardiac cycle.
Duration: 0.8seconds
Significance of Measuring ‘R-R’ Interval
Measurement of ‘R-R’ interval helps to calculate:
 1. Heart rate
 2. Heart rate variability.
PROCEDURES
 RESULTS

DETERMINATION OF HEART RATE

Method 1:

Number of small squares dividing by 1500

Lead Used: Lead II

Number of large squares between R waves: 21

Heart Rate: 1500/21 =71

Method 2:

Number of large squares dividing by 300

Lead used: Lead 11

Heart Rate: 300/4 = 75

Method 3:

Lead Used: Lead II

RR interval: 21

Duration: 0.84s

Heart Rate: 0.84*21 = 71

DETERMINE THE RHYTHM

Method I:

Inspecting the rhythm strips for consistency in p-p intervals

Rhythm: Normal Sinus Rhythm

DETERMINATION OF CARDIAC AXIS

Method 1: Quadrant method

-90

+180 0 Lead I

+90
aVF

Cardiac Axis: +90-0

Normal Axis

Method 2:

Biphasic lead: aVL

Lead perpendicular to aVL: Lead II

Direction of Lead II QRS complex: Positive

Cardiac axis: Between +90-0

Normal Axis
MEASUREMENTS OF WAVES

LEAD 1

P waves

Duration: 0.08 seconds

Amplitude: 0.15mv

QRS Complex

Duration: 0.06 seconds

Amplitude: 0.5mv

Direction: Positive

T wave

Duration: 0.16 seconds

Amplitude: 0.3mv

MEASUREMENT OF INTERVALS AND SEGEMNTS

LEAD I

PR interval

Duration: 0.16s

PR segment

Duration: 0.04s

QT interval

Duration: 0.36s

ST segment

Duration: 0.12
MEASUREMENTS OF WAVES

LEAD II

P waves

Duration:

Amplitude:

QRS Complex

Duration:

Amplitude:

Direction:

T wave

Duration:

Amplitude:

MEASUREMENT OF INTERVALS AND SEGEMNTS

LEAD II

PR interval

Duration:

PR segment

Duration:

QT interval

Duration:

ST segment

Duration:
 MEASUREMENTS OF WAVES LEAD III

P waves

Duration:

Amplitude:

QRS Complex

Duration:

Amplitude:

Direction:

T wave

Duration:

Amplitude:

MEASUREMENT OF INTERVALS AND SEGEMNTS

LEAD III

PR interval

Duration:

PR segment

Duration:

QT interval

Duration:

ST segment

Duration:
RR interval: 21 small boxes, 0.84s

MEASUREMENTS OF WAVES

AVR

P waves

Duration:

Amplitude:

QRS Complex

Duration:

Amplitude:

Direction:

T wave

Duration:

Amplitude:

Direction:

MEASUREMENT OF INTERVALS AND SEGEMNTS

AVL

PR interval

Duration:

PR segment

Duration:

QT interval

Duration:

ST segment
Duration:

MEASUREMENTS OF WAVES

AVF

P waves

Duration:

Amplitude:

QRS Complex

Duration:

Amplitude:

Direction:

T wave

Duration:

Amplitude:

MEASUREMENT OF INTERVALS AND SEGEMNTS

AVF

PR interval

Duration:

PR segment

Duration:

QT interval

Duration:

ST segment

Duration:
MEASUREMENTS OF WAVES

LEAD V1

P waves

Duration:

Amplitude:

QRS Complex

Duration:

Amplitude:

Direction:

T wave

Duration:

Amplitude:

MEASUREMENT OF INTERVALS AND SEGEMNTS

LEAD V1

PR interval

Duration:

PR segment

Duration:

QT interval

Duration:

ST segment

Duration:
MEASUREMENTS OF WAVES

LEAD V6

P waves

Duration:

Amplitude:

QRS Complex

Duration:

Amplitude:

Direction:

T wave

Duration:

Amplitude:

MEASUREMENT OF INTERVALS AND SEGEMNTS

LEAD V6

PR interval

Duration:

PR segment

Duration:

QT interval

Duration:

ST segment

Duration: