ELECTROCARDOGRAPHY

Dewi Irawati MD, MS Dept.of Physiology FMUI

ELECTROCARDIOGRAPH
Recording of electrical activity of the heart (depolarization and repolarization of the myocardial cells) through special electrodes Human body: volume conductor ability to conduct electrical activity in all direction Significancy:
Overview of spread of action potential (action potential summation of active cells), variates with time, spread of impulse during one cycle. Recording of electrical potential (voltage) difference between two electrodes

ECG Recorder
Galvanometer, sensitive to electrical potential changes Active/recording electrode at 2 different points/site Amplification of electrical potential difference Recording apparatus - speed Specific curve: amplitude (mV) and duration (seconds)

Technique of recording an ECG

Special Graphic Paper:
Distance between 2 thin lines = 1 mm Distance between 2 thick lines = 5 mm Paper speed 25 mm/sec. ( 1 mm = 0.04 sec.)

Sensitivity: , 1 and 2 (1 mV = 5, 10 or 20 cm)

ECG Leads Bipolar:

Potential difference between 2 active electrodes Einthoven: I, II and III

Unipolar:
Potential diference between 1 active electrode and indifferent electrode Augmented extremity leads GOLDBERGER: aVR, aVL and aVF Precordial leads WILSON: V1, V2, V3, V4, V5 dan V6

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly)

3 Bipolar Limb Leads: RA I = RA vs. LA (+) LA

LL

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly)

3 Bipolar Limb Leads: RA I = RA vs. LA (+) II = RA vs. LL (+) LA

LL

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly)

3 Bipolar Limb Leads: RA I = RA vs. LA (+) II = RA vs. LL (+) III = LA vs. LL (+) LA

LL

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly)

3 Bipolar Limb Leads: RA I = RA vs. LA (+) II = RA vs. LL (+) III = LA vs. LL (+) LA

3 Augmented Limb Leads:

aVR = (LA-LL) vs. RA(+) LL

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly)

3 Bipolar Limb Leads: RA I = RA vs. LA (+) II = RA vs. LL (+) III = LA vs. LL (+) LA

3 Augmented Limb Leads:

aVR = (LA-LL) vs. RA(+) aVL = (RA-LL) vs. LA(+) LL

ECG Recordings (QRS Vector pointing leftward, inferiorly & posteriorly)

3 Bipolar Limb Leads: RA I = RA vs. LA (+) II = RA vs. LL (+) III = LA vs. LL (+) LA

3 Augmented Limb Leads:

aVR = (LA-LL) vs. RA(+) aVL = (RA-LL) vs. LA(+) aVF = (RA-LA) vs. LL(+) LL

6 PRECORDIAL (CHEST) LEADS

Spine

V6 V5 Sternum V1 V2 V3 V4

ECG Recordings: (QRS vector---leftward, inferiorly and posteriorly

3 Bipolar Limb Leads I = RA vs. LA(+) II = RA vs. LL(+) III = LA vs. LL(+) 3 Augmented Limb Leads aVR = (LA-LL) vs. RA(+) aVL = (RA-LL) vs. LA(+) aVF = (RA-LA) vs. LL(+)

6 Precordial (Chest) Leads: Indifferent electrode (RA-LA-LL) vs. chest lead moved from position V1 through position V6.

ECG Curve

ECG Analysis
Normal rhythm: sinus rhythm
Every P wave is followed by QRS complex and T wave All 12 lead

ECG Analysis
Heart rate:
60 P-P (R-R) interval (mm) X 0.04

ECG Analysis
P wave Lead II
Amplitude: < 0.25 mV Duration: < 0.11 sec.

ECG Analysis
P-R interval Lead II
Duration: 0.12 - 0.2 sec.

ECG Analysis
QRS complex Lead V2 V3 QRS configuration: V1 V6
rS Rs Transitional zone

Duration: < 0.12 sec.

QRS interval
V2 V3 < 0.10 s

ECG Analysis
VAT (Ventricular Activation Time)
Spread of action potential from endocardium epicardium Duration: V1-2 < 0.03 sec V5-6 < 0.05 sec

ECG Analysis
QRS electrical heart axis QRS T angle: < 70
I Lead I: - 1 + 8 = +7

III
Lead III: - 2 + 12 = +10

ECG Analysis
Q-T interval
Onset of Q wave end of T wave Total ventricular activity Varies with heart beat QTc (corrected) nomogram

ECG Analysis
S-T segment all leads
Iso-electric Important clinical significance

ECG Analysis
T wave configuration all leads
Positive deflection except aVR and sometimes V1

ECG Analysis
U wave
Late Purkinje cells depolarization Unknown significance