ECG

(Electro Cardio Graphy)

• ECG shows electrical activity of the HEART.
• It gives valuable information about the Cardiac disorder.
Origin of Cardiac Action Potential:
• Heart is divided into 4 chambers.
LA-Left Atrium RA-Right Atrium
LV-Left Ventricle RV-Right Ventricle
• There are two Nodes
SA- Sino Atrial Node AV- Arito Ventricular Node
• SA Node initiates heart activity generates impulse at the normal
rate of the heart.
• Propagation through RA to LA.
• AV Node delays the spread of excitation of about 0.12sec.
• Bundle of His carries action potential to the ventricle.
• SA node -> atrial muscle -> AV node -> bundle of His -> Left
and Right Bundle Branches -> Ventricular muscle
ECG WAVEFORM
 Origin Amplitude(mV) Duration(Sec)
P Wave Atrial depolarization or contraction 0.25 0.12 to 0.22 P-R interval

R Wave Repolarization of atria and 1.60 0.07 to 0.1

(QRS Comx) depolarization of ventricle
T Wave Ventricular repolarization 0.1 to 0.5 0.05 to 0.15 S-T interval
Relaxation of myocardium
S-T interval Ventricular contraction 0.2 T-V interval
W- Wave Slow repolarization of the Intra < 0.1
ventricular
•
ECG
3 distinct waves are produced during cardiac cycle
• P wave caused by atrial depolarization
• QRS complex caused by ventricular depolarization
• T wave results from ventricular repolarization
Elements of the ECG:
• P wave: Depolarization of both atria;
• Relationship between P and QRS helps distinguish various cardiac
arrhythmias
• Shape and duration of P may indicate atrial enlargement
• PR interval: from onset of P wave to onset of QRS
• Normal duration = 0.12-2.0 sec (120-200 ms) (3-4 horizontal boxes)
• Represents atria to ventricular conduction time (through His bundle)
• Prolonged PR interval may indicate a 1st degree heart block
• QRS complex: Ventricular depolarization
• Larger than P wave because of greater muscle mass of ventricles
• Normal duration = 0.08-0.12 seconds
• Its duration, amplitude, and morphology are useful in diagnosing cardiac
arrhythmias, ventricular hypertrophy, MI, electrolyte derangement, etc.
• Q wave greater than 1/3 the height of the R wave, greater than 0.04 sec
are abnormal and may represent MI
ST segment
• Connects the QRS complex and T wave
• Duration of 0.08-0.12 sec (80-120 msec

T wave
• Represents repolarization or recovery of ventricles
• Interval from beginning of QRS to apex of T is referred to as the
absolute refractory period

QT Interval
• Measured from beginning of QRS to the end of the T wave
• Normal QT is usually about 0.40 sec
• QT interval varies based on heart rate
 LEAD SYSTEM
There are three types of lead systems:
• Bipolar lead system (Standard lead system)
• Unipolar lead system (Augmented unipolar limb lead system)
• Chest lead system.
BIPOLAR LEAD SYSTEM
• It is known as Einthoven leads.
• In this system electrodes are placed in 4 different places. These
are:
LA-Left Arm RA-Right Arm
LL-Left Leg RL-Right Leg
• Usually LL electrode acts as ground reference electrode.
 Recommended positions for Electrodes

• Bipolar leads record voltage

between electrodes placed
on wrists & legs (right leg is
ground)
• Lead I records between right
arm & left arm
• Lead II: right arm & left leg
• Lead III: left arm & left leg
 LEAD-I

•The difference between

LA and RA electrode.
•It is represented as V1
•LL reference electrode
 LEAD-II

•The difference between

LL and RA electrode.
•It is represented as V2
•LL reference electrode
 LEAD-III

•The difference between

LL and LA electrode.
•It is represented as V3
•LL reference electrode
EINTHOVAN TRIANGLE
 AUGUMENTED UNIPOLAR LIMB LEADS
•This system is introduced by Wilson.
•In this system, voltage is taken between single exploratory
electrode and central terminal.
•Two equal resistors are connected to a pair of limb electrodes and the
center point acts as one terminal to measure the voltage

•Floating Negative Electrode

•Center of Chest

Different 3 three lead connections are:

aVR – Augmented Voltage Right Arm.
aVL– Augmented Voltage Left Arm.
 aVR – Augmented Voltage Right Arm.

RA LA
aVR= -V1-V3/2
V1 and V3 are bipolar
lead voltages

RL
LL
aVL– Augmented Voltage Left Arm.
aVL= V1-V2/2
V1 and V2 are bipolar
lead voltages
aVF – Augmented Voltage Foot.

aVF= V2-V1/2
V1 and V2 are bipolar
lead voltages
 Precordial (Unipolar Chest) Leads
• This lead system is known as Wilson system.
• Positive electrodes located on anterior surface of
chest.
• The Exploratory is obtained from one of the six
chest electrode.
• By connecting three equal large resistance to LA,
RA and LL(ref electrode) central terminal.
• Floating negative electrode with augmented limb
leads
Precordial (Unipolar Chest) Leads
Precordial (Unipolar Chest) Leads
 Precordial(Unipolar Chest) Leads
• V1 = Fourth intercostal space of right sternal
margin
• V2 = Fourth intercostal space of left sternal margin
• V3 = Midway between V2 and V4
• V4 = Fifth between V2 and V4 at mid-clavicular
line
• V5 = Same level as V4 on anterior auxiliary line
• V6 = Same level as V4 on mid auxiliary line
 ECG Recording Setup

• Lead II strip across bottom to interpret rhythm

• Begin in top left hand corner
• Read top to bottom in 4 columns
• May only have 2-4 beats per lead
Normal 12 Lead ECG
Analysis of ECG Waveform

Normal ECG Waveform.

PQ segment has prolonged conduction

time > 0.22 Sec
Result: I st AV block

QRS complex is widened >0.1 Sec

Analysis of ECG Waveform(Cont…)
•ST segment is elevated
myocardial infraction

•ST segment is depressed •Patient is dead

and negative T wave is
present
•Coronary insufficiency

•Train of pulse instead PQRST wave

•May be death
•Ventricular fibrillation
• AV node block occurs when node is damaged
• First–degree AV node block is when conduction thru
AV node > 0.2 sec
– Causes long P-R interval

U
P T
Q S
• Second-degree AV node block is when only 1 out of
2-4 atrial APs can pass to ventricles
– Causes P waves with no QRS

U
P T
Q S
• In third-degree or complete AV node block, no atrial activity
passes to ventricles
– Ventricles are driven slowly by bundle of His or Purkinjes

U
P T
Q S