THE ELECTROCARDIOGRAM: ECG

By Gaurishi Agarwal, 32
ECG : An
Electrocardiogram is a
simple test that can be used
to check the heart’s rhythm
and electrical activities.
The electrodes attached to
the skin are used to detect
the electrical signals
produced by the heart each
time it beats.
 Willem Einthoven invented the
first practical
Electrocardiograph (ECG or
EKG) in 1895’
 The first ECG machine
consisted of a ‘capillary
electrometer’.
 With this instrument, Einthoven was able to
measure the changes of electrical potential caused
by the contractions of the heart muscles and
record them graphically.
 BASIS OF ECG

 Body is a ‘Volume Conductor’ , ie body fluids are

good conductors of electricity because it contains lay
quantities of electrolytes.
 Therefore, electrical changes occurring in the heart
with each heart beat are conducted all over the body
and can be picked up from the body surface.
 The record of these electrical fluctuations during
cardiac cycle is called Electrocardiogram (ECG).
 DEPOLARIZATION AND
REPOLARIZATION WAVES

 Depolarization Wave : The wave that results due to the

spread of depolarization along the muscle fiber
membrane.
 Repolarisation Wave : The wave that results due to the
spread of repolarization along the muscle fiber membrane.
 The negative or positive deflection on the graph depends
upon the direction of dipole vector.
 The bigger the dipole, the bigger the deflection in
respective direction.
 STANDARD ECG

 A Standard ECG consists of 10 Electrodes which are used

to make 12 leads.
 The leads are of 3 types:
• 3 Limb Leads
• 3 Augmented Leads
• 6 Chest Leads
 The Electrodes are used to record the heart’s electrical
activity from the body surface, with the help of AgCl gel.
 LIMB LEADS

 The Limb leads or Einthoven leads are 3 in number

 They are denoted as – Lead I, Lead II, Lead III.
 Lead I : the negative terminal is connected to the right arm and
the positive terminal to the left arm.
 Lead II : the negative terminal is connected to the right arm and
the positive terminal to the left leg.
 Lead III : the negative terminal is connected to the left arm and
the positive terminal to the left leg.
 The right foot is grounded.
 EINTHOVEN’S TRIANGLE : The triangle in the following figure,
called Einthoven Triangle, is drawn around the area of heart.
 This illustrates that two arms and the left leg
form apices of a triangles surrounding the
heart.
 EINTHOVEN’S LAW : It states that if the
electrical potential of any two bipolar limb
leads is known than the potential of the
remaining lead can be calculated by a
simple mathematical equation.
 Lead II = Lead I + Lead III
 AUGMENTED LEADS

 The Augmented leads are unipolar limb leads with slight

modification in the recording technique.
 They are 3 in number.
 They are denoted as – aVR , aVL , aVF
 The augmented limb leads are the recording between one
limb connected to positive terminal and the rest two at the
negative terminal of the ECG machine.
 This arrangement increases the potential by 50%.
 Vector of augmented limb lead =
3/2 Vector of unaugmented limb lead
 CHEST LEADS (PRECORDIAL LEADS)

 These are 6 in number. They are as follows, along with

their respective positions.
 V1 : 4th intercoastal space to the right of the sternum.
 V2 : 4th intercoastal space to the left of the sternum.
 V3 : midway between V2 and V4 .
 V4 : 5th left intercoastal space in mid clavicular line.
 V5 : 5th left intercoastal space in anterior axillary line.
 V6 : 5th left intercoastal space in mid-axillary line.
 Usually 6 standard chest leads are
recorded one at a time, from the
anterior chest wall, via a single
electrode placed at the specified
positions one at a time.
NORMAL ECG

Headings:-
P wave
P-R Segment
QRS Complex
S-T Segment
J-point
T wave
U wave
 NORMAL ELECTROCARDIOGRAM

‘P’-Wave
• 1st wave of ECG, duration 0.1 sec.
• Due to Atrial depolarization, represents the spread of
impulse from SAN to atrial muscles.
• Peak represents excitation of AVN
• Height is upto 0.5mV
P-R Segment
• It is a brief Isoelectric period of 0.04s after the P wave.
QRS Complex
• Represents Ventricular depolarization
• Completed just before opening of Semilunar valves
• Atrial repolarization activity merges with QRS complex
‘Q’ Wave
• Represents excitation of mid portion of the interventricular
septum.
‘R’ Wave
• Prominent pointed positive wave
• Represents onset of ventricular systole
• Its height is directly proportional to functional activity of
ventricles, does not exceed 2.5mV in normal individuals.
‘S’ Wave
• Negative pointed deflection
• Represents excitation of more basal parts of ventricles
‘T’ Wave
• Rounded positive deflection, duration of 0.27s
• Represents Ventricular repolarization
• End of t wave coincides with closure of semilunar valves
• Flat T wave indicates insufficient oxygen supply to heart
muscle
‘U’ Wave
• Rarely seen , positive small rounded wave
• It is due to slow repolarization of Capillary muscles.
P-R Interval
• Represents Atrial depolarization plus conduction time through
Bundle of HIS
• Normal duration 0.12 to 0.16s at a HR of 72/min
• Duration decreases with increase of HR
• If duration is more than 0.2 s, indicates delayed conduction of
bundle of HIS
• If duration is less than 0.12s, indicates impulse has probably
arisen in AVN
S-T Interval
• Represents ventricular repolarization, 0.32s duration
J- point
• A point of no electrical activity at the end of S Wave
• Important in assessing S-T segment elevation or depression
Thank You!