Cardiovascular System

Mechanical activity & Electrical

Activity of Heart
 The Human Heart
• The human heart can be considered as a large muscle
whose beating is simply muscular contraction.
• Therefore contractions of the heart cause a potential to be
developed.
• The measurement of the potential produced by cardiac
muscle is called electro-cardiology.
• Sensing the heart’s electrical activity
via electrodes is ECG.
First, to make sure we know where the heart is …
 What is an ECG?
• ECG is a surface measurement of the electrical potential generated
by electrical activity in cardiac tissue.

• The electrocardiogram (ECG) is a representation of the electrical

events of the cardiac cycle.

• Each event has a distinctive waveform.

• The study of each event can lead to greater insight into a patient’s
cardiac pathophysiology.
What types of pathology can we identify and study from ECGs?

Analysis of the ECG can provide early warning of potential

problems such as:

• Arrhythmias
• Myocardial ischemia and infarction
• Pericarditis
• Chamber hypertrophy
• Electrolyte disturbances (i.e. hyperkalemia, hypokalemia)
• Drug toxicity (i.e. digoxin and drugs which prolong the QT interval)
 ECG Leads
• Leads are electrode setups which measure the
difference in electrical potential between either:
– Two different points on the body (bipolar leads)

– One point on the body and a virtual reference point

with zero electrical potential, located in the center of
the heart (unipolar leads)
The basic four limb electrodes:

right arm left arm

electrical polarity:
neutral or ground
negative
positive
right leg left leg
Lead I (toward left)
right arm left arm

electrical polarity:
neutral or ground
negative
positive
right leg left leg
Lead II (toward left foot)
right arm left arm

electrical polarity:
neutral or ground
negative
positive
right leg left leg
Lead III (down & rightward)
right arm left arm

electrical polarity:
neutral or ground
negative
positive
right leg left leg
Leads I, II, & III together
(“Einthoven’s triangle”)
right arm left arm

electrical polarity:
neutral or ground
negative
positive
right leg left leg
Plus “augmented” leads, e.g.,
aVR right arm left arm

electrical polarity:
neutral or ground
negative
positive
right leg left leg
Einthoven Triangle:
Note potential difference for each lead of
triangle
 ECG Leads
The standard ECG has 12 leads: 3 Standard Limb Leads
3 Augmented Limb Leads
6 Precordial Leads

The axis of a particular lead represents the viewpoint from

which it looks at the heart.
 12-Lead ECG measurement
• Most widely used ECG measurement setup in clinical environment
• Signal is measured non-invasively with 9 electrodes + 1 reference electrode (right
leg)

Einthoven leads: I, II & III Goldberger augmented leads: VR, VL & VF Precordial leads: V1-V6

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Cardiac Axis by Different Leads
Waveforms and Intervals
 Different Segments of ECG
• P wave: the sequential activation (depolarization) of the right and left atria
• QRS complex: right and left ventricular depolarization (normally the ventricles are
activated simultaneously)
• ST-T wave: ventricular repolarization
•  U wave: origin for this wave is not clear - but probably represents
"afterdepolarizations" in the ventricles
• PR interval: time interval from onset of atrial depolarization (P wave) to onset of
ventricular depolarization (QRS complex)
• QRS duration: duration of ventricular muscle depolarization
• QT interval: duration of ventricular depolarization and repolarization
• RR interval: duration of ventricular cardiac cycle (an indicator of ventricular ra
•  PP interval: duration of atrial cycle (an indicator or atrial rate)