THE ELECTROCARDIOGRAPH

ELECTROCARDIOGRAM-ECG
ELEKTROKARDIOGRAPH-EKG
 Outline
• Definition
• Electrical System of the Heart
• Discovery
• The Procedure
• Indications
 Definition
• The Heart is an Electromechanical Organ.
• Each Heartbeat or Contraction is preceded by
an electrical impulse or current which can be
detected on the body surface
• The detection and recording on the body
surface, of the electrical current that precedes
each heartbeat, is called the Electrocardiogram
or graph (English) or Elektrokardiogram or
graph (German)
 Electrical System of the Heart
• All myocardial cells are excitable, a property
called Automaticity
• SA Node – a collection of myocardial cells in the
RA at the entry of IVC, with the highest intrinsic
automaticity.
• SAN cells spontaneously, rhythmically depolarize
and repolarize to generate electrical current.
• Current from SAN is conducted via specialized
pathways simultaneously through both Atria
• Current from Atria arrive at AV Node (AVN)
• From AVN, current reaches the Bundle of His,
which conducts it rapidly to the ventricular
muscles to contract, via it’s Right and Left
Branches and the terminal Purkinje Fibers.
 Discovery – A brief history
• Willem Einthovin, a Dutch physician and physiologist
is considered founder and father ECG
• He invented the String Galvanometer, the first ECG
machine introduced into medical practice
• He is credited with naming the recorded deflections
P, Q, R, S and T and Einthovin’s Triangle
• He is also credited with coining the term
Electrocardiogram but he told the Dutch Medical
Association that it belongs to Augustus Waller
Einthovin’s ECG Machine
 The ECG Discovery – other actors

• 1786 - Luigi Galvani discovered that there is electrical activity in animal

tissue
• 1842 – Carlo Metteucci discovered that electric current accompanied each
heartbeat in the frog
• 1856 – Rudolph von Koelliker and Heinrich Muller confirmed Metteucci’s
observation in the human heart.
• 1887 – Augustus Waller recorded electrical current from the heart, on the
human body surface, Thomas Goswell, using 2 mercury capillary
electrometers, placed on the front and back of the chest, at St. Mary’s
Hospital, London.
• 1889 – Waller demonstrates his technique on his dog, Jimmy, at the First
International Congress of Physiologists in Bale. In the audience was Willem
Einthovin, a Dutch physician and physiologist.
 Other actors

• 1891 – British physiologists William Bayliss & Edward Starling using more
sensitive electrometers than Waller’s, record three or triphasic
deflections preceding each heartbeat.
• 1895 – Willem Einthovin, using electrometers (electrodes) more sensitive
than even Bayliss & Starling’s records 5 deflections he named P, Q, R, S
and T.
• 1901- Einthovin invents the String Galvanometer
• 1905 – Commercial Production of Einthovin’s Galvanometer begins
ECG machines today
 The Procedure
• The ECG is recorded on a graph paper.
• The graph has vertical lines that indicate Time in seconds
and horizontal lines that indicate distances in millimeters
• The vertical lines are of two thickness: Thick lines that are
0.2secs apart and Thin lines 0.04secs apart
• The horizontal lines are also of two thickness: Thick lines
that are 5mm apart and thin lines 1mm apart. The distance
between the horizontal lines represent Voltage in mmVolts
• The ECG paper moves through the machine at a standard
speed of 25mm/sec.
 How to Determine HR on the ECG

• Time between Thick vertical lines on the ECG

paper is 0.2secs
• Therefore in 60secs (1min) there will be
60/0.2 thick lines.
• Therefore if QRSes fall on every thick line,
then HR = 300bpm, if every other HR =
150bpm, if every 3rd HR = 100bpm etc., etc.
 How to Determine HR on the ECG (CONT’D).

If the heart rate is regular, then if a QRS complex

falls every solid line then there will be
60/0.2 = 300complexes in 60secs (1min) i.e. the
HR = 300bpm
If QRSes fall on every other solid line, the HR
will be 60/0.4 = 150bpm
etc
 Indications (uses) of ECG
Investigations
• Chest Pain
• Palpitations
• Fast or Slow Pulse
• Dizziness
• BLOC (Brief Loss of Consciousness)
• SOB (shortness of breath)
• Hypertension
• Electrolyte Imbalances

Monitoring
• Monitoring for abnormal rhythms