Eb^.+rre.'\ O\c.+r,re, of lyre.

yreAr\

Think about and Discuss: What is

actually being measured when
we do an ECG on a oerson?

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12-lead ECG ' S{on&rd <a+ ,, p

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surraco d.p.nd3on th. orionrarton dr rho rocordtns 6tocrrodas

Elocrrodos may be loosoty thoughr ot as ..y€s..rhar "so.

.r€clrlcal acllvllyand kantlat. tt Intoa vtstbto r.cordtng, th.

Wheihoran upward dsfl€clton or downward dsfloc{on ts

.ocord.d is dot.rminod by tho oriontaton ofoloctode3 with
.ospocl to th€ cu.ront flow in rhe h.arr,

'il.

Waves, Segments and

Intervals on ECG
. Various components ofthe ECG recoro can
be correlated to specific cardiac evenrs:

. A normal ECG exhibits three distinct

waveforms: the P wave, the eRS somplex,
and the T wave.

. Intervals.atria or ventricles
. Segments- lsoelectric portions
 - qt crq _con+roctrfrq . ,- -.
.J

GP.S - { e.r+rrcu\a F &oo\arr2-or+ron

O*ria\ re Do\orr2q{iof\ :
.t)
21- ln Ag:\ Ccf,hplc,X
ik dgp5\ar.' c on{roc{

otrror ls dego\'ar
P-Z rnrenal - aC4--Feds
T rn\e.r - V
Discuss: What is being measured
- {e'.r+ Acl
P-R segment
P-R interval
S-T segment
Q-T interval
T-P segment

\ q..,,ra\\ : O.Ol'l SeC

*\ \ --7- s O .2o sec

ln
r\

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L '

3
The following important points about the
ECG record should,also be noted:

' Firing of the SA node does not generate

sufficient electrical actlvity to reach the
surface of the body.

. ln a normal ECG, there is no separate

wave lor atrial repolarization'

. The P wave is much smaller than the QRs

comDlex.

The ECG can be used to diagnose

abnormal heart rates, arrhythmias, and
damage of the heart muscle:
**Because electrical activity triggers
mechanical activity, abnormal electrical
patterns are usually accompanied by
abnormal contractile activity of the
heart.

FaSA rlear{ pe.ta,..-3 lo

-rhcn1 /ca-d /*i

Abnormalities in rate
. na+e-
The distance between two consecutive
QRS complexes on an ECG record is
calibrated to the beat-to'beat heart rate.
. Tachycardia
. Bradycardia

Sb'/ hta at- jcrta,t itol to

\r
grad\ lcard;o/o
sra\ /co.d /ro
 Discuss: What's the heart rate? l\ F,.d P
2') rnereu "e, PfZ ecg ,.'+ec
3.) qc-s o.,,.'".r+ v
q\ P\^\ thn^
'
-\
b. ..
) llear+ fa+e

Discuss: What's the heart rate? { arvrL o€ "8" ,.t

Cor--rrr,

ba+uJcct1 l,nca tY'e rr x to

+'rrrcau\o-
k\e++
a)
Fhsli^vn
-

Abnormalities in rhythm Orrh'v{nr.^ia - 4b. h'cor\ f\ltYrrrr

. The term rhyihm refers to the regularity
of the ECG waves

. Abnormalities in rhythm easily detected

on an ECG include PVC, atrial flutter,
atrial fibrillation, ventrlcular fi brlllation,
and heart block
 Premature Ventricular
Contraction

Premalu16 vontjlcular contraction {PVC), also known

as vontrlculal prematua€ boat (VPB) or cixttasvstola.
is a form of iregulsr heanbeat inwhich the ventdctg
convac6 0r€maturelv.

Pre-ventricular contractions

Atrial Flutter
. Charactsrized by a rapid but regutar
sequence of atrial depolarizations at rates
between 200 and 380 beats per minute.

o
 Atrial Fibrillation ca^ Ipa d b\oo.t c\ot a
. Characterized by rapid irregular
uncoordinated deDolarizations of the atria {
with no detinite P waves. Slo3kt bb od - -furbo\c-rr cc
. Accordingly, atrial contractions are chao'?lc
and asynchronized. Because impulses
orL*."**
reach the AV node erratically, the
ventricular rhythm is also very irregular.
s+* *<

Pulse Deficit cao * f, nd di0 rn cou n*

. lf the heart rate is determined directly, tretrr' +elr kto+ and
either by the ECG, and the pulse rate is
taken concurrently at the wrist, the
heart rate will exceed the pulse rate.

7
 Ventricular fibrillation L.Ce lx.aa{,.^... o
. The ECG tracing in ventricular - r\rrrl{\zrrn de{urbancA
fibrillations is very irregular with no
detectable pattern or rhythm. - lourer cl.ovnhers ?uN co
. lf circutation is not restored in less than hear+ coh'+ pJ(ytg bbod
4 minutes through external cardiac
compression or electrical defibrillation, -- Cacdiqa arrcs {
irreversible brain damage occurs and
death is imminent.
 Heart Block ' Lreats {oooc, F-\ou.)
. Arises from defects in the cardiac
conducting system.
. The atria still beat regularly, but the
a.e t)otr+ia\l
ventricles occasionally fail to be
stimulated and thus do not contract b\ocUal
following atrlal contraction.

E{al b\ o cg lion
A! not urorLrnl

Cardiac Myopathies
. Abnormal ECG waves are also
important in recognizing and assessing
cardiac myopathies (damage of the
heart muscle).
. Acute inferior myocardlal infarction
' ST elevation in the inferiar leads ll. lll and aVF
. reciprocal ST depression in the anterior leads

"-.J", -[ .; ,"-.lj,-i, l-1r,

,"1- -t,i. .lt.-!',i - l-r" -1;.-,1r"...,-ll,
., .U.- -f", ,.1,. ..1 - -t'., .f..,- 1. , |ir

. Old inferior myocardial infarction

. a Q wave in lead lll wider than 1 mm (1 small
square) an0
. a Q wave in lead aVF wider than 0.5 mm and
' a Q wave of any size in lead ll

1r -L-r r.ic-1-,-4-.ir-t- j.-f.-,-t^-t^:t.

i q-'.-.r-*r-+**-'..
",-"1-1-1.- -J-._.1.^....

1r.,.1-_i^-4_,k*" *r.^ .N.lr-,I-_f

{__]- .i-... .

'
1'1-1.--.*-r-}--1-+-i--H.--1-f -

. Abnormal QRS waveforms can be seen when a

portion of the heart muscle becomes necrotic.
. In addition to ECG changes, because damaged
heart muscle cells release characteristic
enzymes into the blood, the level of these
enzymes in the blood provides a further index of
the extent of myocardial damage.
. Interpretation ot an ECG is a complex
lask requiring extensive knowledge and
rrarnrng.

10