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A recording of the electrical activity of the heart over time Gold standard for diagnosis of cardiac arrhythmias
Electrocardiogram (ECG/EKG)
Is a recording of electrical activity of heart conducted thru ions in body to surface
Fig 13.22a
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Recording of the ECG: Leads used: Limb leads are I, II, II. So called because at one time subjects had to literally place arms and legs in buckets of salt water. Each of the leads are bipolar; i.e., it requires two sensors on the skin to make a lead. If one connects a line between two sensors, one has a vector. There will be a positive end at one electrode and negative at the other. The positioning for leads I, II, and III were first given by Einthoven. Form the basis of Einthovens triangle.
Fig 13.23
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Fig. 13.22b
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
Fig 13.24
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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
Fig. 13.24b
Fig. 13.24c
Fig. 13.24d
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
QRS complex:
Represents 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
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
Fig. 13.24g
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
ST segment:
Connects the QRS complex and T wave Duration of 0.08-0.12 sec (80-120 msec
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
Fig 13.34
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Fig 13.35
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Fig 13.35
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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
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Representation in culture
In TV medical dramas, an isoelectric ECG (no cardiac electrical activity, aka, flatline, is used as a symbol of death or extreme medical peril. Technically, this is known as asystole, a form of cardiac arrest, with a partcularly bad prognosis.
Defibrillation, which can be used to correct arrythmias such as ventricular fibrillation and pulseless ventricular tachycardia, cannot correct asystole.