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Electrocardiograp
hic view of the
heart
posterior wall
V5-V6 anterolateral wall V1-V2
(reciprocal)
A normal adult 12-lead ECG. Sinus rhythm is present with a heart rate of 75 beats
per minute.
Waves
Positiv
e
Negativ
e
Segment
s
Intervals
Voltage
calibration:
2 large
squares (10
mm)
5 mm
= 1 mV = 0.5
mV
5 mm
= 0.2
s
Voltage
Paper speed: 25 mm/sec
(atrial repolarization is
submerged in QRS complex)
QRS complex (0.06 to
0.1 s)
(1- 3 small squares)
-represents ventricular
depolarization.
- In most people, QRS
complex is tallest in lead
II, but in leads I and III, it
is also predominantly
upright (i.e. R wave is
greater than S).
- Long QT syndrome
(K+ channel mutation,
myocardial ischemia
electrolyte abnormalities)
ST segment
- the part between S wave and
T wave.
- is the time at which the
entire ventricle is depolarized.
-roughly corresponds to
the plateau phase of
ventricular depolarization
-Important for diagnosis of ventricular
ischemia (depressed or elevated)
ST segment
- An elevation of the ST segment
is the hallmark of an acute
myocardial infarction.
- Horizontal ST segment depression
of more than 2mm indicates
ischaemia.
Cardiac axis
Depolarization wave of the
heart normally spreads through
the ventricles from 11 oclock
to 5 oclock,
i.e. towards leads I, II and III.
So the deflections in lead VR
are normally mainly downward
(negative) and lead II mainly
upward (positive).
Direction of the axis can be
derived most easily from the
QRS complex in leads
I, II and III.
The cardiac axis
By near-consensus, the normal QRS
axis is defined as ranging from -30
to +90.
-30 to -90 is referred to as a left axis
deviation (LAD)
+90 to +180 is referred to as a right
axis deviation (RAD)
Rate: 150 -
250 /m
(Abnormal P waves,
one P wave/QRS)
Rate: 250 -
350 /m
(saw-tooth waves)
Rate:
Atrial 350+
fibrillation with a/m
totally
irregular ventricular rate.
Atrial rate 300-500/min.
Supraventricular rhythms
Atrial tachycardia:
QRS complex rate greater than
150/min;
Abnormal P waves, usually with short
PR intervals, usually one P wave per
QRS complex, but sometimes P wave
rate 200-240/min with 2:1 block
Rate: 150 -
250 /m
(Abnormal P waves,
one P wave/QRS)
Supraventricular rhythms
Atrial flutter: P wave rate 300/min,
saw-toothed pattern, 2:1, 3:1 or 4:1
block
Rate: 250 -
350 /m
Supraventricular rhythms
Atrial fibrillation:
the most irregular rhythm of all,
QRS complex rate characteristically
over 160/min without treatment, but
can be slower
no P waves identifiable, but there is a
varying completely irregular wavy
baseline
Ventricular
Arrhythmias
Ventricular
premature beat
(extrasystole)
Ventricular
tachycardia
(fast rate, no P wave,
wide bizarre QRS)
Ventricular Defibrillator
fibrillation
(erratic, wavy
Ventricular extrasystoles:
Early QRS complex;
No P wave,
QRS complex wide (greater than 120ms);
abnormally shaped; followed by a
compensatory pause
Abnormally shaped T wave,
Next P wave is on time
Ventricular tachycardia:
No P waves;
QRS complex rate greater than
160/min; accelerated idioventricular
rhythm
Wide bizarrely shaped QRS complex
Ventricular fibrillation:
The most frequent cause of sudden
death in patients with myocardial
infarction
In the absence of emergency
treatment, lasts a few minutes; fatal
Look at the patient, not the ECG
Ventricular Defibrillator
fibrillation
(erratic, wavy
baseline)
Cardiac Electrocardiograp Diagnosi
Physiology hy s
Ventricular Fibrillation
Ischemia
Electric Shock
Detection of conduction
abnormalities (e.g. heart block,
accelerated conduction)
First degree block:
One P wave per QRS complex
PR interval greater than .2 s
Mobitz Type 2:
(2:1 or 3:1 block)
Occasional non-conducted beats
Two or three P waves per QRS complex
Normal P wave rate,
PR intervals are constant
QRS is dropped intermittantly
Progressive PR lengthening then
non-conducted P wave,
And then repetition of the cycle
Bundle Branch Block
After 4 min of
exercise