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° Recording of the potential fluctuations during
cardiac cycle
° Body acts as volume conductor with heart at
the center
° Electrodes
° Leads
Vormal ECG
jpecial conductile system of heart



uexaxial system


° Paper speed of 25mm/sec
Basis of wave formation
 ( Kt is an arrow that points in the direction
of electrical potential generated in the heart,
the arrowhead indicating the positive
direction and the length indicating the
amplitude of potential developed.
ãormation of QRj waves
ãormation of T wave
|etermination of cardiac axis
° Mean axis of ventricular depolarization: 59϶
(-30϶ to +110϶)
Left axis deviation: < -30϶
Causes- lying down, deep expiration, obesity
- ascites, abdominal mass lesion
- left ventricular hypertrophy, left
bundle branch block
LA| in LVu
Right axis deviation: > +110϶
Causes- standing, tall & lanky, deep inspiration
- right ventricular hypertrophy, right
bundle branch block
Cardiac arrhythmias
° Abnormal sinus rhythms:
1. jinus tachycardia
2. jinus bradycardia:

3. jinoatrial nodal block:

Abnormal rhythms due to conduction
° AV nodal block:
(i) Kncomplete heart block- first degree and
second degree

(ii) Complete heart block- third degree-

idioventricular rhythm- stokes-adams





Premature contractions
° Ectopic beat, extrasystole, premature beat
Premature atrial contractions:
° abnormal P wave, compensatory pause
° jeen in healthy persons, smoking, lack of
sleep, athletes
AV nodal premature contractions:
° impulse travels in both directions
° P wave is superimposed onto QRj-T complex
Premature ventricular contraction:
° Prolonged and high-voltage QRj
° Vo P wave preceding ectopic QRj
° T wave is of opposite polarity that of QRj
Paroxysmal tachycardias
° ueart rate become rapid paroxysms,
beginning suddenly, persisting for few seconds
to hours and ending suddenly
° Treated by vagal stimulation
° Lidocaine & Lignocaine- suppress sodium
Paroxysmal Atrial Tachycardia:
° Tachycardia with altered shape of P wave
Paroxysmal ventricular tachycardia:
° Appears like series of ventricular premature
° Associated with considerable ischaemic
° Can lead to ventricular fibrillation
° |igitalis toxicity
° Quinidine blocks irritable foci
Atrial tachyarrhythmias
Atrial Tachycardia:
° Atrial rates upto 220/min
° All impulses travel across to ventricles
° PR and TP intervals are shortened
° T wave and next P wave merge
Atrial flutter:
° Atrial rate is 200-350/min
° jaw-tooth pattern waves
° Associated with 2:1 AV block
° AV node cant transmit > 230 impulses/min
Atrial fibrillation:
° Atrial rate is 300-500/min; irregular
° Atria show irregular oscillations- ãibrillations
° Ventricular rate is 80-160/min
° Treatment- digitalis/ electroshock
Ventricular Tachyrrhythmias
Ventricular tachycardia:
° Upto 200/min
° Polymorphic QRj complexes
° Reduced cardiac output
Ventricular flutter:
° Rate- 200-350/min
Ventricular fibrillation:
° 350-500/min
° Krregular & ineffective ventricular contraction
° Quivering ͞bag of worms͟
° Kneffective pumping of blood
Re-entry phenomenon- circus movements
° Kncreased length of pathway- dilatation
° |ecreased velocity of conduction- blockage of
purkinje system, ischemia, hyperkalemia
° jhortened refractory period- drugs
Chain reaction mechanism
° |emonstrated by applying 60-cycle electrical
Electroshock |efibrillation
° uigh voltage AC current or |C current is used
° Applied externally to chest wall for a short
° 110v 60-cycle AC current for 0.1 sec
° 1000v |C for few thousandths of a second
° ueart quietens for 3-5 secs; jAV might take
Cardiac massage
° Closed
° Open
Long QT syndrome
° Krregular repolarization, increased incidence of
ventricular arrhythmias
° Congenital, electrolyte disturbances, drugs, MK
Accelerated AV conduction
° Wolff-Parkinson-White syndrome
° Bundle of Kent- aberrant connection
° Conducts rapidly- one ventricle is activated
° Kmpulse pass retrograde to atria- circus
° jhort PR and prolonged QRj


Lown-Ganong-Levine syndrome
° Aberrant bundle which enters conducting
system distal to AV node
° jhort PR interval and normal QRj
° Attacks of PjVT, usually nodal tachycardia
° Radiofrequency catheter ablation
Effect of electrolyte imbalance on ECG