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Reasons to Have an ECG
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Ê  
ï Ê e eart itself is made up of 4 c ambers, 2 atria and
2 ventricles. De-oxygenated blood returns to t e rig t
side of t e eart via t e venous circulation. It is
pumped into t e rig t ventricle and t en to t e lungs
w ere carbon dioxide is released and oxygen is
absorbed. Ê e oxygenated blood t en travels back to
t e left side of t e eart into t e left atria, t en into
t e left ventricle from w ere it is pumped into t e
aorta and arterial circulation.
Ê  
ï @ystolic blood pressure:
Is t e pressure created in t e arteries w en t e ventricles
contract

ï Diastolic blood pressure:


ß en t e ventricles starts to refill, t e pressure from t e
arteries falls simultaneously t e atriums contract creating
pressure known as t e diastolic pressure.
Ê  
ï Image: Ê e passage of blood t roug t e eart
Ê  
ï Image: Ê e cardiac conduction system
Ê  
ï Image: Ê e cardiac conduction system
   
ï Ê e ECG mac ine is designed to recognise and record any electrical
activity wit in t e eart. It prints out t is information on ECG paper
made up of small squares 1mm squared.
   
ï Eac electrical stimulus takes t e form of a wave and so
patterns emerge made up of a number of connected waves. A
standard ECG is printed at 25mm per second or 25 small
squares per second (see above). In t is way it is possible to
calculate t e duration of individual waves.
ï 10 small squares vertically is equal to 1 millivolt. @o it is
possible to calculate t e amount of voltage being released
wit in t e eart. If t e line is flat at any time in t e
duration of a series of waves, it indicates no electrical
activity at t at particular moment.
ï Ê e direction in w ic t e waves point indicates w et er
electricity is moving towards or away from a particular lead.
   
 

ï @inus r yt m is t e name given to t e normal r yt m
of t e eart w ere electrical stimuli are initiated in
t e @A node, and are t en conducted t roug t e AV
node and bundle of His, bundle branc es and
Purkinje fibres.
ï Depolarisation and repolarisation of t e atria and
ventricles s ow up as 3 distinct waves on ECG. A
unique labelling system is used to identify eac wave.
ï Less muscle means less cells w ic means less voltage.
 

Ê   
ï Ê e first wave (p wave) represents atrial
depolarisation
Ê   
ï After t e first wave t ere follows a s ort period w ere
t e line is flat. Ê is is t e point at w ic t e stimulus is
delayed in t e bundle of His to allow t e atria enoug
time to pump all t e blood into t e ventricles.
ï As t e ventricles fill, t e growing pressure causes t e
valves between t e atria and ventricles to close. At t is
point t e electrical stimulus passes from t e bundle of
His into t e bundle branc es and Purkinje fibres. Ê e
amount of electrical energy generated is recorded as a
complex of 3 waves known collectively as t e QR@
complex. Measuring t e waves vertically s ows voltage.
More voltage is required to cause ventricular contraction
and t erefore t e wave is muc bigger.
Ê  
ï Q wave and represents depolarisation in t e septum.
Ê  
ï R wave represents t e ventricular depolarisation
Ê  
ï @ wave represents depolarisation of t e Purkinje
fibres.
Ê Ê 
ï Ê wave represents ventricular repolarisation.
Ê Ê 
ï Ê ere is a brief period between t e end of t e QR@ complex and t e
beginning of t e Ê wave w ere t ere is no conduction and t e line is
flat. Ê is is known as t e @Ê segment and it is a key indicator for bot
myocardial isc emia and necrosis if it goes up or down.
ï V1: 4t intercostal space rig t sternal
border
ï V2: 4t intercostal space left sternal border
ï V3: alfway between V2 and V4
ï V4: left 5t intercostal space,mid-
clavicular line
ï V5: orizontal to V4, anterior axillary line
ï V6: orizontal to V5, mid-axillary line
 Ê  
ï Ask t e patient to remove all metalic objects
including watc es, rings, neclaces, pocketed coins and
p ones etc«
ï Let t e patient relax before t e procedure starts and
ask t em to lay still for a minute during t e
procedure.
ï Explain t e procedure and reassure t em t at no pain
will be felt during t e procedure.
ÕÕ