THE BASICS OF EKG

PRESENTED BY:
Raghwender Singh (D-
754)
 INRODUCTION
ECG or EKG

ECG is essential for diagnosis

Essential in management of cardiac

rhythm

Helps in diagnosis of chest pain

Proper use of thrombolysis in treatment

of MI depend upon it
 HISTORY

1842- Italian scientist Carlo Matteucci realizes

that electricity is associated with the heart
beat

1872- French scientist Gabriel Lippmann ,

invented the capillary electrometer which can
measure electricity by utilizing mercury
1876- Irish scientist Marey analyzes the
electric pattern of frogs heart
 CONTD
1895 - William Einthoven , credited for the
invention of EKG

1906 - using the string electrometer EKG,

William Einthoven diagnoses some heart
problems

1924 - the noble prize for physiology or

medicine is given to William Einthoven for his
work on EKG
MODERN ECG INSTRUMENT
 ELECTRICITY OF HEART

Contraction of any muscle is associated with

electrical charges called depolarization

These changes can be detected by electrodes

attached to the surface of the body

Although the heart has 4 chambers, from the

electrical point it is having only 2
 THE WIRING DIAGRAM OF
THE HEART

SA

AV node

Bundle of His

Bundle branches (left and right)

 THE SHAPE OF ECG

Contraction of atria - P wave

Ventricular depolarization - QRS

complex

Ventricular repolarization - T wave

NORMAL ECG
ECG INTERPRETATION
 RELATIONSHIP BETWEEN THE NUMBER OF LARGE
SQUARES COVERED BY R-R INTERVAL AND THE
HEART RATE

R-R INTERVAL(large HEART RATE (beats/min)

squares)
1 300

2 150

3 100

4 75

5 60

6 50
ECG RHYTHM
 NORMAL SINUS RHYTHM
Looking at the ECG you'll see that:-

RHYTHM - Regular
RATE - (60-100 bpm)
QRS DURATION - Normal
P WAVE - Visible before each QRS
complex
P-R INTERVAL - Normal (<5 small Squares.
Anything above and this would
be 1st degree block)

Indicates that the electrical signal is generated

by the sinus node and travelling in a normal
fashion in the heart.
NORMAL SINUS RHYTHM
 SINUS BRADYCARDIA
Looking at the ECG you'll see that:-

RHYTHM - Regular
RATE - Less than 60 beats per
minute
QRS DURATION - Normal
P WAVE - Visible before each QRS
complex
P-R INTERVAL - Normal

Usually benign and often caused by patients on

beta blockers
SINUS BRADYCARDIA
 SINUS TACHYCARDIA
Looking at the ECG you'll see that:-

RHYTHM - Regular
RATE - More than 100 beats per
minute
QRS DURATION - Normal
P WAVE - Visible before each QRS
complex
P-R INTERVAL - Normal

The impulse generating the heart beats are

normal, but they are occurring at a faster pace
than normal. Seen during exercise
SINUS TACHYCARDIA
 ECG RULES
If you follow Professor Chamberlains 10
rules they'll give you an understanding
of what is normal:-
 RULE 1

PR interval should be 120 to 200

milliseconds or 3 to 5 little squares
 RULE 2

The width of the QRS complex should not

exceed 110 ms, less than 3 little squares
 RULE 3

The QRS complex should be dominantly

upright in leads I and II
 RULE 4

QRS and T waves tend to have the same

general direction in the limb leads
 RULE 5

All waves are negative

in lead aVR
 RULE 6

The R wave must grow from V1 to at least V4

The S wave must grow from V1 to at least V3
and disappear in V6
 RULE 7

The ST segment should start isoelectric

except in V1 and V2 where it may be
elevated
 RULE 8

The P waves should be upright in I, II,

and V2 to V6
 RULE 9

There should be no Q wave or only a

small q less than 0.04 seconds in width
in I, II, V2 to V6
 RULE 10

The T wave must be upright in I, II, V2 to

V6
REFERENCES:-
The EKG made easy-John R. Hampton
www.ambulancetechnicianstudy.co.uk
www.learntheheart.com