ELECTROCARDIOGRAM(ECG)

BY SURAJ PRAKASH AGARWAL

DEFINATION
USES OF ECG
ECG LEADS
WAVES OF NORMAL ECG
INTERVALS
DEFINITION
 ECG is the process of recording the electrical
activity of the heart over the period of time using
electrodes placed on skin

These electrodes detect the

electrical changes on the skin
that arises from the heart
muscle of depolarizing during
each heartbeat
 Electrocardiogram - The graph paper recording
produced by the machine is termed an
electrocardiogram, It is usually called ECG or EKG
 Speed = 25mm/s
Electrocardiograph – it is a
instrument (machine) by which
electrical activities of heart are
recorded
USES OF ECG
ECG is useful in determination and
diagnosing the following
I. Heart rate
II. Heart rhythm

III. Conduction pathway is abnormal

IV. Poor blood flow of heart muscle

(ischemia )
V. Coronary heart disease
ELECTRODES AND LEAD
 Electrodes - Electrodes Usually consist of a
conducting gel, embedded in the middle of a self-
adhesive pad onto which cables clip. Ten
electrodes are used for a 12-lead ECG. it placed
on t6he patient limbs and on the surface of chest
Limbs leads Chest leads
The limb electrodes
 RA - On the right arm, avoiding thick muscle
 LA – On the left arm this time.
 RL - On the right leg, lateral calf muscle
 LL - On the left leg this time.
The 6 chest electrodes
 V1 - Fourth intercostal space, right sternal
border.
 V2 - Fourth intercostal space, left sternal
border.
 V3 - Midway between V2 and V4.
 V4 - Fifth intercostal space, left midclavicular
line.
 V5 - Level with V4, left anterior axillary line.
 V6 - Level with V4, left mid axillary line
Unipolar limb lead

LEADS aVR, aVL, aVF THEY

ARE ALSO DERIVED FROM THE
LIMB ELECTRODES, THEY
MEASURE THE ELECTRIC
POTENTIAL AT ONE POINT
WITH RESPECT TO A NULL
POINT. THEY ARE THE
AUGMENTED LIMB LEADS aVR
aVF aVL RA LA RL LL
LEADS
V1,V2,V3,V4,V5,V
6
THEY ARE PLACED
DIRECTLY ON THE
CHEST. BECAUSE OF
THEIR CLOSE PROXIMITY
OF THE HEART, THEY DO
NOT REQUIRE
AUGMENTATION. THEY
ARE CALLED THE
PRECORDIAL LEADS RA
LA RL LL V1 V2 V3 V4 V5
V6
WAVE OF NORMAL WAVE
 Normal ECG consists of wave , complexes
, intervals , and segment .

 Major complexes in ECG

I. ‘P’ Wave the article complex.

II. ‘QRS’ complex the initial ventricle
complex.
III. ‘T’ wave the ventricular complex.
IV. ‘QRST’ the ventricular complex.
 P WAVE
• p wave is produced due to depolarition of artial
musculature .
CAUS • Depolarization spreads form SA node to all part of artial
E– musculature

Durati • 0.1 sec

on –

Amplit • 0.1 to 0.12 mv

ude –

• It is normally positive in leads I, II , aVF, V4,V5 and V6.

Morph it is normally negative in aVR. It may be positive,
ology – negative,biphasic or flat.
Clinical Significance of P wave
Variation in the duration , amplitude and morphology of
‘p’ wave helps in the diagnosis of several cardiac
problems which are listed in table.
Clinical condition Variation in p wave
Atrial extra systole Decrease in amplitude and shapeless
Followed by compensatory pause
Atrial paroxysmal Inverted
tachycardia
Atrial fibrillation Absent
Sinoatrial block-AV Upper nodal rhythm: Inverted
nodal rhythm Middle nodal rhytm:Absent
Lower nodal rhytm:Appears after QRS complex

Hyperkalemia Decrease in amplitude or absent

Hypokalemia Increase in amplitude
Right artia Increase in amplitude and pointed
enlargement
Left atrial enlargement Increase in amplitude and broad or M shaped
 QRS COMPLEX
cause
• Due to depolarization of ventricular musculature
• Q wave – depolarization of basal portion of intraventricular septum
• R wave – depolazation of apical portion of intra ventricular septum
• S wave – depolarization of basal portion of ventricular muscle
Amplitude
• Q wave – 0.1 to 0.2 mv
• R wave – 1 mv
• S wave – 0.4 mv
morphology
• Q wave is small with amplitude of 4 mm or less in leads 1 , 2 , Avl V5 AND V6
• FORM CHEST LEAD V1 TO V6 r Wave become gradually larger
• s wave is larger in v1 and v2
duration
• 0.08 to 0.10

Clinical significance
• In hyperkalemia – wave prolonged
• In bundle branch block – prolonged and deformed
‘T’ WAVE
 Cause – Repolarization of ventricular
musculatature
 Duration – 0.2 sec.
 amplitude – 0.3 sec.
 Morphology – positive in lead in 1, 2 and v5 and v6 .
It is normally inverted in lead AVR
 Clinical significance -

Clinical condition Variation in T wave

hyperkalemia Increase in amplitude
Hypokalemia Decrease in amplitude ,
Myocardial infarction flat or inverted t wave
Pericarditis
Anxiety and old age
QRS WAVE

T WAVE
 U WAVE
 U wave is not always seen . It is also an
insignificant wave in ECG .
 It is supposed to be due to Repolarization of
papillary muscle or purkinje fiber
 Clinical significance-

Clinical condition Variation u wave

hypo kalmia Very prominent
myocardial ischemia inverted
Bradycardia prominent
heperkalmia
P- R INTERVAL
 Interval between the onset of P wave and onset of
Q wave
 Significance – the arterial depolarization and
condition of impulsion through AV node
 Duration – 120 to 200 ms

 Clinical significance -

Clinical condition variation

First degree of heart block prolonged
Wolf Parkinson white shortened
syndrome
Type 2 glycogen storage
disease
Q-R INTERVAL
 Interval between the onset of q wave and the and
of ‘T’ wave
 Duration – 40 and 420 ms

 Signifying – ventricular depolarization and

ventricular Repolarization
 Clinical significance -

Clinical condition variation

Myocardial infection prolonged

Hypothyroidism
hypocalcaemia

hypocalcaemia Shortened
Condition of
myocardial
infarction
S-T SEGMENT
 It is time interval between the end of ‘S’ wave and
onset of ‘T’ wave it is the isoelectric period

 DURATION - 0.08 sec

 J POINT - the point where S-T segment start is called

j point
Clinical condition variation
 Clinical Ant. & Inf. Myocardial infarction elevated
Left bundle branch block
significance Acute myocardial ischemia depressed
hypokalemia
hyperecalcaemia shortened
hypocalcaemia prolonged
ANT. & INF.
Acute
Myocardial
myocardial
infarction
ischemia
POST. MI
R-R INTERVAL

 It interval between two

consecutive R wave

 Significance – it is duration of one cardiac cycle

 Duration – 0.8 sec

 Significance of measuring R-R WAVE

I. It help to calculated of heart rate
II. Heart rate variability
BY – SURAJ PRAKASH AGARWAL
FIRST YEAR STUDENT