ECG - Electrocardiogram
Objectives:
➡️
Definition
➡️
Electrdes&Leads Placement
➡️
Interpretation of the ECG
➡️
How to read on ECG in 10 Steps
➡️
Uses
➡️
Diagnosis
Definition:
ECG - Electrocardiogram.
An ECG is a simple, noninvasive procedure.
ECG is the process of records the electrical activity
of the heart using electrodes placed on the skin.
The electrodes detect the small electrical changes
that are a consequence of Cardiac muscle
depolarization followed by repolarization during
each Cardiac cycle.
Electrodes&Leads Placement:
➡️ Commonly 10 electrodes attached to the body are used to form
12 ECG leads, each lead measuring a specific electrical potential
difference.
➡️ Conventional ECG leads :
ECG leads
↙️ ↘️
Frontal plane(Standard Horizontal plane(Chest/Precordial/
Leads&Unipolar leads) Transfer leads)
⬇️ ⬇️
aVR, aVL, aVF. V1,V2,V3,V4,V5,V6
LeadI, LeadII, LeadIII
Leads Placement&Colour Code:
Unipolar leads:
➡️ aVR -(Red)augmented unipolar right hand arm lead
➡️ aVL -(Yellow)augmented unipolar left hand arm lead
➡️ aVF -(Green) augmented unipolar left foot lead
➡️ Neutral lead -(Black) Right foot lead
Chest leads:
➡️ V1-(Red)Right side 4th intercostal space
➡️ V2-(Yellow)Left side 4th intercostal space
➡️ V3-(Green) Between V3&V4
➡️ V4-(Brown)Left side 5th intercostal space, mid clavicular line
➡️ V5-(Black)Horizontal line, Left side 5th intercoastal space in anterior auxillary
line.
➡️ V6-(Violet) Horizontal line, Left side 5th intercostal space in mid axillary line.
Eindhoven's Triangle:
Eindhoven's Law:If electrocardiograms are taken
simultaneously with the three limb leads, at any
given instant the potential in lead II is equal to the
sum of the potentiala in lead I and lead III.
Interpretation of the ECG:
➡️Interpretation of the ECG is fundamentally about
understanding the electrical conducting of the heart.
A)Basic actions of the ECG:
➡️Electromagnetic force directed towards the
(+)electrode of a lead ->Upward &Positive deflection.
➡️Electromagnetic force directed away from the(-
)electrode of a lead ->Downward & Negative deflection.
Interpretation of the ECG:
B)Rate&Rhythm:
Rate➡️ Refers to how fast the heart beat.
Rhythm➡️ Refers to the types of heart beat.
C)Axis:
➡️ The QRS axis represents the average direction of electrical
activity in the heart during Ventricular repolarization.
Classification Angle Notes Lead I Lead aVF
Normal -30°to+90° Normal (+)defletion (+) deflection
RAD +90°to RVH,LPFB ( -) deflection (+) deflection
±180°
LAD -30°to -90° LVH,LPFB (+) deflection ( -) deflection
Indeterminate -90°to COPD ( -) deflection ( -) deflection
axis ±180°
d) Amplitudes&Intervals:
d)Amplitudes&Intervals:
Feature Description Duration
P wave Atrial depolarization <80ms
QRS complex Ventricular depolarization 80to 100ms
T wave Ventricular repolarization 160ms
U wave Repolarization of the purkinje
fibres
PR Interal Begining of the P wave to 120to 200ms
begining of the QRS complex
QT Interval Begining of the QRS complex
to begining of the T qave
ST Segment Connect th QRS complex&the
T wave
J point End of the QRS
complex&begining of the
Twave
Interpretation of the ECG:
Amplitude&Intervals:
How to read on ECG in 10 steps:
➡️ Check: ->Calibration - 25mm/sec.
->Standardization - 1mv=10mm deflection
->aVR -
negative(Levocardia)/positive(Dextrocardia).
1)Rhythm 6)Q wave
2)Rate 7)QRS complex
3)Axis 8)QT Interval
4)P wave 9)ST segment
5)PR Interval 10)T wave
Uses of the ECG:
Assess your rhythm abnormalities such as
arrhythmias.
Diagnose poor blood flow to the heart muscle.E G:
Ischemia&MI. ST elevation such as STEMI or
NSTEMI.
Diagnose a electrolyte abnormalities such as
hyperkalemia.
Diagnose abnormalities of such as Heart chamber
enlargement&abnormal electrical conduction.
Diagnosis of the ECG:
➡️ Overall the diagnosis are made based on the [Link] following is
an organized list of possible ECG based diagnose.
1)Rhythm disturbances&Arrhythmias:
Atrial fibrillation&flutter
Ventricular fibrillation&flutter
Sinus Arrhythmias&SVT
2)Heart block&conduction problems:
SAnode &AV node block
Rt bundle - RBBB(Complete/Incomplete)
Lt bundle - LBBB(Complete/Incomplete)
QT Syndrome
Diagnosis of the ECG:
3) Electrolytes disturbances&intoxication:
Calcium: Hypo&Hypercalcaemia
Potassium:Hypo&Hyperkalaemia
Digitalis intoxication
4)Ischemia&Infarction:
ST elevation&ST depression
MI(Heart attack)-NSTEMI&STEMI
5)Structural:
Acute pericarditis
Rt&Lt Ventricular Hypertrophy
