Electrical Conduction and ECG
ECG
Muscle cell is electrically activated, result is mechanical
response.
ECG (electrocardiogram) measures the electrical activation
(depolarization ) and recovery (repolarization) of the cell
membranes of the myocardial tissue.
ECG does not measure and mechanical response of the heart,
however, since electrical and mechanical activities are closely
related, ECG is used to diagnose certain abnormalities of the
mechanical action of the heart.
areas of ischemia or myocardial damage
LV Hypertrophy
electrolyte disturbances / drug toxicity
Normal Cardiac Cycle
Systole Diastole
Electrical Depolarization Repolarization
“impulse “activate” “recovery”
”
Mechanic Contract Relax
al “empty” “fill”
“pump,
contracti
on”
ECG Complexes
Cardiac Vectors
The electrical potentials produced by the heart are the sum of minute
amounts of electricity generated from each individual cardiac muscle
cell.
A vector is the visual representation of the summation of the millions of
individual depolarizations.
A vector is a graphic illustration of a physical force that has both
magnitude and direction.
Electrical current can be represented by a vector.
When atrial and ventricular myocytes depolarize and repolarize, a large
current is created.
ECG reflects the electrical activity of the entire heart – the sum of all the
action potentials of all the cardiac cells.
Cardiac Vectors
The deflections recorded by an ECG are either isoelectric, positive or
negatively deflected depending on the orientation of the axis of the
recording lead with respect to the direction of the current.
Vector travelling in the same direction, toward the positive electrode
will be recorded as Positive
Vector travelling in the opposite direction, away from the positive
electrode will be recorded as Negative
Vector travelling on an angle to the axis (either toward or away from
positive electrode) will have less amplitude
Vector of current flow is directed perpendicular to the axis in either
direction will be recorded as biphasic.
Biphasic deflection has equal positive and negative components.
• ECG description
• amplitude (voltage)
• recorded in mm
• positive or negative or biphasic
• width (duration)
Axis
Quadrants
Normal – positive lead I and aVF
Left – positive lead I and negative aVF
Right – negative lead I and positive aVF
Extreme right – negative lead I and aVF
AXIS
ECG Complexes
ECG Paper
Small boxes = 1 mm / 0.04 seconds
Large boxes = 5 mm / 0.20 seconds
One second is 5 large boxes
Three seconds is 15 large boxes
Six seconds is 30 large boxes
Each minute has 300 large boxes
Paper speed = 25 mm / sec
What Is In Each Beat?
(the cardiac cycle in waves, complexes, and intervals)
P Wave – atrial contraction or depolarization, (usually upright)
QRS Complex – time for ventricular contraction or depolarization
(usually upright) (0.06 - 0.11 sec) (delays in the bundle branches will
widen the QRS)
T Wave – ventricular repolarization “recharging” (usually upright)
PR Interval – time between atrial depolarization to ventricular
depolarization (beginning of P wave to beginning of QRS)(0.12 - 0.20sec)
(prolonged PR = delays in the AV node conduction)
QT Interval – represents one complete ventricular depolarization and
repolarization (beginning of QRS to the end of the T wave) (0.32 – 0.44sec)
(disturbances are usually due to electrolyte disturbances or drug effects)
ECG Complexes
Reading a Rhythm Strip
What Do I Look For?
Regularity - What is the R – R Interval?
Rate - Is the rate normal (60-100), slow, or fast?
***Six-second strip method - (30 big boxes) & multiply
times ten
P Wave – Is there a P wave before every QRS? Is it upright?
QRS Complex – Is there a normal QRS complex following
each P wave? Wide or normal?
T wave – How does your T wave look? Upright?
Measure your intervals – PR Interval, QRS, QT
ECG Waves
P wave
atrial
depolarization
≤ 2.5 mm in
amplitude
< 0.12 sec in
width
PR interval (0.12 -
0.20 sec.)
time of stimulus
through atria and AV
node
prolonged interval
= first-degree
heart block
ECG Waves
QRS
Ventricle depolarization
Q wave: when initial deflection is negative
R wave: first positive deflection
S wave: negative deflection after the R wave
ECG Waves
QRS
May contain R wave only
May contain QS wave
only
Small waves indicated
with small letters (q, r, s)
Repeated waves are
indicated as ‘prime’
Q waves
Pathologic Q waves are a sign of previous myocardial
infarction.
They are the result of absence of electrical activity. A myocardial
infarction can be thought of as an electrical 'hole' as scar tissue is
electrically dead and therefore results in pathologic Q waves.
Pathological (abnormal) Q waves are defined as greater than 1/3
the height of the R wave, greater than 0.04 sec (40 msec) in
duration.
ECG Waves
QRS
width usually 0.12 second or less
ECG Waves
RR interval
interval between two consecutive QRS complexes
ECG Waves
J point:
end of QRS wave
beginning of ST segment
ST segment
beginning of ventricular repolarization
normally isoelectric (flat)
changes, elevation or depression, may indicate pathological
condition
ECG Waves
ECG Waves
T wave
part of ventricular repolarization
asymmetrical shape
usually not measured
normally upright in lead II
ECG Waves
QT interval
from beginning of QRS to the end of the T wave
ventricular repolarization
length varies with heart rate
RR HR QT
(sec) (bpm) (sec)
1.00 60 0.43
0.40 150 0.27
ECG Waves
Rate Corrected QT Interval
QTc = QT divided by square root of RR
normal is less than or equal to 0.44 sec.
ECG Waves
Long QT interval
certain drugs
electrolyte disturbances
hypothermia
ischemia
infarction
subarachnoid hemorrhage
Short QT interval
drugs or hypercalcemia
ECG Waves
U Wave
last phase of repolarization
small wave after the T wave
not always seen
significance is not known
Heart Rate Calculation
Count boxes (for regular rhythm HR)
Count the number of large boxes
between two consecutive QRS
complexes. Divide 300 by that
number
300 ÷ 4 = 75
Count the small boxes. Divide 1500
by that number
1500 ÷ 20 = 75
Heart Rate Calculation
most accurate
1500 divided by the
take time to calculate
number of small boxes
only use with regular
between two R waves
rhythms
300 divided by the
quick 1 lg sq = 300 bpm
not too accurate 2 lg sq = 150 bpm
number of large boxes
only use with regular
between two R waves 3 lg sq = 100 bpm
rhythm
4 lg sq = 75bpm
5 lg sq = 60 bpm
10 multiplied by the less precise 6 lg sq = 50 bpm
number of R waves in 6 use with irregular rhythms
seconds very quick
The ECG as a Combination of Atrial and
Ventricular Parts
Atrial ECG = P wave
Ventricular ECG = QRS-T waves
Normally, sinus node paces the heart and P wave precedes QRS
P-QRS-T
Sometimes, atria and ventricles paced separately (e.g. complete
heart block)
