1. SPIROMETRY Measurement of Lung Volumes and Capacities the lungs contain maximum volume of air and this is called th At the end of forced inspiratio f eer ity (TLC). Thisls subdivided in volumes and capacities as follows 1 to, Ota 1, Tidal Volume (TV) : itis the volume of ar that is inspired or expired during quiet breathing. Normally itis 500m) 8 Inspiratory Reserve Volume (IRV): It is the maximum volume that can be inspired beyond normal inspiration. Normal average jy, males is 3000 ml. 3... Expiratory Reserve Volume (ERV): It is the maximum volume of air that can be breathed out beyond normal expiration. Normal average for males is 1100ml. 4. Vital Capacity (VC): Itis the volume that can be expired forcibly after maximum inspiration. It comprises IRV, TV and ERV and is about 70% to 80% of total lung capacity. It is related to age, sex, height & surface ares It also varies with posture and previous practice. Normal average for males is 4600 mi. for females 3100 ml 5. _ Inspiratory Capacity (1C): Volume of air that can be forcibly inspired at the end of normal expiration. It comprises IRV and [Link] average is 3500 ml. 6. Functional Residual Capacity (FRC): Volume of air that remains in the lungs after a quiet expiration. This end expiratory volume reflects the equilibrium position of the chestand lungs. Normal average is 2300 ml. 7. Residual Volume (RV): It is the volume of air that remains in the lungs after maximum expiration. Normal average s 1200 ml. Of these; TV, ERV and VC can be directly measured by a spirometer while Residual volume, FRC and total lung capacity can not directly measured. They are indirectly measured by “Nitrogen -wash’ or “Helium dilution" technique. Hutchison’s Spirometer Itconsists of two light metal cylindrical jars, bigger one containing water in which a smaller one (ht is air tight due to water seal) fits in an inverted position and is counterbalanced by weight passing" pulley. A central tubing inside the bigger jar and rising above the level of the water is connected ou" with a mouth - piece. When the subject breathes out through the mouth - piece the rise of press" within the air tight smaller jar will raise itand the rise in the level is graduated in such away soast©#* a direct reading ofamount of air: 146Spirometer Diagram ; Pointer Outer Movable Disc Inner fixed Disc Link Chain Aluminium: Hollow tube for chain cylinder (the bell) Corrugated rubber tube Mouth piece Procedure : 1 Check that the spiromet ratory V! ris airtight ames empty the spiro k for reach cord meter completely. Adjust the dial with the 2. For recording exP! pointer at Zero mar 4, Usesterile mouth piece: e mouth pieceinthe meth 4 seril Fit the ste! piec enosets closed, Breathing i should be through the je moutl! reathingout jrthe mouth 5, While b our noseRecord the following: 1, Tidal Volume : After a normal quiet inspl expiration 2. Expiratory Reserve Volume : After This gives ERV. 3. Vital Capacity : Take a deepest possible breath and then make deepest possible expirayo, recording inspiratory volumes, spirometer should be half filled with fresh atmosphe., Records of different lung volume and capacities can be obtained by using different instr, suchas a Benedict- Roth's apparatus ration breath out in the mouth piece with a quiet expiration blow out forcibly through the mp th ie b —_Expirograph Records of TV, ERV, LR. V.C.¢ Maximum Breathing Capacity and Minute Respiratory Volume. Respiratory minute volume (Pulmonary Ventilation) : Volume ofair that is breathed in oroutat physical and mental restin one minute. RM\V.=[Link]. rate Normally 500x14=7 liter /min. Timed vital capacity (Qr Forced expiratory volume) : Itis fraction of vital capacity exhaled at the end of 1** 2"°4 or 3 second, and expressed as percentag. vital capacity. Itcan be recorded ona fast moving drum. Normally FEV.-80% FEW,- 90-92% FEV.;94-96% Maximum Breathing capacity (Or Maximum ventilatory volume) : Itisthe greatest volume of air thatcan beventilated on commandin one minute. The subjectisasked» breathe as rapidly and as deeply as he can for fifteen seconds. And then itis calculated for one mini (Itis done for 15 seconds to prevent excessive COzwashout with resultant dizziness) Normal average MW is about 100 L/min. (range for average malesis 81-170L/ min. decreases in old age. It depends on muscular forces available, compliance of thoracic wall andi and airway resistance, Difference between M V V and pulmonary ventilation (PV) under any condition is called Breathing reserve (BR) Thus at rest for an adult, if M V Vis 110 U min & PvaLim BR=MVV-PV=110-8=102L/min. The percentage Breathing Reserveis MVV-PVx 100is called Dyspnoeicindex. MVV Inthe above example, percentage reserveis 110-8 x100 110 ie. about 93.8%. Thus only 7% of MV Vis utilised for ventilation under resting conditions. 0" exercise, PV is increased and percentage breathing reserve decreases. Dyspnoea is pres" percentage falls to less than 60% & this is known as Dyspnoeic point. Percentage reserve may teen MW (disease of lung) or when PV increases (as in muscular exercise): 3" hen conditions dyspnoea is experienced when dyspnoeic point is reached. In any condition“ y is reduced, MV Valso decreases and hence the percentage BR ‘an be obtained. It can also be used to record Time Vital Capacity,cidal VOLLUMAe IN Whe Kirsh veacling- 550 mI 274 veading- 500m} 374 veaoling 4 viet capacity - 45) remting - 429.6-na}. 550 m virst capacity - 18" veading -1200 mI a . 2" yeading ~ 1500 mI 34 yeadiug - 2000 ™I ye giual Vidal vouume ic- 5594500 +550 + 58333 MI 3 yue final Vital capacity is + \z00 + 1500 +2000 +15 66°6 ml 3 g000 -— l\ 5goom! tec) 2000-2100 wh ty[}tmoarenn *“ Writing lever Diaphragm , Marey's tambour a : \ Pressure ~ Corrugated | rubber tubing rubber tube aoe ey2. STETHOGRAPHY To graphically record resp) aim :To graphically record respiratory movements under various conditions Apparatus 1 Stethograph, 2 Recording drum, 3, Marey's tambour stethograph conse ofa corrugated rubber tubing having a side tube and alip attached. The side tube is ct cted to a rubber tubing which connects it to Marey’s tambour having-a lever with a pointer which records the movements yo peor speed: Slow. Gear slow, pulley 4:1 Procedure! : , 1. Tiethe Stethograph round the chest where respiratory movements are maximum. Connect the tube of Marey’s tambour by means ofarubbertubing tothe: ‘Stethograph, Sce that the subject does not face the kymograph. Record few normal respirations. Upstroke of the record corresponds to expiration and downstroke to inspiration. 5, _ Askthe subjectto hyperventilateie. rapid and forcible breathing for two minutes wed by a straight line on the Observations : Increase in rate and amplitude of the respirations is fllo yy apnoea (temporary cessation of breathing).. graph ie. hyperventilation is followed 6 Waittil the respiratory ratecomesbacktonormaland then ask he subjectto drink water mn: Respiration stops during deglutition deglutition a 7. Record few normal respirations, take the: pointer away from the drum, stop the drum andask the patient to take éxercise for 3 minutes. Then again take the record, after the cessation of exercise. Observation: After the exercise there is increase in the rate and depth of respiration (hyperventilation.) 8. Record fewnormal respirations and take therec Downstroke (inspiration), record is a stral dis interrupted by small waves, itisnotastraightline 's of breath holding. hy holding a straight lin Observatio! pnoea cords duringtalking. ight line but upstroke i.e. expiration is Observation: gradual 9. Record the effect: will be recorded and after breaking point Observations : During brea increased rate and depthisrecorded QUESTIONS: 1. Define the terms apnoca eupnoea,[Link] 2. otisthemechanssmortyervent/uniteNn prexervist? : Whatisthecause ofhyperventiation aApe dere eos attr , eee Movvsel guste ° ee Hyperaproca 12 ir a. - caplyaee HApreroprota 1 Ine ase “ : ane og 4 : a Lung evcevete, wnt a — qereration 4 : be aud 1% goumned " an acne is ' 6, ts eb be rupe erate At eeGUISUL- Mb He beqinniug oy eacenase, When Corin COMM a UTng mung the , Yespivatory cemtveo vs activate vespiratbry comye ven kfatton Seurdy tm puoey Ho / oth alae Gedo IMpUtots é p a to rough CON OFF rat, APAAING 18 increome een before tncerdise. ance Me YL in Cmhcercise Aas, We movement 6% Joie, auvig, SY wurdts OONAD aYgerem (ro™M joi and muccen whiutn anivate respivaéry centre amd keeps pulmonary respiration trigh- Normatyy, Ly inereQoe in vemmMattion is SUfficieMr & supply exact ameunr #7 0, needed luring excercise. Thergore Hre tencentratton ef amd partial pressure % 0, ond co, iy bt00d wgually do Nok Cramge bur if neurat weeehauisms are 160 leon oy WO Shong, when ently Level M0, amd C0, will wrange and de He aoljustments in 1 0, ; wy) { ehemor 16 veutiadorn eb, directly aus 7 entra eceptéys Mo vece ptOrs do He ginal adj wrk ments: Be and 0, on peripheral teemucar fanbre3. PERIMETRY Perimetry is the process'of mapping uniocular filed of vision. Principle of the method: If one eye is fixed on a point in space, then the visual field for this eye may be thought of as the part of a surface ofa sphere on to which all the visible objects are projected. The limits to this field will be determined by sensitivity and extent of the retina and the accessibility of light rays from the environment. Equipment: Perimeter, perimeter chart and test objects. Perimeter: The instrument consists of mainly three parts i) Stand to supportthearc. ii) Chinrestattached tothearc. iii) Anarcofacircle, The stand: It gives stability to the instrument. Ithas a vertical limb upon which the arc is pivoted. The vertical limb is broad. Ithas a circular scale to read the meridian in which thearchas moved. Chin rest: Chin rest is adjustable. The patient’s head is supported on a chin rest. The right hand cup of the chin restis used when the left eye is examined. ‘Arc : Perimeter consist of a meta! arm shaped in a large arc of a circle with its'concavity directed towards the subject (patient), The arcitselfis pivoted at the center enabling itto be rotated through any meridian, This movable arcis calibrated in degrees and the scale is marked on the convex surface. Ifthe objectis placed at any point on the arc, the angleit subtends with the fixation axis at the eye may beread off. The arc may be rotated abouta horizontal axisinto any required meridian. Perimeter chart : The field of vision is depicted by a circle which is divided into number of segments by meridians. The concentric circle depicts the degree on each meridian. The perimeter chart canbe fixed to the wooden disc Which is attached to the handle of the are and moves with it. From the chart, the meridian on which the arcis positioned can be made out. Test object : The test Object is white and 5 mm in size. It is fixed on a sliding holder on the arc. Test object's sizeand colour can be changed Procedure: 1 Ask the subject to sit comfortably ona stool with his chin resting on the chin rest. 2. The chin restis adjusted in such a way that the line joining the fixating eye & the center ofthe arc is horizontal. The distance between the center of the arc and the fixating eye is 33 cm. Position the arc in frontal plane on zero meridian and fix the chart on the disc. 4. Using 5 mm size test object (white in colour) start moving the object disc from the periphery towards the center till the subject perceives the object. Note the reading in degrees 0 the arc & mark iton the charton this particular meridian, 5. Take such seven more readings on different meridians ie. 45°. 90°, 135° & 180° ete. On tempor! & nasal sides respectively, 6. Joining these cight points, pet the field of vision for that particular eye. 7. Findoutthe field of vision for the other eye. 8. _ Findoutthe field of vision using different coloured test objects.Mark the en the arc on temporal side at 100° meridian, move the disc from the chy rowan 1¢ center: Initially the subject will visualize the object upto 20° or so. Th the ieee from his visual field: Mark this reading on the chart. Now a ie objec raha an : i center. By about 10° or sothe object will be seen once again. Mark this Soin jese two points by a small circle. This circle will indicate the blind spot fortheparticular eye. precautions: 4, Gazeshouldbe strictly fixedat the center 2, Theothereyemustbe covered, Normal field of vision: The normal field of vision for white object is extended upto 100°, 56°, 60° and 75° on temporal, superior, nasal and inferior sides respectively plind spot: Itissituated on temporal sidein lower half QUESTIONS: 1, Define field of vision. Describe confrontation perimetry. How does field of vision differ with different colours? Whatis the reason for blind spot? Fer yt Tea take ; yeep Explain the following terms a. _Homonymous Hemianopia. b, _ Bitemporal Hemianopia c. _ BinasalHemianopia oO BS ey TK We ff Lett oe Right eye— Sy LISTER'S PERIMETER CHapy OR PRISTLEY SMITH TYPE PPRO: 16 To Re-Order Quote Cat No.KIGHT - 4 visual > J ae am << fied - Mia f Wa ae EA ’ yy, S IN TOTAL blindness ~ g—nosay, — > : *S) yetna of Right eye. © ev royal i . A B a RIGHT nasal hemi anopsia: LEFT homony mous hemianopsia. BITEMPORAL Ur hereronymous J / hemianops!a- =4. ERGOGRAPHY york done by the intact voluntary mu: sone scle. Instrument used / or recording th All ng this is known sf . ‘ ne ontonetinacsetamssean idee ff of fatigue. sostuaythe effect of occlusion of blood supply on the work done. od: pand iS placed in the hand grip, the palm facing upwe meet Hh ger holders. On the middle finger at Se ace eee ring fingers In the srt of 1 0f2 kilograms by means of string which in turn isattached ee Joint is attached 2 not agarum, The metronome isstarted andthe imidle finger i pointer wrtngonthe ving The contractions are recorded on the drum tl fague eet ila et ni pe finger) The seat of fatigue is neither in the myoneura STE alie the nerve or in the reflex arc To prove this fat, the nner is picked a ae re rmuscle is observed. Therefore seat of fatigue lies in the CN higher Sa seconds muscle nor i contraction 0} spinal cord. : The same experiment ‘is repeated by this time short pauses of rest are Is of work. Five seconds rest pause is taken after every ten seconds of this procedure that the onset of fatigue is delayed by giving rest periods ch more than whenitis doneatastretch. qheeffect of rest pause taken after short interva work. Itis observed with vathe total amount of work doneis mu 3 Bffectofocclusion of blood supply : A) Effectof venous occlus by raising the pressure to $0 mm of Hg. in the sphygmo the arm ofthe subject. doen and fatigue time de Venous occlusion is obtained manometer cuff which istied to crease as compared t© Procedure is repeated as in No. 1 Work experimentnumber 1. B) _Effectofarterial occlusion: Hg. Above the systolic blood pressure procedure is repeated as ‘ompared toA. Pressure is raised 10 to 20 mm of e decrease further as inNo, Work done and fatigue tim ply it by number of -orded and multi] cord can be divided t of the lines rec rage heightthe re culate ave! gle. C 7 ee : Find out the average heigh! ractions and (hen multiply by the load. To ca! igleand one trian int ‘two different parts i.e. one rectan}est oy Percentage CULAde Le reremraqe daouge = peveentdiqe care avferial OccLssiow temapared suite coudsnour ato, compared sui hr coumpared is 65.¢% doue wuilr vesh 1s. and paune 1444 coudiuvous wu0vk wuita vemous occasion 1S wuitr couduuour uhork suit 6e-41 = Physiological | Weight Metronone] __ ONSET OF Fatigue age No) Gondtionsot | One, Frequency —— att, | posein | “compared wath ‘work done “Average No of ‘granig pe ea ting | tines centimeter | ioe Continous 4 ne 5! ao r | 8#290 100%. nas : workdone vorcrretineety with rest pause 1 ll oe igo.2 5] 2 T7264 7 = 7 be continuous: _ work done me ‘with Vemuous oceulusion 1 1-05 51 | 54-857] Se,72 ee: 4 4. Continuous a work done rh arcrial ceounen 1 tet ae ssr | 61,442 ste | erqsCowie Wim ergs + QO n 981 par BEETS Oe 780240 ere ‘ + Ope 295 X5 6195 om aug att eee se 7 INTE 1 10 vy po ne ¥50 of 05” 9 ns wo tao AOL Bit | 1 Sah , “ A vesk pause AR 3r6—1tom Ms Set + 21 1015 om 2 7 Avy Hi + 2g05 7 270mm | as bre enn’ 3099 am Ww * 18000 4002 T vo iu evggnt 130-248) (27, 126+?LI = Oy! Orta (3) vemous Uuuaiew Win C145 -* SAee5 AR 2 HS XS 40925 oy? 52,71 ey AUT 19S ¥§ —r Come 8 Ava ME > 14 15 +95 13+ b> Los ¥ 57 59595 W I 5465 , = S547 A Na a . / / —— . i c 6 } <_ Fi ae @ ortlry orelusion win erqs> 53x4tl BP Se 4S G15 ont 51,443 1 AT 4 165% 5 —, 3615 emn2 fva ath + 1065 5 1106 Rae D—rly 4a? oe, ’ WW EBAS : \ - 7lit: Nin. Average height= Where Aisarea of rectangleand pisareaoftriangle average height = (axb) + (axc/2) ‘then work done = average height x No. of tines x load ~ gms em erge multiply this by 981. Conclusion The seat of fatigue in case of intact v inthe synapses of the CNS. ns. To convert it in oluntary muscle is psychological QUESTIONS: Q1__ Describe the mechanism of ot Q2 How does fatigue of the isolated nerve muscle prepation diff the intact voluntary muscle? rset of fatiguein intact muscfe ? ferent from that i Mh... ¥ i i | NORMAL venous NERVE Quran SEE REST ROE STEN quzpiany OCCLUSION OCCLUSION 1594. INTRODUCTION TO ECG The Electrocardiogram (ECG) is a linear graph of the volt myocardium. The heart muscle possesses the ; impulses that arise in the conducting system spread throughout the myo excitation of the muscle fibres. This results in weak electric currents whey entire body. These can be recorded by placing electrodes at » connecting them toan electrocardiographic apparatus, KE HMuctuations Property of automatic rhythmic N sprea VIOUS positions ELECTROPHYSIOLOGY Inanormal resting cell, due to the sodium pump mechanism, thereis.a differe 90 millivolts across the cell membrane, the Nein electric outside having positive ch negative charges, Potent, ArBES and the Side han, Fig. 1 : Resting cel! Positives surface charges and negative charges inside he barrier of the cell membrane is broken at that point. Th: ions flow inside the cell and the negative ions migrate to the surface. This reverses the pola") and this process is called depolarisation, During recovery, the positive iOns return to the outersit! and the negative ions migrate back 'ntothe cell. This processis called repolarisation. Stimulus t+ + f . Fig 25 Stimulated catty sitive tons the cell a thes sto ite into the ee ue Hand negative ions MigrSE n,the stimulated cell will hav tive sur U n ea negative e-cha o ge, wherea’ s the resting surface cre potential difference exists between th current flows from the negative to the positive al Saree oles i.e. from the ati sepotart oan sitive wil gna resting cells. se Utperestinecel® * ia ~~ 7 fig. 3 : Direction of deflection of the wave at various positions of the electrode. of depolarization will record a positive OF an upright deflection whereas ave is receding will recor ization records a dipha: -kness of the muscle inv anelectrode facing the wave nthe side where the W: deflection. An s to the wave of depolari danegative or downward flection or no change at al! anelectrode 01 sic de! secrode at right angle olved. Themagnitude of the deflection depends upon the thicl wave. Atrial repolaration is repolarisation by the Ta wave, tis obscured by the ricular represented by the P vtichs rarely perceptible in a normal EGG because i plex and ventri tilatation is represented by the QRS com| QRS complex. Vent on by the T wave Atrial depolarization is cular repolarisati ection as depolarization. Aepolari isation can occur in the same or opposite dir as occurs 1m direction as depolarization ( Pg itis “ seen that when depolarization occurs in the same e atria sn occurs in the im), the Ta wave is inverted if the P wave is upright However if depolarization 0° urs int posite f yeardium to direction as depolarization (as in the ventricle deporarisatie fom endocardium © ae is upright t the QRS m to endocardium) the Tw "Pear jum a nd repolarisation from epicardiun : mle Peis uprightResting colt + + + aes + + Depolari — Repolari: In the same direction In the opposite direction +o. - —- 4+ —~)} +t + + + i, ' -) + + + + - + + FS + <—— + + + epolarisation and, repolarisation of a cell A Resting cell. B Stimulated coll, . © Completely depolarised celt D andE Re, risation. ‘polarisation in the same direction aS depolal solarisation. F and G Repotarisation in the pposite direction as depSa Node Anterior Fascicle Left Bundle Posterior Pascicle Left Bundle atrial (SA) node in the wall of the right atrium This 1 (AV)node. Atthe AV of the heart begins at the sino: d. reaches the atrio-ventricuta! pepolarisation n spreads over the atrium ani e wave 0 e septum, then the apex wave of depolarisatio ads to the bundle of node there is 2 normal sand the Purkinje’s fib endocardium to the epicar occurs in the reverse directi f depolarisation then spre delay in conduction. Th of the left ventricle from the res, stimulating at first th dium and finally the righ ion, from the epicardi state and is unable to ofthe heart. Repolarisation During this period, the imuli. After this, the SA tventricleand the base jum to the endocardium. myocardium is in a refractory respond to additional node once again initiates the wave ofdepolarisation ois processcontinaesat eer MEI ELECTROCARDIOGRAPHS LEADS CG consists of 3 bi polar limb leads 3 augn The commonly used 12 lead E leadsand 6 unipolar precordial leads. BIPOLAR LIMB LEADS , The three standard bipol; ele tric potential between two polls 7 the fron am (RA), ar limb leads (1-1 and Ut, selected bY | mthover tal plane ofthe body plectrodes Jeg (Ls) anywher™ on f/ree has been wr ; eft arm (LA) and left st abov i: above the wrist and the ankles: H Ine mo am put, tation stump.Lead lis produced by the potential difference between RAandLa. Lead Ilis Produced by the Potential difference between RAand LL. Lead IIlis produced by the potential difference between LAand LL. Thus, the current will flow from RA toen aT wl ib leads eVR, avi and AVF. Fig. 8: Unipolar augmented™ UNIPOLAR AUGMENTED LIMB LEADS in unipolar lead1 cardiology two electrodes are employed. By an electric arrangemen, recorded by one electrode (indifferent electrode) are rendered negligible so that only sh, activity of the other electrode (exploring electrode) is recorded The indifferent electrode terminal is RA + LA + LL and equals zero. Now if the exploring ele placed on the right arm a potential difference between RA and the indifferent electrode cont Since the potential of the indifferent electrode is negligible, it is taken as zero, Hence the Deter recorded isthe actual potential of RA. Ina similar manner actual potentials of LA and Li, are by placing the exploring electrode over the left arm and the left leg respectively. These three ez designated VR, VLand VF. Exploring Electrode 166‘hnique, th or change in the tec , the voltage of these lead: By amyeadsareclied augmented leads aVR, aVLanda VF s can be increased by 50% and re apRECORDIALTEADS . dial unipolar leads detect the electrical six precor ical potential at specific points piatenorizont plane ofthe body. The Common precordial positions used are ba follows ‘he chest wa w Fe Fourth intercostal SP a jdistantbetween V2and V4. ys: Eau gitthleft intercostal space inthe mid-clavicular line. jurtnintercostal Pace atthe right sternal border, ace at the left sternal border. ve: el rhe anerioraiary ineinthesamenorzonta panes vs: vy ehemid-aillaryTineinehesame orizontalrlaneas\OTHER UNIPOLAR PRECORDIALLEADS ds taken at othe c In addition to the above six precordial leads, precordia, leads taken at other points ON the chess . may be useful, V..V,,and V, are recorded Dare eee Ger ue USI ee eae left border of spine respectively. VE is recorded atthe tip of the ensiformcartilage VARtoV ane Feconded the right side in the same position as V,— V, respectively. 3V! — 3 V,may be recorded acy, yp ton ut space higher. ECG PAPER “ ines | mm. apart both horizontally andy er upon which the ECG is recorded is ruled in lines erty by ath ie tao direction is heavier than the rest. The vertical axis represents Voltage. With non Standardisation, each | mm represents 0.1 mV. The horizontal axis represents time, With nord Speed, | me represents 0,04 sec: i.e. each $ mm, represents 0,2 see, and in one minute the ECG paper moves by 300 thice lines or [Link] mm. Fig. //: The ECG paper. 1 mm 0.04 sec. on the horizontal axis. 1 mm 0. 1 mV on rertical axis PRECAUTIONS WHILE TAKING AN ECG e may be 1. The patient mus, be placed comfortably on a bed and should be [Link]. The procedure my e patient ®xplined to an apprehensive patient, to relieve hi. anxiety. Any muscular pitching by, he may alter thetracing 2, Theelectrodes musthein proper contact with theskinections must be checl eon eed properly as wrong i 8: connections can co achil ompletely alter the ent and the macl nemust be oper! prop ly standardised so that | mV. produce: d sa deflection of tem hine must be propert ly grounded to avoid interference fr ce from altern ating ‘ The - Sent: 1500 Saar? ot — (600 ‘or a 18 beats per ww ve corning 4 ele erocarr biogTa™ is Hae cervals Herne RATE eusten 2 Ce-K) iM tead WY~~ WAVE AND COMPLEXES PWAVE “4 ion. This wave is best visualised in | atrial depolarisation. ; 2 ang a Prva ra seit (0:3mV) or 3mm horizontally (0.12 ec.). The P wave vg joes 3 ~ lead exceptaVR. TaORPt WAVE i i lly not seer cd by atrial repolarisation. This wave is usually a thet orsenmex IT may be seen’in AV block where the P waves ma merges QRS complexes. nin anormal ECG as, Y Not befollowea 7 ed by the Ta @ Ta Ta Fig, 17, Normal Ta wave, (A case of complete heart block. P waves are not followed by QRS complex so that the Ta wave is not obscured). . QRS COMPLEX The QRS complexis produced by ventricular depolaris; waves. Sometimes, in addition, there arethe R’ 1, Q wave : The Q wave is the ne gative deflection which precedes the R ‘wave. It denotes depolarisation of the ventricular septum fromleftto right. ation. Itis a complex. comprising of theQ Rands and S' waves. 2. Rwave: The Rwaveis the first positive deflection of the QRS complex. It denotes depolarisation ofthe ventricles, at first the anteroseptal portion followed by the major ventricular musclemass 3. Swave: The S wave is the first negative deflection of the QRS complex that follows the R wave 7 occurs due to depolarisation of the posterobasal Part of the left ventricle, pulmonary conusa"® the “PPer most partofthe interventricular septum, 4 Rand’ waves: TheR’ waveis the Second positive wave of the QRS complex and the S wares the second negative deflection of the QRS complex after the R wave. The relative heights 0!“ é recent ary with the leads examined, the position ofthe ee and the degree of abnor Present. TWAVE TheT waveis prod oir? ‘iced by ventricular repolarisation. [ti e with OW9 Polarisation. Itisas e-shaped wave asymmetrical, the peak begingnear ane isa smooth dome-shap aVFiand V2 xcept in le nd than the beginning It is normally upright exceP""ents ; presents the slow repolarisation of the Purkinj’s fib s fibers the sre 0 wave Tram it fallows th T tum it fo! lows the T wave ‘o and precedes the P wave of oy ca ean enemas “ ee rit ves tend ‘to be inverted in II, IIT, V1 waves th : II, V1 and V2. itis transiently inverted eae tf overload, digitalis effect and ene ae A Fas paint ‘ myocardial infarction most of the changes may revert to normal and pei oe Oe nd yet inverted U waves ma persist 7 aDRRINTERVAL ine eae yo nitinesal dona They are used to "seesaw : caeutation of heart rate:In 1 minute, with the normal speed, 1500 SE qaesarecrere enciedstnce egeen eh 7 TEE wr skandteheatrate/minaeis en stares cover Y beats (heartrate/mm) 1500 beat 1500 squares beats /min ‘small squares between tw ated by dividing 1500 by the number of: ral in the ECG below is 25. Thus the hi 60 eheartrate can be calcul: eart rate is 1500/ 25= ‘Thustht Por Rwaves. The R-Rinterve consecutive eats/mm. a of the QRS complex "eval between aur! PRINTERVAL p wave to beginn He PR interval is measured from the beginning ofthe enn ve ite term PQ interval is more accurale oF ents Ce eat tricular depolarisation and hence Tneludes ee imme (Ken Moe atrial depolarisation, 20) enon an the node. THe nO em gerval ranges tu OEE DS repo a larisation and the delay of exc!QUINTERVAL of the Q wave to the end of the U wave. It has no ¢} Unica d from the beginning with the QT interval and the latter may be erroneoy, Duly QU interval is measure be confused significance except that it may interpreted as increased. PRSEGMENT complex. Itis normally isoelectr: The PRsegment is from the end of the P wave to the beginning of QRS STJUNCTION nctionis the pointat which the QRS complex ends and the ST segment begins. ST SEGMENT n to the beginning of the T wave. It is usually isoelecr:: 2mm) in precordial leads. The depression o: ent (i.e. the part between the ts the time The ST ju The ST segmentis measured from the ST junctio but may be slightly depressed (0.5 mm) or elevated (0. elevation of the ST segment should be evaluated in relation to the TP segm: end of the T wave and beginning of the P wave of the following cardiac cycle). It represen between ventricular depolarisation and repolarisation.5. CARI DIAC EFFICIENCY TEST onthe response of CV: er munction CVS to tandardlsed exercise to which the bod; tar sinimal tthe end ‘omptresponse toa sudden stress. Vesa ardlneledof stress fexercle the heart rat a art rate an level. The resp onse to exerci evel heperton reise depends on cardiac reserve, nutrition ness. In order t aa aoe HOP ntofw See rea pane ofcardiac efficiency, itis ess ti iW ied to the heart und f stig done BY formulating & standard exercise performed by a subject ES psibeobservations are made which serveas aindex srihceticencyatheart, and after tis fol f arward’s step Test Askthe subjectto take vigorous exe pefees tespletely exhausted: Incase sul fpashoreer me: arofstep:18" Record the pulseal [Link] 1-1 asare Dae sc nes srcient cardio a ene weeetrate and Be sei estin, nt oeurn €O the resting pote rwerand motival u av gil netests for PP sical fit t adefinite amou AG eriod of 5 minutes so that end of cise of 20 steps / min. forap‘ hhe test for 5 mins. He may doso ject is unable to continue t feerthe exercise at followingintervals a) /2min. fter2min.to2.1/2min- bjt After 3 min. to 3.1/2 min. thenefficiency index= duration of ext Innormal individuals, itis 100% butitis more inathletes. Interpretation of scoresis as follows Above 90 = Excellent 80-90 = Good 55-90 = AveraBe Below 55 = poor physical condition t.9", 12) times Per 2 Master's stey p test time for pulse rate © ‘Ask to stepup am! is over. Note the recovery a pis the basal pulse rate of aperson- SB ltrhis pulse rate immediately after the exercise is OVE tonormal level. ee el te the 1-19.24 and 30 per min 3 nol y of t0P5 Oe rma inert person the asing frequen® ery time for pulse rate 0 to initial valuein m Re ie oe the experiment by incre Piserate ater each exercise and reco’ *Serateafter exercise should return Treadmill test. Bicycle ergometry. Wisnioy, etry. What 'sthe cardiac reserve ?ee Resting. 8] Master stép's Test: | vesting pulse + = bpm. pulse reading ary excercise, 73 ar me emd & 1 min — 46 bpm ak Mme ed a oe a teem at Mme mad 4 3rd eee Go opm Or Me end of |. og Mee Gh ke end a 6h win OeCalculation \ A) Hovward's TEST nurotton_ of «RE Cin Ste) x100 43 \8* veadiug -a- 38st or 2Catb +c) 274 veadiug - b- 34 xt or +4 300 x100-+ 300x100 374 veading-¢- 35 ¥27% 2Cae+344 352 22% 2, cawdiac eggidemay [138 qa J Mr ShavTYas cCaTAIAC ficiency is ve (>40) Resultsweight 7 45 bg 1 Body Surface Area + \447 wt | Age 4% 19 vex 4 Feuale 2 BHR 35.5 callhylm? | 3: BMK > 4.47 x 35-5 7\52-2 call hy | hour CBM KY SAD a “COL vequived during sleeprGugg Seaxdt 52x Wx] tog Oe (op (its) ia ff 5. waking Wvs CHS) - 11x 52 ee aul | 116 cal -® 1 Work oMewamee- 1x8 x45 = |612 cals. | — 4) Jovar catovies (2223 cals. | ©) 6 Now work aluowonee -|400 tals. | BHA + (222-3 cat |\©@ ! Tora! S46) 4\2445 cals. | Jemperative conrectou St Cora Ft SG 9 1200-6 —>)H- Jovar — (1)-@) 2322. \- Be 25 —® cat cals. oy ter Jemp- tovredrou Corb Promens Fats (101 OF TC) | CISA 04 TC) CIS 1. Of TC) 15-4 cat! [34k-3 call) 34k eal. weight — 165 wu A