BASICS OF ECG
Kenemo MD.
Why do we need ECG?
Basically is one way to know how the heart functions
Rate and the rhythm and then to tell disorders such as
myocardial ischemia, heart block.
Can not tell us about the pumping action of the heart
or the blood pressure
However we know that if a patient has a rhythm such as
ventricular fibrillation they will have no blood pressure
Where to put the ECG leads
Cardiac conduction system
The Electrical Conduction
System
The heart has automatic contraction of muscles the whole life.
SA node: Starting point for all electricity and has fastest rate of
automaticity
It is called the pacemaker of the heart-leading source of all
electricity in the heart
- Rate 60-100 bpm
AV node: Has a delay which allows for atrial contraction and
more filling of the ventricles:
Rate 40-60 bpm
The Electrical Conduction
System
Bundle of His:
Has the ability to self initiate electrical activity if there
is no faster impulse from above
-Rate 40-60 bpm
Purkinje Fibers: Network of fibers that carry an
electrical impulse directly to the ventricular muscle cells
- Rate 20-40 bpm
SHAPE OF ECG
P-wave
SA node fires, sends the
electrical pulse outward to
both atria. Atria contract
helping to fill the ventricles
PR-interval
Impulse travels through the
AV node to the ventricles.
Delay allows ventricles to fill
QRS complex
Impulse spreads from
the Bundle of HIS
through the
ventricular muscles
T- wave
Ventricular
repolarization. No
associated activity of
the heart
Resting phase of the
cardiac cycle
Interpretation of ECG
WHAT IS A NORMAL ECG?
Must have the following features:
Generally: Almost all waves as they appear in the
normal ECG shape
RATE: between 60 and 100, therefore the electricity
starts from SA node. This is called SINUS ECG or
Sinus Rhythm
Heart Rhythm
Is it regular or irregular?
The P-wave
Are P-waves present?
Are they occurring regularly?
Is there a P-wave for every QRS?
Are the P-waves smooth, rounded and upright in
appearance?
Do they all look the same?
What is this rhythm?
Rate 80 bpm Normal sinus rhythm
What is this rhythm?
Rate is 75 bpm Normal sinus rhythm
What is this rhythm
Rate is 120 beats/min Sinus tachycardia
What is this rhythm?
What is this rhythm?
Rate 25 bpm Sinus bradycardia
ABNORMAL ECG
This is when some features are missing or abnormally
shaped. This is ARHYTHMIA.
Atrial fibrillation
Atrial fibrillation (AF) is a common heart rhythm
disorder in which the electrical impulses in the upper
cardiac chambers (atria) degenerate from their usual
organized rhythm into a rapid chaotic pattern.
Atrial fibrillation
Pulse is irregularly irregular
Atrial fibrillation :
More common in older people
May be caused by:
Surgical procedures,
pulmonary embolism,
chronic lung disease,
hyperthyroidism,
alcohol ingestion
Mitral stenosis
Atrial fibrillation
Atrial fibrillation
What is this rhythm?
Supraventricular Tachycardia
Supraventricular Tachycardia
The heart has no time to fill
What is this rhythm?
Rate 180 bpm Supra-ventricular
tachycardia (SVT)
Ventricular Arrhythmias
Premature Ventricular
Contraction (PVC)
Premature Ventricular
Contraction (PVC)
Ventricular Tachycardia
Three or more fast ventricular beats in a row
Ventricular Tachycardia
Wide, fast beats. No P waves
Ventricular Tachycardia
Ventricular Tachycardia
What is this rhythm?
Ventricular Fibrillation
No cardiac Output
What is this rhythm?
Asystole
No electrical activity
No cardiac output
Asystole
Asystole
Why worry when ECG is
abnormal?
There will not be any blood going out of the heart-NO
cardiac output.
If the degree of abnormality if mild-the heart gets just
insufficiency. If abnormality is severe you get cardiac
ARREST.
Treatment of abnormal ECG (arrhythmias) depends on
severity. It starts from using drugs, converting by
electricity-CARDIOVERSION or putting artificial
PACEMAKER.
If all FAIL-cardiac transplant.
AND THAT’S ALL FOR NOW….