Ecg Didacs-Sampiano

ELECTROCARDIOGRAPHY
MCC CORSINO I SAMPIANO

OBJECTIVES
● To identify and briefly discuss
electrocardiography and its components
● To discuss the basic steps in ECG reading
● Be familiar with Abnormal ECG findings
The Heart
• Contracts approx. 100,000 times /day or 3 billion
times lifetime.
• CONDUCTIVE SYSTEM of the HEART
• generates rhythmical electrical impulses to
initiate rhythmical contraction of the heart
muscle
• conducts these impulses rapidly through the
heart.
Characteristic of Cardiac Cells
Cardiac
Action
Potentia
l
CONDUCTION SYSTEM OF
THE HEART
Electrocardiography
● Graphical representation of electrical

activity generated by the heart
12-Lead Electrocardiogram
(ECG)
● Records the heart’s electrical activity using a series of electrodes placed
on the patient’s extremities and chest wall.
● Includes:
○ 6 limb leads
■ 3 bipolar leads: I, II and III
■ 3 unipolar (augmented) leads: aVF, aVR and aVL
○ 6 chest (precordial) leads: V1, V2, V3, V4, V5, and V6
Limb Leads
Standard Limb Leads

Limb Leads
Augmented Limb Leads
Chest Leads
Standard Chest Leads
Chest Leads
Additional Leads in Special Circumstances
ECG Paper
Components of ECG
Components of ECG
P - Wave
Represents atrial depolarization
Location Precedes the QRS complex
Normal Duration 0.06-0.12 second
Normal 2-3 millimeters

Amplitude
Configuration Small, rounded and upright

Components of ECG
QRS Complex
Represents ventricular depolarization
Location Follows the PR Interval
Normal Duration 0.06-0.10 second
Normal Amplitude 5-30 millimeters
Configuration Q wave: first negative deflection after

P wave
R wave: first positive deflection after
the P wave or the Q wave
S wave: first negative deflection after
the R wave
Components of ECG
T - Wave
Represents ventricular repolarization
Location Follows the S wave
Configuration Typically round and smooth

Components of ECG
PR Interval
Interval between the beginning of atrial depolarization and

the beginning of ventricular depolarization
Location From the beginning of the P

wave to the beginning of the
QRS complex
Duration 0.12-0.20 second

Components of ECG
QT Interval
Measures ventricular depolarization and repolarization
Location Extends from the beginning of

the QRS complex to the end of
the T wave
Duration 0.44-0.46 second

Components of ECG
PR Segment
Reflects the time delay between the atrial and ventricular

depolarization
Location Flat line between the end of the

P wave and beginning of QRS
complex
Components of ECG
ST Segment
Represents end of ventricular depolarization and beginning

of ventricular repolarization
Location Extends from the end of the S

wave to the beginning of the T
wave
Duration Usually isoelectric (neither

positive nor negative)
Basic Steps in ECG reading
1. Determine the rate
2. Determine the rhythm
3. Measure intervals
4. Determine QRS electrical axis
5. Check for chamber enlargements
6. Check for ST and T-wave changes
7. Check for other arrhythmias and abnormalities
Step 1 - Determine the Rate
Step 2 - Determine the Rhythm
Step 3 - Measure Intervals
P wave Atrial depolarization 0.06-0.12 second

≤ 3 small squares
PR Interval Conduction delay within the AV 0.12-0.20 second

node ≤ 5 small squares
QRS Ventricular depolarization 0.06-0.10 second

Interval
QT Interval Ventricular depolarization and 0.44-0.46 second

repolarization Upper limit:
Men: 0.45 second
Women: 0.46 second
P Wave Abnormalities
PR Interval Abnormalities
First-degree AV Block
Second-degree AV Block
Third-degree AV Block
High-grade AV Block
Wolff-Parkinson-White Syndrome
Wolff-Parkinson-White Syndrome
QRS Complex Abnormalities
QT Interval Abnormalities
Prolonged QT Interval
Shortened QT Interval
Prolonged QT Interval
Shortened QT Interval
Step 4 - Determine QRS Electrical Axis
Step 4 - Determine QRS Electrical Axis
Step 5 - Check for Chamber Enlargement
Atrial Enlargement
Ventricular Enlargement
Step 6 - Check for ST and T-wave Changes
Location of Myocardial Ischemia
ST Segment Changes in Myocardial
Infarction
Step 6 - Check for Other
Arrhythmias and Abnormalities
Sinoatrial (SA) Node
Disorders
Sinus Arrest
Sinus Arrest
Sinus Exit Block
Sick Sinus Syndrome
Sick Sinus Syndrome
Ventricular Arrhythmias
Ventricular Tachycardia
Ventricular Tachycardia
Torsades de pointes
Torsades de pointes
Ventricular Fibrillation
Ventricular Fibrillation
Supraventricular
Tachyarrhythmias
Atrial Flutter
Atrial Flutter
Atrial Fibrillation
Atrial Fibrillation
Atrial Fibrillation
Premature Beats
Premature Atrial Contractions (PAC)
Premature Atrial Contractions (PAC)
Premature Ventricular Contractions (PVC)
Metabolic Disorders
REFERENCES

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ELECTROCARDIOGRAPHY

MCC CORSINO I SAMPIANO

● Graphical representation of electrical

Standard Limb Leads

Location Precedes the QRS complex

Normal Duration 0.06-0.12 second

Normal 2-3 millimeters

Configuration Small, rounded and upright

Location Follows the PR Interval

Normal Duration 0.06-0.10 second

Normal Amplitude 5-30 millimeters

Configuration Q wave: first negative deflection after

Location Follows the S wave

Configuration Typically round and smooth

Interval between the beginning of atrial depolarization and

Location From the beginning of the P

Duration 0.12-0.20 second

Measures ventricular depolarization and repolarization

Location Extends from the beginning of

Duration 0.44-0.46 second

Reflects the time delay between the atrial and ventricular

Location Flat line between the end of the

Represents end of ventricular depolarization and beginning

Location Extends from the end of the S

Duration Usually isoelectric (neither

P wave Atrial depolarization 0.06-0.12 second

PR Interval Conduction delay within the AV 0.12-0.20 second

QRS Ventricular depolarization 0.06-0.10 second

QT Interval Ventricular depolarization and 0.44-0.46 second

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