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EKG Introduction

The electrocardiogram (ECG or EKG) records the electrical activity of the heart over time and can detect cardiac arrhythmias, electrolyte disturbances, and conduction abnormalities. It is useful for diagnosing ischemic heart disease during stress tests and some non-cardiac conditions. The ECG graph paper records voltage and time intervals that are analyzed to evaluate the P wave, PR interval, QRS complex, ST segment, T wave, and QT interval which provide information on atrial and ventricular depolarization and recovery. Common arrhythmias like AV node block and atrial flutter that can be detected on ECG are described.

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96 views

EKG Introduction

The electrocardiogram (ECG or EKG) records the electrical activity of the heart over time and can detect cardiac arrhythmias, electrolyte disturbances, and conduction abnormalities. It is useful for diagnosing ischemic heart disease during stress tests and some non-cardiac conditions. The ECG graph paper records voltage and time intervals that are analyzed to evaluate the P wave, PR interval, QRS complex, ST segment, T wave, and QT interval which provide information on atrial and ventricular depolarization and recovery. Common arrhythmias like AV node block and atrial flutter that can be detected on ECG are described.

Uploaded by

Jj Jung
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Electrocardiography

Arecordingoftheelectricalactivityoftheheartovertime
Goldstandardfordiagnosisofcardiacarrhythmias
Helpsdetectelectrolytedisturbances(hyper&hypokalemia)
Allowsfordetectionofconductionabnormalities
Screeningtoolforischemicheartdiseaseduringstresstests
Helpfulwithnoncardiacdiseases(e.g.pulmonaryembolismor
hypothermia

Electrocardiogram(ECG/EKG)
Isarecordingofelectricalactivityofheartconductedthruionsin
bodytosurface

ECGGraphPaper

Runsatapaperspeedof25mm/sec
EachsmallblockofECGpaperis1mm2
Atapaperspeedof25mm/s,onesmallblockequals0.04s
Fivesmallblocksmakeup1largeblockwhichtranslatesinto0.20
s(200msec)
Hence,thereare5largeblockspersecond
Voltage:1mm=0.1mVbetweeneachindividualblockvertically

Normalconductionpathway:

SAnode>atrialmuscle>AVnode>bundleofHis>Leftand
RightBundleBranches>Ventricularmuscle

TypesofECGRecordings
Bipolarleadsrecordvoltage
betweenelectrodesplacedon
wrists&legs(rightlegis
ground)
LeadIrecordsbetweenright
arm&leftarm
LeadII:rightarm&leftleg
LeadIII:leftarm&leftleg

ElementsoftheECG:
Pwave:Depolarizationofbothatria;
RelationshipbetweenPandQRShelpsdistinguishvariouscardiac
arrhythmias
ShapeanddurationofPmayindicateatrialenlargement

PRinterval:fromonsetofPwavetoonsetofQRS
Normalduration=0.122.0sec(34horizontalboxes)
Representsatriatoventricularconductiontime(throughHisbundle)
ProlongedPRintervalmayindicatea1stdegreeheartblock
QRScomplex:Ventriculardepolarization
LargerthanPwavebecauseofgreatermusclemassofventricles
Normalduration=0.080.12seconds
Itsduration,amplitude,andmorphologyareusefulindiagnosingcardiac
arrhythmias,ventricularhypertrophy,MI,electrolytederangement,etc.
Qwavegreaterthan1/3theheightoftheRwave,greaterthan0.04secare
abnormalandmayrepresentMI

STsegment:
ConnectstheQRScomplexandTwave
Durationof0.080.12sec(80120msec
Twave:
Representsrepolarizationorrecoveryofventricles
IntervalfrombeginningofQRStoapexofTisreferredto
astheabsoluterefractoryperiod
QTInterval
MeasuredfrombeginningofQRStotheendoftheTwave
NormalQTisusuallyabout0.40sec
QTintervalvariesbasedonheartrate

ElementsoftheECG:

Pwave
Depolarizationofbothatria;

RelationshipbetweenPandQRShelpsdistinguishvarious
cardiacarrhythmias
ShapeanddurationofPmayindicateatrialenlargement

QRScomplex:
Representsventriculardepolarization
LargerthanPwavebecauseofgreatermusclemassofventricles
Normalduration=0.080.12seconds
Itsduration,amplitude,andmorphologyareusefulindiagnosingcardiac
arrhythmias,ventricularhypertrophy,MI,electrolytederangement,etc.
Qwavegreaterthan1/3theheightoftheRwave,greaterthan0.04secare
abnormalandmayrepresentMI

PRinterval:
FromonsetofPwavetoonsetofQRS
Normalduration=0.122.0sec(120200ms)(34horizontal
boxes)
Representsatriatoventricularconductiontime(throughHis
bundle)
ProlongedPRintervalmayindicatea1stdegreeheartblock

Twave:

Representsrepolarizationorrecoveryofventricles
IntervalfrombeginningofQRStoapexofTisreferredto
astheabsoluterefractoryperiod

STsegment:

ConnectstheQRScomplexandTwave
Durationof0.080.12sec(80120msec

QTInterval

MeasuredfrombeginningofQRStotheendoftheTwave
NormalQTisusuallyabout0.40sec
QTintervalvariesbasedonheartrate

IschemicHeartDisease
Ismostcommonlyduetoatherosclerosisin
coronaryarteries
Ischemiaoccurswhenbloodsupplytotissueis
deficient
Causesincreasedlacticacidfromanaerobicmetabolism

Oftenaccompaniedbyanginapectoris(chestpain)

IschemicHeartDisease
DetectablebychangesinSTsegmentofECG
Myocardialinfarction(MI)isaheartattack
Diagnosedbyhighlevelsofcreatinephosphate(CPK)&lactate
dehydrogenase(LDH)

ArrhythmiasDetectedonECG
Arrhythmiasareabnormalheartrhythms
Heartrate<60/minisbradycardia;>100/minis
tachycardia

ArrhythmiasDetectedonECG
Influttercontractionratescanbe200300/min
Infibrillationcontractionofmyocardialcellsis
uncoordinated&pumpingineffective
Ventricularfibrillationislifethreatening
Electricaldefibrillationresynchronizesheartbydepolarizingallcellsatsame
time

ArrhythmiasDetectedonECG
AVnodeblockoccurwhennodeisdamaged
FirstdegreeAVnodeblockiswhenconductionthroughAVnode>
0.2sec
CauseslongPRinterval

SeconddegreeAVnodeblockiswhenonly1outof24atrialAPs
canpasstoventricles
CausesPwaveswithnoQRS

InthirddegreeorcompleteAVnodeblocknoatrialactivitypassesto
ventricles
VentriclesdrivenslowlybybundleofHisorPurkinjes

ArrhythmiasDetectedonECG
AVnodeblockoccurswhennodeisdamaged
FirstdegreeAVnodeblockiswhenconduction
thruAVnode>0.2sec
CauseslongPRinterval

ArrhythmiasDetectedonECG
SeconddegreeAVnodeblockiswhenonly1outof2
4atrialAPscanpasstoventricles
CausesPwaveswithnoQRS

ArrhythmiasDetectedonECG
InthirddegreeorcompleteAVnodeblock,noatrialactivity
passestoventricles
VentriclesaredrivenslowlybybundleofHisorPurkinjes

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