VVK Ecg

An Introduction to the
12 lead ECG
Dr. Vivek lohan

Electrocardiography
• A recording of the electrical activity of the heart

• Gold standard for diagnosis of cardiac arrhythmias
• Helps detect electrolyte disturbances
• Allows for detection of conduction abnormalities
• Screening tool for ischemic heart disease during
stress tests
• Helpful with non-cardiac diseases (e.g. pulmonary
embolism or hypothermia
Chest Leads
6 Unipolar leads
Also known as precordial leads
V1, V2, V3, V4, V5 and V6 - all positive
ECG Graph Paper
• Runs at a paper speed of 25 mm/sec
• Each small block of ECG paper is 1 mm2
•one small block equals 0.04 s
•Voltage: 10 mm = 1 mV
Recording an ECG
1. Explain procedure to patient,
obtain consent and check for
allergies
2. Check cables are connected
3. Ensure surface is clean and dry
4. Ensure electrodes are in good
contact with skin
5. Enter patient data
6. Wait until the tracing is free
from artifact
7. Request that patient lies still.
8. Push button to start tracing
• A good basic knowledge of the heart and
cardiac function is essential in order to
understand the 12 lead ECG
• Anatomical position of the heart

• Coronary Artery Circulation
• Conduction System
Anatomical Position
of the Heart
• Lies in the mediastinum behind the sternum
• between the lungs, just above the diaphragm
• the apex (tip of the left ventricle) lies at the fifth intercostal space, mid-
clavicular line
Coronary Artery Circulation
Coronary Artery Circulation
Right Coronary Artery
• right atrium
• right ventricle
• inferior wall of left ventricle
• posterior wall of left ventricle
• 1/3 interventricular septum
Surfaces of the Left Ventricle
• Inferior - underneath
• Anterior - front
• Lateral - left side
• Posterior - back
Inferior Surface
• Leads II, III and avF look UP from below to the inferior
surface of the left ventricle
• Mostly per fused by the Right Coronary Artery
Inferior Leads
–II
–III
–aVF
Anterior Surface
• The front of the heart viewing the left ventricle and the
septum
• Leads V2, V3 and V4 look towards this surface
• Mostly fed by the Left Anterior Descending branch of the
Left artery
Anterior Leads
– V2
– V3
– V4
Lateral Surface
• The left sided wall of the left ventricle
• Leads V5 and V6, I and avL look at this surface
• Mostly fed by the Circumflex branch of the left artery
Lateral Leads
V5, V6, I, aVL

Posterior Surface
• Posterior wall infarcts are rare
• Posterior diagnoses can be made by looking at the anterior
leads as a mirror image. Normally there are inferior
ischemic changes
• Blood supply predominantly from the Right Coronary
Artery
RIGHT LEFT
Inferior Antero-Septal
II, III, AVF V1,V2, V3,V4
Lateral
Posterior I, AVL, V5, V6
V1, V2, V3
The standard 12 Lead ECG
6 Limb Leads 6 Chest Leads (Precordial leads)
avR, avL, avF, I, II, III V1, V2, V3, V4, V5 and V6
Views the surfaces of the left ventricle from

12 different angles
Limb leads Chest Leads
Limb Leads
3 Unipolar leads
• avR - right arm (+)

• avL - left arm (+)
• avF - left foot (+)
• note that right foot is a ground lead

Limb Leads
3 Bipolar Leads
form (Einthovens Triangle)
Lead I - measures electrical potential

between right arm (-) and left arm (+)
Lead II - measures electrical potential

between right arm (-) and left leg (+)
Lead III - measures electrical potential

between left arm (-) and left leg (+)
Elements of the ECG:
•The P wave represents atrial depolarisation
•the PR interval is the time from onset of atrial activation to onset of ventricular
activation
•The QRS complex represents ventricular depolarisation
•The S-T segment should be iso-electric, representing the ventricles before
repolarisation
•The T-wave represents ventricular repolarisation
•The QT interval is the duration of ventricular activation and recovery.
Elements of the ECG:
P wave
• Depolarization of both atria;
• Relationship between P and QRS helps
distinguish various cardiac arrhythmias
• Shape and duration of P may indicate atrial
enlargement
QRS complex:
• Represents ventricular depolarization
• Larger than P wave because of greater muscle mass of
ventricles
• Normal duration = 0.08-0.12 seconds
• Its duration, amplitude, and morphology are useful in
diagnosing cardiac arrhythmias, ventricular
hypertrophy, MI, electrolyte derangement, etc.
• Q wave greater than 1/3 the height of the R wave,
greater than 0.04 sec are abnormal and may represent
MI
PR interval
• From onset of P wave to onset of QRS
• Normal duration = 0.12-2.0 sec (120-200
ms) (3-4 horizontal boxes)
• Represents atria to ventricular conduction
time (through His bundle)
• Prolonged PR interval may indicate a 1st
degree heart block
T wave
• Represents depolarization or recovery of
ventricles
• Interval from beginning of QRS to apex of
T is referred to as the absolute refractory
period
ST segment
• Connects the QRS complex and T wave
• Duration of 0.08-0.12 sec (80-120 msec
QT Interval
• Measured from beginning of QRS to the end of the
T wave
• Normal QT is usually about 0.40 sec
• QT interval varies based on heart rate
ECG
• 3 distinct waves are
produced during
cardiac cycle
• P wave caused by
atrial depolarization
• QRS complex
caused by ventricular
depolarization
• T wave results from
ventricular
repolarization
Fig 13.24
13-63
Part II

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An Introduction to the

Dr. Vivek lohan

• A recording of the electrical activity of the heart

• Anatomical position of the heart

• Lateral - left side

V5, V6, I, aVL

Views the surfaces of the left ventricle from

• avR - right arm (+)

• note that right foot is a ground lead

Lead I - measures electrical potential

Lead II - measures electrical potential

Lead III - measures electrical potential

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