Ecg Basics

USMD
Teona Abramishvili
2019
Cardiac cells (electrophysiologic types )
• Pacemaker Cells ( SA node, AV node)

• Specialized rapidly conducting tissues (

purkinje fibers )

• Ventricular and atrial muscle cells

Cardiac exitation
Cardiac depolarization and
repolarization
Depolarization and repolarization of
cardiac muscle cells
Placement of electrodes
STANDART CHEST LEADS
Precordial Leads

8
BIPOLAR AND AUGMENTED UNIPOLAR
LEADS
Conduction system of the heart
ECG WAVES AND CARDIAC CYCLE
MAJOR WAVES AND INTERVALS
Cardiac cycle on Ecg
 A system
 Quality of ECG?

 Rate
 Rhythm
 Axis

 P wave
 PR interval
 QRS duration
 QRS morphology
 Abnormal Q waves
 ST segment
 T wave
 QT interval
Calculating the rate
Calculating heart rate
Calculating the rate
P-wave
Abnormal P wave
PQ interval
QRS duration
 The R Wave

• The R wave is the first upward deflection

after the P wave (even when Q waves are
absent). The R wave is normally the easiest
waveform to identify on the ECG and
represents early ventricular depolarisation.
• The R wave may be enlarged with
ventricular hypertrophy, a thin chest wall or
with an athletic physique. It may be
reduced by a variety of mechanisms
including obesity.
 The S Wave

• The S wave is the first negative deflection

after the R wave. It represents the late
ventricular depolarisation.
 The Q Wave

• When visible, the Q wave is any initial

downward deflection after the P wave.
The normal Q wave represents septal
depolarisation.
Q wave
 QT interval
 Don’t worry about too much…

 Start of QRS to end of T wave

 Needs to be corrected for HR
 Various formulae
◦ eg. Bazett’s:

 Computer calculated often wrong

 Long QT can be genetic (long QT sy.) or secondary eg. drugs

(amiodarone, sotalol)
 Associated with risk of sudden death due to Torsades de Pointes
 The T Wave

• The T wave represents repolarisation of the ventricles. It is

normally upright, somewhat rounded, and slightly
asymmetric. Its morphology will alter with breath holding
and digitalis toxicity.
• The T wave may be inverted or flat with myocardial
ischaemia, bundle branch block, ventricular hypertrophy,
and ventricular ectopic beats. It is tall and peaked with
hyperkalaemia (potassium decreases the duration of the
refractory period and enhances repolarisation).
• The T wave is flat and notched with conditions such as
pericarditis, hypothyroid, and cardiomyopathies and flat
with hypokalaemia.
T WAVE
The heart axis deviation
Circle of axes
Normal ECG