Electrocardiography

An ECG is simply a representation of the

electrical activity of the heart muscle as it
changes with time, usually printed on paper
for easier analysis.
Like other muscles, cardiac muscle contracts in
response to electrical depolarization of the
muscle cells.
 Steps in Recording an ECG
Patient in supine position
Adequate skin preparation
Turn on ECG machine to warm up
Attach leads to the patient
Center stylus
Standardize the ECG tracing to 1 mV
Start recording the 12 lead ECG
Record special leads if needed
Proper labeling of the tracing
CARDIAC CONDUCTION SYSTEM
 Determination of Rate
25 mm. x 60 sec. = 1500 mm
sec. min.
Rate/min. = 1500
number of small squares
 Normal Intervals
PR interval Normal range 120 200 ms (3 5 small squares on ECG paper).
QRS duration. Normal range up to 120 ms (3 small squares on ECG paper).
QT interval Normal range up to 440 ms
Normal:
0.35-0.43 for men
0.35-0.45 for women
Corrected QT

ST segment
Normal: 0.5-1mm from the midline
Elevation infarct or acute injury
Depression ischemia
 12 SURFACE LEADS OF ECG
6 limb leads
Bipolar leads: I, II, III
Augmented or unipolar leads: AVR, AVF, AVL
6 chest leads
V1-V6
 12 SURFACE LEADS OF ECG
DIRECTION OF DEPOLARIZATION DEFLECTION
Towards (+) side Positive
Away from (+) side Negative
Perpendicular Isoelectric
 HEXAXIAL SYSTEM
The axis is the indicator of the general direction of the
wave of depolarization as it flows through the
ventricles
Identifies what are the leads looking at the lateral wall
and inferior wall
Inferior wall leads
Lead II
Lead III
AVF
High Lateral wall leads
Lead I
AVL
 HEXAXIAL SYSTEM

Normal axis: +90 to -30

The normal axis is in the right
lower quadrant
Lead I and AVF a normal axis
associated with positive
deflections and point to the left
and downward

Upper right quadrant= left axis

deviation
Left lower quadrant= right axis
deviation
Upper left quadrant= extreme
right axis deviation
 CHEST LEADS/PRECORDIAL LEADS
To view the SEPTUM of the
heart
V1: 4th ICS R of the sternum
V2: 4th ICS L of the sternum
These leads will look at the
signals on the R ventricle and
Septum

ANTERIOR WALL of the heart

V3: between V2 and V4
V4: 5th LICS MCL

LATERAL WALL of the heart

V5: LAAL
V6: LMAL
 CONTIGUOUS LEADS
Inferior
Lead II
Lead III
Avf

Lateral
V5
V6
Lead I
aVL

Antero-septal
V1-V4
 SYSTEMIC APPROACH TO ECG
INTERPRETATION
Regularity
Rate
Rhythm
Basic intervals
QRS axis
Abnormalities
 SYSTEMIC APPROACH TO ECG
INTERPRETATION
Regularity
Regular or irregular?

Rate
Count the number of
QRS complex in a 6 sec
strip them multiply by 10
Rate/min= no. of
complexes (in a 6 sec
strip)x 10
Count number of small
squares between 2
successive R
300-150-100-75-60-50
 INTERPRETATION
Rhythm
Normal sinus rhythm
Look for p wave and it should be followed by
normal QRS complex tat a regular rate
1:1 conduction
Normal sinus rhythm rate = 60-100bpm
Regular RR interval cycle length not >10%
PR interval= 0.12-0.20 sec
Upright in leads I, II, aVL, and L precordial leads
 INTERPRETATION
Basic Intervals
PR
QRS duration
QT
QTC
 INTERPRETATION
QRS axis
Equiphasic Waveforms
1. Look for the lead with an
equiphasic deflection.
(The electrical current is
perpendicular to it)
2. Use the lead
perpendicular to it to tell
you whether it is (+) or (-)
3. If there are no leads that
are equiphasic, choose
the lead with the smallest
deflection as if it were
equiphasic. That is, the
axis will be perpendicular
to that lead.
 INTERPRETATION
QRS axis
Smallest deflection
1. Check the lead parallel to the
current flow to see if the
direction of the axis is (+) or (-)
2. An adjustment is made since
the lead perpendicular to the
current flow is not equiphasic
3. See if the smallest deflection
is (+) or (-)
If more (+) move axis slightly
towards the (+) electrode
If more (-) move axis slightly
away from (+) electrode