THE BASICS OF EKG

PRESENTED BY:
Raghwender Singh (D- 754)
 INRODUCTION
 ECG or EKG

 ECG is essential for diagnosis

 Essential in management of cardiac rhythm

 Helps in diagnosis of chest pain

 Proper use of thrombolysis in treatment of MI depend

upon it
 HISTORY

 1842- Italian scientist Carlo Matteucci realizes that

electricity is associated with the heart beat

 1872- French scientist Gabriel Lippmann , invented the

capillary electrometer which can measure electricity by
utilizing mercury

 1876- Irish scientist Marey analyzes the electric pattern of

frog’s heart
 CONTD…

 1895 - William Einthoven , credited for the invention of

EKG

 1906 - using the string electrometer EKG,

William Einthoven diagnoses some heart problems

 1924 - the noble prize for physiology or medicine is given to

William Einthoven for his work on EKG
MODERN ECG INSTRUMENT
 ELECTRICITY OF HEART

 Contraction of any muscle is associated with electrical

charges called depolarization

 These changes can be detected by electrodes attached to

the surface of the body

 Although the heart has 4 chambers, from the electrical

point it is having only 2
 THE WIRING DIAGRAM OF
THE HEART

• SA

• AV node

• Bundle of His

• Bundle branches (left and right)

 THE SHAPE OF ECG

• Contraction of atria - P wave

 Ventricular depolarization - QRS complex

 Ventricular repolarization - T wave

NORMAL ECG
ECG INTERPRETATION
 RELATIONSHIP BETWEEN THE NUMBER OF
LARGE SQUARES COVERED BY R-R INTERVAL
AND THE HEART RATE

R-R INTERVAL(large squares) HEART RATE (beats/min)

1 300

2 150

3 100

4 75

5 60

6 50
ECG RHYTHM
 NORMAL SINUS RHYTHM
Looking at the ECG you'll see that:-

• RHYTHM - Regular
• RATE - (60-100 bpm)
• QRS DURATION - Normal
• P WAVE -Visible before each QRS complex
• P-R INTERVAL - Normal (<5 small Squares. Anything
above and this would be 1st degree
block)

• Indicates that the electrical signal is generated by the sinus

node and travelling in a normal fashion in the heart.
NORMAL SINUS RHYTHM
 SINUS BRADYCARDIA
Looking at the ECG you'll see that:-

• RHYTHM - Regular
• RATE - Less than 60 beats per minute
• QRS DURATION - Normal
• P WAVE -Visible before each QRS
complex
• P-R INTERVAL - Normal

• Usually benign and often caused by patients on beta

blockers
SINUS BRADYCARDIA
 SINUS TACHYCARDIA
Looking at the ECG you'll see that:-

• RHYTHM - Regular
• RATE - More than 100 beats per minute
• QRS DURATION - Normal
• P WAVE -Visible before each QRS complex
• P-R INTERVAL - Normal

• The impulse generating the heart beats are normal, but they
are occurring at a faster pace than normal. Seen during
exercise
SINUS TACHYCARDIA
 ECG RULES
 If you follow Professor Chamberlains 10 rules they'll
give you an understanding of what is normal:-
 RULE 1

PR interval should be 120 to 200

milliseconds or 3 to 5 little squares
 RULE 2

The width of the QRS complex should not

exceed 110 ms, less than 3 little squares
 RULE 3

The QRS complex should be dominantly upright in

leads I and II
 RULE 4

QRS and T waves tend to have the same general

direction in the limb leads
 RULE 5

All waves are negative in lead

aVR
 RULE 6

The R wave must grow from V1 to at least V4

The S wave must grow from V1 to at least V3
and disappear in V6
 RULE 7

The ST segment should start isoelectric except in V1

and V2 where it may be elevated
 RULE 8

The P waves should be upright in I, II, and V2 to V6

 RULE 9

There should be no Q wave or only a small q less than

0.04 seconds in width in I, II, V2 to V6
 RULE 10

The T wave must be upright in I, II, V2 to V6

REFERENCES:-
 The EKG made easy-John R. Hampton
 www.ambulancetechnicianstudy.co.uk
 www.learntheheart.com