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The Electrocardiogram

as an example of electrostatics
Introduction
This set of slides contains some background relevant to the
underlying physics explaining the electrocardiogram.
These slides were taken from 12 Lead EKG STAT! A light hearted
approach by D.M. Koenig, D. Topp, and L.G. Vonfrolio (edited
by M.L. Kahn, MD). An interactive program is available to study
ECGs more in detail, particularly from a medical point of view
(start programma).
A detailed physical description of the electrocardiogram is
provided by Russel K. Hobbie in the paper The Elctrocardiogram
as an example of electrastatics, Am.J.Phys.41(1973)824-831, and
in his book Intermediate Physics for Medicine and Biology,
Chapter 7 (pp. 181-205).
Electrocardiography (ECG, EKG)

• Electrocardiography - graphic recording of the electrical activity


(potentials) produced by the conduction system and the myocardium of
the heart during it depolariztion / repolarization cycle.

• During the late 1800's and early 1900's, Dutch physiologist Willem
Einthoven developed the early elctrocardiogram. He won the Nobel
prize for its invention in 1924.
• Hubert Mann first uses the electrocardiogram to describe
electrocardiographic changes associated with a heart attack in 1920.

• The science of electrocardiography is not exact. The sensitivity and


specificity of the tool in relation to various diagnoses are relatively low

• Electrocardiograms must be viewed in the context of other clinical


test correlates. They are especially useful when compared across
time to see how the electrical activity of the heart has changed
(perhaps as the result of some pathology).
Time

= outward ion movement (exiting the cell)

= inward ion movement (going into the cell)


Na+
tnerruC

- 40 mv K+
Threshold Ca++
Depolarization

Atrial Muscle (Nodal) Action Potential


Action Potential of a Myocardial Cell
+25
Overshoot 1 Corresponding ECG Overlay
+10 mv
0
2
-25

-50
0

-75
4
-100 SNP
ARP RRP
Resting Potential Active Transport
- 90 mv K+ Na+ out K+ back in
Na+ Ca++
Depolarization Wave of a Strip of Nerve Cells + +

(or Myocardial Muscle Cells minus the depiction of Ca influx)

“Wave of Depolarization“ or ”Propigation of Action Potential” moving from left to right

Polarized Repolarizing Depolarized Depolarizing Polarized


Cell Cell Cell Cell Cell
( K+ efflux ) ( Na+ influx )

Na+ Na+ Na+

K+ Na+ K+ Na+ K+ K+ K+
---- ++++ ----
++++ ---- ++++

The needle of this The needle of this


The needle of this recording electrode recording
recording electrode is biphasic electrode inscribes
inscribes a totally because half of the a totally positive
negative complex time the wave of complex because
because the wave depolarization is the wave of
of depolariztion is moving towards it depolariztion is
moving away from while the other half moving towards it
it during the entire of the time it is during the entire
time the strip is moving away time the strip is
depoarizing from it depoarizing
The Concept of a "Lead"

Lead I - +

G
Electrocardiograph

• Right arm (RA) negative, left arm (LA) positive, right


leg (RL) ground……this arrangement of electrodes
enables a "directional view" recording of the heart's
electrical potentials as they are sequentially activated
throughout the entire cardiac cycle
- +
The Concept of a "Lead"
Lead I

• The directional flow of electricity from Lead I can be


viewed as flowing from the RA toward the LA and
passing through the heart. Also, it is useful to imagine a
camera lens taking an "electrical picture" of the heart
with the lead as its line of sight
The Concept of a "Lead"
The Limb Leads

LEAD AVR LEAD AVL


-150o -30o

0o
LEAD I

60o
120o LEAD II
90o
LEAD III
LEAD AVF

• Each of the limb leads (I, II, III, AVR, AVL, AVF)
can be assigned an angle of clockwise or
counterclockwise rotation to describe its position in
the frontal plane
The Concept of a "Lead" LA
Leads I II III
RA
- -

RA - + LA
LEAD I

LEAD III +LL


LL
+
LEAD II

Remember, the RL
is always the ground

• By changing the arrangement of which arms or legs


are positive or negative, two other leads ( II & III ) can be
created and we have two more "pictures" of the heart's
electrical activity from different angles
The Concept of a "Lead"
RA & LA
Leads AVR AVL AVF
-
LEAD AVR LEAD AVL
RA +
+ LA

- -
RA & RL LL & LA
LEAD AVF
LL +
• By combining certain limb leads into a central
terminal, which served as the negative electrode,
other leads could be formed to "fill in the gaps" in
terms of the angles of directional recording. These
leads required augmentation of voltage to be read and
are thus labeled.
The Concept of a "Lead"
The Precordial Leads
• Each of the precordial leads is unipolar (1 electrode
constitutes a lead) and is designed to view the electrical
activity of the heart in the horizontal or transverse
plane

V1 V2
V3
V4 V5 V6
Hexaxial Array for Axis Determination
determination of the angle of the main
cardiac vector in the frontal plain
Lead I Example 1

If lead I is mostly positive, the


axis must lie in the right half of
of the coordinate system
If lead AVF is mostly positive, the
Lead AVF
axis must lie in the bottom half of
of the coordinate system
I AVF Combining the two plots, we see
that the axis must lie in the bottom
right hand quadrant
Once the quadrant has been
I AVF AVL determined, find the most
equiphasic or smallest limb lead.
The axis will lie about 90o away
from this lead. Given that AVL is
the most equiphasic lead, the axis
here is at approximately 60o.
Since QRS complex in AVL is a
I AVF AVL slightly more positive, the true
axis will lie a little closer to AVL
(the depolarization vector is
moving a little more towards AVL
than away from it). A better
estimate would be about 50o.
Example 2 If lead I is mostly negative, the
axis must lie in the left half of
Lead I of the coordinate system
Lead AVF If lead AVF is mostly positive, the
axis must lie in the bottom half of
of the coordinate system
I AVF
Combining the two plots, we see
that the axis must lie in the bottom
left hand quadrant (Right Axis
Deviation)
I AVF II Once the quadrant has been
determined, find the most
equiphasic or smallest limb lead.
The axis will lie about 90o away
from this lead. Given that II is the
most equiphasic lead, the axis
here is at approximately 150o.
Since the QRS in II is a slightly
I AVF II more negative, the true axis will
lie a little farther away from lead II
than just 90o (the depolarization
vector is moving a little more
away from lead II than toward it).
A better estimate would be 160o.
Precise calculation of the axis can be done using the
coordinate system to plot net voltages of perpendicular
leads, drawing a resultant rectangle, then connecting the
origin of the coordinate system with the opposite corner
of the rectangle. A protractor can then be used to
measure the deflection from 0. Consider the example:

Since Lead III is the most


equiphasic lead and it is
slightly more positive than
negative, this axis could be
estimated at about 40o.
ECG basics
.1 mv paper
Voltage

.5 mv

.04 seconds Time .20 seconds


Paper speed = 25mm / second
Heart Rate = number of R-waves in a 6 second strip divided by 10
= 1500 divided by the number of small boxes between consecutive R-waves
= large square estimation counts ( 300 - 150 - 100 - 75 - 60 - 50 - 43 )
= 1500 divided by the number of small boxes between consecutive R-waves
= large square estimation counts ( 300 - 150 - 100 - 75 - 60 - 50 - 43 )