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ACTION POTENTIAL
Polarization
Depolarization
Repolarization
ACTION POTENTIAL
CARDIAC CELLS
PROPERTIES
Automaticity
Excitability
Conductivity
Contractility
CONDUCTION SYSTEM
Internodal Pathway
CONDUCTION SYSTEM
Bundle of His
Rate : 40 60 bpm
Bundle Branches
LBB & RBB
LBB : anterior, posterior, septal
fascicles
Purkinje Fibers
Rate : 20 40 bpm
CONDUCTION SYSTEM
CONDUCTION SYSTEM
LEADS
Precordial Leads
V1, V2, V3, V4, V5, V6
V1R, V2R, V3R, V4R, V5R, V6R
LEADS
LEADS
LEADS
I, aVL
II, III, aVF
V1, V2
V3, V4
V5, V6
VIEW OF HEART
Lateral
Inferior
Septal
Anterior
Lateral
ECG WAVEFORMS
ECG WAVEFORMS
P wave
ECG WAVEFORMS
PR interval
ECG WAVEFORMS
QRS Complex
ECG WAVEFORMS
ST Segment
Isoelectric (flat)
ECG WAVEFORMS
T wave
ECG WAVEFORMS
RATE MEASUREMENT
Large Boxes 300/R-R interval
Small Boxes 1500/R-R interval
Six-Second Method count the
number of complete QRS
complexes in 6 seconds
AXIS DEVIATION
ABNORMAL
WAVEFORMS
P : tall, notched
P : tall, notched
PR interval : prolonged, shortened
Q : pathologic Q (>0.04 sec, 25% of the R
wave)
QRS complex : widened (>0.10 sec)
ST segment : depression (>1 mm),
elevation (>1 mm in limb leads or >2mm
in precordial leads)
T : peaked/tall, inverted, flattened
QT interval : prolonged, shortened
ABNORMAL
WAVEFORMS
ABNORMAL
WAVEFORMS
R-WAVE PROGRESSION
Poor R-wave progression :
Infarction (anteroseptal)
LBBB
LVH
Severe COPD (emphysema)
ATRIAL ENLARGEMENT
Left Atrial Enlargement
Notched P wave
Right Atrial Enlargement
Peaked P Wave
VENTRICULAR
HYPERTROPHY
VENTRICULAR
HYPERTROPHY
RAD
Reversed R-wave progression (taller R waves and
smaller S waves in V1 & V2; deeper S waves & small R
waves in V5 & V6
MYOCARDIAL
INFARCTION
MYOCARDIAL
INFARCTION
MYOCARDIAL
INFARCTION
MYOCARDIAL
INFARCTION
MYOCARDIAL
INFARCTION
MYOCARDIAL
INFARCTION
Evolutionary changes in
anteroseptal myocardial
infarction
At admission
B. At 24 hours
C. At 48 hours
A.
MYOCARDIAL
INFARCTION
Evolutionary changes in
inferior and right
ventricular infarction
A.
B.
C.
At admission
At 12 hours
Right chest leads
CAUSES OF
DYSRHYTHMIAS
Enhanced Automaticity
Reentry
Escape Beats
Conduction Disturbances
SUPRAVENTRICULAR
ARRHYTHMIAS
Supraventricular Tachycardia
SUPRAVENTRICULAR
ARRHYTHMIAS
Atrial Flutter
SUPRAVENTRICULAR
ARRHYTHMIAS
VENTRICULAR
ARRHYTHMIAS
Ventricular Tachycardia
VENTRICULAR
ARRHYTHMIAS
Ventricular Fibrillation
Rate : indeterminate
Rhythm : chaotic
P waves : none
PR interval : none
QRS : none
VENTRICULAR
ARRHYTHMIAS
Torsades de Pointes
EXTRASYSTOLE
Rhythm
Rate
P wave
PR interval
QRS
EXTRASYSTOLE
Rhythm
: irregular due to the premature beat
Rate
: depends on its basic rhythm
P wave
: none
PR interval
: none
QRS
: > 0.12 sec
Threatening VES :
R on T VES
VES > 6 times/min
Bigemini VES
Multifocal VES
Consecutive VES
EXTRASYSTOLE
BLOCKS
Rate : normal
Rhythm : regular
P waves : normal
PR interval : prolonged (>0.20 sec) but constant
QRS : usually 0.10 sec or less
BLOCKS
BLOCKS
BLOCKS
BLOCKS
BLOCKS
BLOCKS
Fascicular Block/Hemiblock
PULSELESS ELECTRICAL
ACTIVITY (PEA)
Electrical activity is seen in ECG but
no pulse is detected when palpating
the artery
Danke !