ST2362 Symulator Arytmii Serca W

Arrhythmia Monitor
ST2362
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Learning Material
Ver.1.1
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An ISO 9001:2008 company

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Save paper, save trees, save earth
Dear User,
We request you to use the Learning material in the CD form
provided with this supply.
Your this act will help to save paper.

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Please remember that each paper manual requires 50-100 sheets of paper
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on an average.
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Your CD learning material has

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colourful diagrams,
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plenty of theory,
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detailed experiments with observation tables,

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frequently asked questions, etc.
.. and more so sometimes videos as well.
- Scientech Eco Foundation
Scientech Technologies Pvt. Ltd. 2

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ST2362
Arrhythmia Monitor
ST2362
Table of Contents
1 Safety Instructions 6
2 Introduction 7
3 Features 8
4 Technical Specifications 9
5 Controls and indicators 11
6 Arrhythmia Monitor 12
7 Types of Arrhythmia 14
8 Operating Instructions 24
9 Experiments
Experiment 1 25
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Study of Bradycardia
Experiment 2 26
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Study of Tachycardia

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Experiment 3 27
Study of Atrial Fibrillation

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Experiment 4 28
Study of Atrial Flutter

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Experiment 5 29
Study of Premature Atrial Contraction
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Experiment 6 30
Study of Multifocal Atrial Tachycardia
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Experiment 7 31
Study of Paroxysmal Supra Ventricular Tachycardia
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Experiment 8 32
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Study of Sick Sinus Syndrome

Experiment 9 33
Study of Sinus Tachycardia
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Experiment 10 34
Study of Premature Ventricular Contraction
Experiment 11 35
Study of Accelerated Idioventricular Rhythm
Experiment 12 36
Study of Ventricular Tachycardia
Experiment 13 37
Study of Ventricular Fibrillation
Experiment 14 38
Study of Polymorphic Ventricular Tachycardia

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Experiment 15 39
Study of Atrio-Ventricular Nodal Re-entrant Tachycardia
Experiment 16 40
Study of Wolf Parkinson Syndrome
Experiment 17 41
Study of Long QT Syndrome
Experiment 18 42
Study of Junctional Rhythm
Experiment 19 43
Study of Junctional Tachycardia
Experiment 20 44
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Study of I Degree AV Block
Experiment 21 45
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Study of II Degree AV Block
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Experiment 22 46
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Study of III Degree AV Block
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10. Frequently Asked Questions 47

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11. Glossary of Human Cardiovascular System Terms 60

12. Warranty 61
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13. List of Accessories 61

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Safety Instructions
Read the following safety instructions carefully before operating the instrument. To
avoid any personal injury or damage to the instrument or any product connected to it.
Do not operate the instrument if suspect any damage to it.
The instrument should be serviced by qualified personnel only.
For your safety:

Use proper Mains cord : Use only the mains cord designed for this instrument.
Ensure that the mains cord is suitable for your
country.
Ground the Instrument : This instrument is grounded through the protective
earth conductor of the mains cord. To avoid electric
shock the grounding conductor must be connected to
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the earth ground. Before making connections to the

input terminals, ensure that the instrument is properly
grounded.
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Observe Terminal Ratings : To avoid fire or shock hazards, observe all ratings and
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marks on the instrument.

Use only the proper Fuse : Use the fuse type and rating specified for this
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instrument.
Use in proper Atmosphere : Please refer to operating conditions given in the
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manual.
1. Do not operate in wet / damp conditions.
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2. Do not operate in an explosive atmosphere.

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3. Keep the product dust free, clean and dry.

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Introduction
Arrhythmia is any of a group of conditions in which the electrical activity of the
heart is irregular or is faster or slower than normal. Some arrhythmias are life-
threatening medical emergencies that can cause cardiac arrest and sudden death.
Others cause aggravating symptoms, such as an awareness of a different heart beat, or
palpitation, which can be annoying. Some are quite minor and can be regarded as
normal. Sinus arrhythmia is the mild acceleration followed by slowing of the normal
rhythm that occurs with breathing. In adults the normal resting heart rate ranges from
60 beats per minute to 100 beats per minute. The normal heart beat is controlled by a
small area in the upper chamber of the heart called the sinoatrial node or sinus node.
The sinus node contains specialized cells that have spontaneous electrical activity that
starts each normal heart beat.
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Features
The Arrhythmia is divided into the 5 groups viz. Atrial Arrhythmia,
Ventricular Arrhythmia, Atrio-Ventricular Arrhythmia, Junctional
Arrhythmia, Heart Blocks
Provides information about 22 abnormal (Diseased) waves which indicates
particular abnormality in heart
Every Systolic action of heart is indicated by LED (visible) and audible
(Buzzer) sound controls
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RoHS Compliance
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Scientech Products are RoHS Complied.
RoHS Directive concerns with the restrictive use of Hazardous substances (Pb, Cd, Cr, Hg,
Br compounds) in electric and electronic equipments.
Scientech products are Lead Free and Environment Friendly.
It is mandatory that service engineers use lead free solder wire and use the soldering irons
upto (25 W) that reach a temperature of 450C at the tip as the melting temperature of the
unleaded solder is higher than the leaded solder.

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Technical Specifications
Heartbeat Indication : Both visible (LED) and Audible

(Buzzer) controls
Output wave amplitude range : 1-5 Volts
Power Supply : 220/110V 10%, 50Hz / 60Hz
Dimensions (mm) : W 336 D 266 H 54
Weight : 1 Kg (approximately)
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Figure 1
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Controls and Indicators

Power On/Off:
Rocker mains switch for supplying power to the instrument
On-board buzzer:
Audio indication for each heartbeat event executed by heart of human body
On-board LED:
Visible indication for each systole of human Heart
Selection Switch:
A rotary switch is provided to select particular diseased wave
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Arrhythmia Monitor
An Arrhythmia Monitor is basically a sophisticated alarm system. It is not an ECG
interpretation system. It constantly scans the ECG rhythm patterns and issue alarms to
events that may be premonitory or life threatening. The complex computerised system
is useful for multi patient set-ups and can help detect arrhythmia of a wide variety at
graded alarm level. The Arrhythmia, which the instruments are designed to detect, is
premature QRS complexes, widened QRS complexes and runs of widened complexes.
Since the ECG of each patient is different, the instruments generally base their
determination of abnormal or ectopic beats upon a reference obtained from patient
himself. Therefore, any Arrhythmia Monitoring instrument will operate in the
following sequence:
Stores a normal QRS for reference particularly QRS width and R-R interval.
Initiates an alarm automatically, when ectopic beats are detected- either the
ventricular premature or widened varieties.
Gives alarm light signals whenever the premature or widened ectopic beats exist
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up to the rate of 6/min or 12/min.

Detects and triggers alarm when artifacts are present at the source, e.g. muscle
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more due to patient movement, base line shift and improperly connected
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electrodes.
QRS Detection
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There are several methods and computer programs in existence for the automatic
detection of QRS complexes. These include the use of digital filters, non-linear
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transformation, decision processors and template matching. Generally two or more of

these techniques are used in combination in a QRS detector algorithm. A popular
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approach in the detection of arrhythmia is based on template matching. A model of

the normal QRS complex is called a template, is derived from the ECG complex of a
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patient under normal circumstances. This template is stored and compared with the
subsequent incoming real-time ECG to look for a possible match, using mathematical
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criterion. If a waveform does not match the available template but it is suspected
abnormal QRS complex it is treated as a separated template, and further suspected
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QRS complexes are compared with it. Alternatively, algorithm has been developed
based on digital filters to separate out normal and abnormal QRS complexes.
ST/AR Arrhythmia Algorithm

The ST/AR (ST and Arrhythmia) algorithm is a multi-lead ECG algorithm designed
for both arrhythmias and ST segment monitoring. The algorithm processes the ECG
signals for both paced and non-paced patients performs several actions on the
incoming ECG waveform, including filtering the signal, detecting and classifying the
QRS, generating heart rate, waveform, indentifying ectopic events and rhythms and
generating alarms, when necessary.
After the QRS complex is identified a search is made on each lead independently in
the area prior to the R wave to determine if there is an associated P wave. This area is
200ms wide and ends 120ms before the R wave peak. To be accepted as a P wave, it
must be atleast 1/32 of the R wave height and the P-R interval must be close to the

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average P-R interval. P wave detection is used to differentiate between a Sinus

Rhythm and a Supraventricular Rhythm.
Once the QRS is detected and measured, the beat is labelled. Labelling means that the
algorithm ventricular ectopic (V), paced (P), questionable (?) and learning (L). If the
signal quality is not good, the algorithm assigns the label inoperative (I) and
artefact (A).
Any computerised arrhythmia algorithm would not make 100% accurate analysis os
all patients. Data bases are available for the testing of arrhythmia detection algorithm.
These data bases consist of records of patient ECG waveform, together with a set of
annotation files in which each beat is labelled by an expert cardiologist. The
performance of the ST/AR arrhythmia algorithm are shown to be giving very high
accuracy and reliability (above 95%), in both single lead and multi lead.
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Types of Arrhythmias
1. Bradycardia- A slow rhythm (less than 60 beats/min), is labelled Bradycardia.
This may be caused by a slowed signal from the sinus node, a pause in the
normal activity of the sinus node, or by blocking of the electrical impulse on its
way from the atria to the ventricles. Heart block comes in varying degrees and
severity. It may be caused by reversible poisoning of the AV node (with drugs
that impair conduction) or by irreversible damage to the node.
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Bradycardia
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2. Tachycardia- Any heart rate faster than 100beats/minute is labelled

Tachycardia. Tachycardia may result in palpitation; however, tachycardia is not
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necessarily an arrhythmia. Increased heart rate is a normal response to physical

exercise or emotional stress. This is mediated by the sympathetic nervous
system on the sinus node, and is called sinus tachycardia. Other things that
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increase sympathetic nervous system activity in the heart include ingested or

injected substances such as caffeine or amphetamines, and an overactive thyroid
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gland (hyperthyroidism).Tachycardia that is not sinus tachycardia usually results

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from the addition of abnormal impulses to the normal cardiac cycle. Abnormal
impulses can begin by one of three mechanisms: automaticity, re-entry or
triggered activity.
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Tachycardia

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3. Atrial Fibrillation- Atrial fibrillation is the quivering, chaotic motion in the

upper chambers of the heart, known as the atria. Atrial fibrillation is often due
to serious underlying medical conditions, and should be evaluated by a
physician. It is not typically a medical emergency.
Atrial Fibrillation
4. Atrial Flutter- Atrial flutter is an abnormal heart rhythm that occurs in the atria
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of the heart. When it first occurs, it is usually associated with a fast heart rate or
tachycardia, and falls into the category of supra-ventricular tachycardia. While
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this rhythm occurs most often in individuals with cardiovascular disease (e.g.:
hypertension, coronary artery disease, and cardiomyopathy), it may occur
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spontaneously in people with otherwise normal hearts. It is typically not a stable

rhythm, and frequently degenerates into atrial fibrillation. However, it does
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rarely persist for months to years.

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Atrial Flutter
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5. Premature Atrial Contraction (PAC)- Premature atrial contractions (PAC) are

a type of premature heart beat, irregular heart beat or benign arrhythmia which
start in the upper two chambers of the heart, also called atria. These aren't as
serious as a premature ventricular contraction (PVC) and usually require no
medical care. Individuals with the condition may report feeling that his or her
heart "stops" after a symptom. PAC is also sometimes called heart palpitations.

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Premature Atrial Contraction
6. Multifocal Atrial Tachycardia (MAT) - Multifocal atrial tachycardia is a

cardiac arrhythmia, specifically a type of Supraventricular tachycardia. It is
more common in the elderly. It is mostly common in patients with lung
disorders, but it can be occur after acute MI, hyperaemia, and
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hypomagnesaemia. It is sometimes associated with digitalis toxicity in patients

with heart disease. It is characterized by an electrocardiogram (ECG) strip with
3 or more P-waves of variable morphology and varying P-R intervals, plus
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tachycardia, which is a heart rate exceeding 100 beats per minute. The P-waves
and P-R intervals are variable due to a phenomenon called wandering atrial
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pacemaker (WAP). The electrical impulse is generated at a different focus

within the atria of the heart each time. WAP is positive once the heart generates
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at least three different P-wave formations from the same ECG lead. Then, if the
heart rate exceeds 100 beats per minute, the phenomenon is called multifocal
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atrial tachycardia.
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7. Paroxysmal Supra Ventricular Tachycardia (PSVT)-
Paroxysmal Supraventricular Tachycardia

8. Sick Sinus Syndrome (SSS) - Sick sinus syndrome, also called sinus node
dysfunction, is a group of abnormal heart rhythms presumably caused by a
malfunction of the sinus node, the heart's primary pacemaker. Bradycardia-
tachycardia syndrome is a variant of sick sinus syndrome in which slow
arrhythmias and fast arrhythmias alternate. Sick sinus syndrome is a relatively
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uncommon syndrome. It can result in many abnormal heart rhythms

(arrhythmias), including sinus arrest, sinus node exit block, sinus bradycardia,
and other types of bradycardia (slow heart rate).Sick sinus syndrome is more
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common in elderly adults, where the cause is often a non-specific, scar-like

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degeneration of the cardiac conduction system. Cardiac surgery, especially to

the atria, is a common cause of sick sinus syndrome in children.
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Sick Sinus Syndrome

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9. Sinus Tachycardia- Sinus tachycardia (also colloquially known as sinus tach or

sinus tachy) is a rhythm with elevated rate of impulses originating from the
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sinoatrial node, defined as a rate greater than 100beats/min in an average adult.

The normal heart rate in the average adult ranges from 60100 beats/min. Note
that the normal heart rate varies with age, with infants having normal heart rate
of 110150 bpm to the elderly, who have slower normal.

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Sinus Tachycardia
10. Premature Ventricular Contraction (PVC) - Premature ventricular
contraction (PVC), also known as ventricular premature beat (VPB) or extra
systole, is a form of irregular heartbeat in which the ventricle contracts
prematurely. This may be perceived as a "skipped beat" or as palpitations. The
depolarization of cardiac myocytes begins in the ventricle instead of the usual
place, the sinoatrial node. PVCs can be a useful natural probe, since they induce
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Heart rate turbulence whose characteristics can be measured, and used to

evaluate cardiac function.
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Premature Ventricular Contraction

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11. Accelerated Idioventricular Tachycardia (AIR) - The accelerated

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idioventricular rhythm occurs when depolarisation rate of a normally suppressed

focus increases to above that of the "higher order" focuses (the sinoatrial node
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and the atrioventricular node). This most commonly occurs in the setting of a
sinus Bradycardia. In accelerated idioventricular rhythm, the rate of cardiac
contraction is determined by the intrinsic rate of depolarisation of the cardiac
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cells. It can be present at birth.

Accelerated Idioventricular Tachycardia

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12. Ventricular Tachycardia- Ventricular tachycardia (V-tach or VT) is a

tachycardia, or fast heart rhythm that originates in one of the ventricles of the
heart. This is a potentially life-threatening arrhythmia because it may lead to
ventricular fibrillation and sudden death. Although less common, some forms of
this arrhythmia appear benign, especially in young individuals.
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Ventricular Tachycardia
13. Ventricular Fibrillation- Ventricular fibrillation (V-fib or VF) is a condition in
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which there is uncoordinated contraction of the cardiac muscle of the ventricles

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in the heart, making them tremble rather than contract properly. Ventricular
fibrillation is a medical emergency. If the arrhythmia continues for more than a
few seconds, blood circulation will cease, and death may occur in a matter of
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minutes.
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Ventricular Fibrillation
14. Polymorphic Ventricular Tachycardia- Polymorphic (or polymorphous)
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ventricular tachycardia (VT) is defined as an unstable rhythm with a

continuously varying QRS complex morphology in any recorded
electrocardiography (ECG) lead. The simultaneous recording of more than one
ECG lead is often necessary to detect these changes. A rate of at least
200beats/min is the commonly accepted minimum for polymorphic VT, but an
absolute number has not been established and VT at a slower rate can manifest
changing QRS morphology. Some episodes of polymorphic VT cause
hemodynamic collapse and some degenerate into ventricular fibrillation (VF);
however, many episodes terminate spontaneously. Polymorphic ventricular
tachycardia associated with a prolonged QT interval, which has a different
etymology and mechanism, is known as torsade de pointes ("twisting of
points").

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Polymorphic Ventricular Tachycardia
15. Atrio-Ventricular Nodal Re-entrant Tachycardia (AVNRT) - AV nodal re-

entrant tachycardia (AVNRT) is a type of tachycardia (fast rhythm) of the heart.
It is a type of Supraventricular tachycardia (SVT), meaning that it originates
from a location within the heart above the bundle of His. AV nodal re-entrant
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tachycardia is the most common regular Supraventricular tachycardia. It is more

common in women than men (approximately 75% of cases occurring in
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females). The main symptom is palpitations. Treatment may be with specific

physical manoeuvres, medication, or rarely DC cardio version. Frequent attacks
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may require radio frequency ablation, in which the abnormally conducting tissue
in the heart is destroyed.
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Atrio-Ventricular Nodal Re-entrant Tachycardia

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16. Wolf Parkinson Syndrome (WPS) - Wolff-Parkinson-White syndrome

(WPW) is a syndrome of pre-excitation of the ventricles of the heart due to an
accessory pathway known as the bundle of Kent. This accessory pathway is an
abnormal electrical communication from the atria to the ventricles. The
incidence of WPW syndrome is between 0.9 and 3% of the general population.
While the vast majority of individuals with a bundle of Kent remain
asymptomatic throughout their entire lives, there is a risk of sudden death
associated with the syndrome. Sudden death due to WPW syndrome is rare
(incidence of less than 0.6%), and is due to the effect of the accessory pathway
on tachyarrhythmia in these individuals.

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Wolf Parkinson Syndrome
17. Long QT Syndrome (LQTS) - The long QT syndrome (LQTS) is a rare

congenital heart condition with delayed repolarization following depolarization
(excitation) of the heart, associated with syncope (fainting) due to ventricular
arrhythmias, possibly of type torsade de pointes, which can deteriorate into
ventricular fibrillation and ultimately sudden death. Arrhythmia in individuals
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with LQTS is often associated with exercise or excitement. Individuals with

LQTS have a prolongation of the QT interval on the ECG. The QRS complex
corresponds to ventricular depolarization while the T wave corresponds to
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ventricular repolarization. The QT interval is measured from the Q point to the

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end of the T wave. While many individuals with LQTS have persistent
prolongation of the QT interval, some individuals do not always show the QT
prolongation; in these individuals, the QT interval may prolong with the
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administration of certain medications.

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Long QT Syndrome
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18. Junctional Rhythm- Junctional rhythm describes abnormal heart rhythm.

Under normal conditions, the heart's sinoatrial node determines the rate by
which the organ beats - in other words, it is the heart's "pacemaker." The
electrical activity of sinus rhythm originates in the sinoatrial node and
depolarizes the atria. Current then passes from the atria through the bundle of
His, from which it travels along Purkinje fibres to reach and depolarize the
ventricles. This sinus rhythm is important because it ensures that the heart's atria
reliably contract before the ventricles. In junctional rhythm, however, the
sinoatrial node does not control the heart's rhythm - this can happen in the case
of a block in conduction somewhere along the pathway described above. When
this happens, the heart's atrioventricular node takes over as the pacemaker. In

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the case of a junctional rhythm, the atria will actually still contract before the
ventricles; however, this does not happen by the normal pathway and instead is
due to retrograde conduction. Junctional rhythm can be diagnosed by looking at
an EKG: an EKG exhibiting it usually presents without a P wave.
Junctional Rhythm
19. Junctional Tachycardia- Junctional tachycardia is a form of Supraventricular

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tachycardia characterized by involvement of the AV node. It can be contrasted

to atrial tachycardia. It can be associated with digitalis toxicity. It can appear
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similar to atrioventricular nodal re-entrant tachycardia. One form is junctional

ectopic tachycardia.
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Junctional Tachycardia
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20. Ist Degree AV Block- First degree AV block or PR prolongation is a disease of

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the electrical conduction system of the heart in which the PR interval is

lengthened beyond 0.20 seconds. In first degree heart block, the disease is
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almost always at the level of the atrioventricular node (AV node). It has
prevalence in the normal (young adult) population of 0.65-1.1% and the
incidence is 0.13 per 1000 persons.

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I Degree AV Block
21. IInd Degree AV Block- Second degree AV block is a disease of the electrical
conduction system of the heart. It refers to a conduction block between the atria
and ventricles. The presence of second degree AV block is diagnosed when one
or more (but not all) of the atrial impulses fail to conduct to the ventricles due to
impaired conduction.
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IInd Degree AV Block

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22. IIIrd Degree AV Block- Third degrees AV block, also known as complete heart
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block, is a defect of the electrical system of the heart, in which the impulse
generated in the atria (typically the SA node on top of the right atrium) does not
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propagate to the ventricles.

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IIIrd Degree AV Block

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Operating Instructions
1. While studying different waves configuration, lead selection switch should be
on correct position to get the desired wave shape.
2. While analyzing upper selection switch the toggle switch should in ON position
and for bottom selection switch the toggle switch should be in OFF position.
3. Initial nine waves are related to the Atrial Arrhythmia
4. Next five waves are related to the Ventricular Arrhythmia
5. Next three waves are related to the Atrio-Ventricular Arrhythmia
6. Next two waves are related to the Junctional Arrhythmia
7. Last three waves are related to the Heart Blocks
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Experiment 1
Objective: Study of Bradycardia
Equipments Needed:
1. Arrhythmia Monitor ST2362
2. Oscilloscope (DS1102C 100 MHz, 400MSa/s) or Equivalent.
3. Computer with Windows 98/2000/Me/Xp operating system
Procedure:
1. Connect one end of the power supply to Arrhythmia Monitor ST2362, while
other end to mains power supply
2. Switch ON the Mains power supply, then ST2362 trainer
3. Connect one end of USB Cable to Trainer while other end to PC USB Port
4. Put the toggle switch on the ON position
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5. Select Bradycardia Using Selection Switch

Observation:
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1. Observe the Bradycardia Waveform at output terminal

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2. Observe the each Systolic action of the Heart by LED/Buzzer indication

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3. Compare the Bradycardia with the standard shape given in the manual
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Bradycardia
Figure 1.1
Conclusion:
1. Bradycardia wave is observed with appropriate shape
2. Presence of very long delay between two successive R waves giving the
indication of Bradycardia
Questions:
1. What is sinus Bradycardia?
2. What is Bradycardia?

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Experiment 2
Objective: Study of Tachycardia (Faster Heart Rate > 100)
Equipments Needed:
1. Arrhythmia ST2362
Procedure:
1 Connect one end of the power supply to Arrhythmia Monitor ST2362, while
2 Switch ON the Mains power supply, then ST2362 trainer
3 Connect one end of USB Cable to Trainer while other end to PC USB Port
4 Put the toggle switch on the ON position
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5 Select Tachycardia Using Selection Switch

Observation:
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1. Observe the Tachycardia wave at output terminal

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3. Compare the Tachycardia with the Standard shape given in the manual
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Tachycardia
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Figure 2.1
Conclusion:
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1. Tachycardia wave is observed with appropriate shape.

2. Presence of very short delay between two successive R waves giving the
indication of Tachycardia.
3. P wave appears just after the appearance of T wave conform Tachycardia.
Questions:
1. What is sinus tachycardia?
2. What is tachycardia?

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Experiment 3
Objective: Study of Atrial Fibrillation (Impulses have chaotic, random pathways in
atria).
Equipments Needed:
1. Arrhythmia Monitor ST2362.
Procedure:
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5. Select Atrial Fibrillation Using Selection Switch
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Observation:
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1. Observe the Atrial Fibrillation wave at output terminal.

2. Observe the each Systolic action of the Heart by LED/Buzzer indication.
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3. Compare the Atrial Fibrillation with the Standard shape given in the manual
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Atrial Fibrillation
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Figure 3.1
Conclusion:
1 Atrial Fibrillation wave is observed with appropriate shape
2 Presence of abnormal up-word and down-word in P waves and T wave and no
synchronization between two successive P or T wave, indication of Atrial
Fibrillation
3 Atrial depolarization and ventricular repolarization are not having the correct
sequence and strength
Questions:
1. Due to what reason atrial fibrillation occurs?

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Experiment 4
Objective: Study of Atrial Flutter (Impulse Travels in Circular course in atria)
Equipments Needed:
Procedure:
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5. Select Atrial Flutter Using Selection Switch.

Observation:
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1. Observe the Atrial Flutter wave at output terminal.

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3. Compare the Atrial Flutter with the standard shape given in the manual.
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Atrial Flutter
Figure 4.1
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Conclusion:
1. Atrial Flutter wave is observed with appropriate shape.
2. Presence of abnormal up-word and down-word in P waves giving the indication
of Atrial Flutter.
3. Presence of negative polarity of T wave confirms the atrial flutter.
Questions:
1. What do you understand by atrial flutter?
2. What is frequency range of atrial flutter?

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Experiment 5
Objective: Study of Premature Atrial Contraction
Equipments Needed:
Procedure:
1. Connect one end of the power supply to Arrhythmia monitor ST2362, while
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5. Select Premature Atrial contraction Using Selection Switch

Observation:
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1. Observe the Premature Atrial contraction wave at OUTPUT terminal

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3. Compare the Premature Atrial contraction with the Standard shape given in the
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Premature Atrial Contraction

Figure 5.1
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Conclusion:
1. Premature Atrial contraction wave is observedwith appropriate shape.
2. Presence of abnormal up-word and down-word in P waves and T wave and no
Fibrillation.
3. Atrial depolarization and ventricular repolarization are not having the correct
sequence and strength.
Questions:
1. What is PAC?
2. What is the function of PAC?

ST2362
Experiment 6
Objective: Study of Multifocal Atrial Tachycardia
Equipments Needed:
1 Arrhythmia Monitor ST2362.
2 Oscilloscope (DS1102C 100 MHz, 400MSa/s) or Equivalent.
3 Computer with Windows 98/2000/Me/Xp operating system
Procedure:
ww
5. Select Multifocal Atrial Tachycardia Using Selection Switch

Observation:
w.
1. Observe the Multifocal Atrial Tachycardia wave at OUTPUT terminal

hik

3. Compare the Multifocal Atrial Tachycardia with the Standard shape given in
-co
the manual.
ns
ult
ing
.pl
Multifocal Atrial Tachycardia

/ed
Figure 6.1
u
Conclusion:
1. Multifocal Atrial Tachycardia wave is observedwith appropriate shape.
Fibrillation.
Questions:
1. What is Multifocal Atrial Tachycardia?

ST2362
Experiment 7
Objective: Study of Paroxysmal Ventricular Tachycardia
Equipments Needed:
Procedure:
ww
5. Select Paroxysmal Supra Ventricular Tachycardia Using Selection Switch.

Observation:
w.
1. Observe the Paroxysmal Supra Ventricular Tachycardia wave at OUTPUT

hik
terminal.
-co
3. Compare the Paroxysmal Supra Ventricular Tachycardia with the Standard

shape given in the manual.
ns
ult
ing
.pl
Paroxysmal Supra Ventricular Tachycardia

/ed
Figure 7.1
Conclusion:
u
1. Paroxysmal Supra Ventricular Tachycardia wave is observedwith appropriate

shape.
Fibrillation.
Questions:
1. What is Paroxysmal Supra Ventricular Tachycardia?
2. What indicates abnormal ventricular activation?

ST2362
Experiment 8
Objective: Study of Sick Sinus Syndrome
Equipments Needed:
Procedure:
ww
5. Select Sick Sinus Syndrome Using Selection Switch.

Observation:
w.
1. Observe the Sick Sinus Syndrome wave at OUTPUT terminal.

hik

3. Compare the Sick Sinus Syndrome with the Standard shape given in the manual.
-co
ns
ult
ing
.pl
Sick Sinus Syndrome

/ed
Figure 8.1
Conclusion:
u
1. Sick Sinus Syndrome wave is observedwith appropriate shape

Fibrillation.
3. Atrial depolarization and ventricular repolarization are not have the
Correct sequence and strength
Questions:
1. What do you understand by Sick Sinus Syndrome?
2. Which type of activity is held during P,QRS and T wave?

ST2362
Experiment 9
Objective: Study of Sinus Tachycardia
Equipments Needed:
Procedure:
1. Connect the Arrhythmia Monitor ST2362 to AC mains.
2. Switch On the Power switch.
3. Connect the USB Port Cable from Trainer to PC USB Port
4. Select Sinus Tachycardia Using Selection Switch.
Observation:
ww
1. Observe the Sinus Tachycardia wave at OUTPUT terminal.

w.

3. Compare the Sinus Tachycardia with the Standard shape given in the manual.
hik
-co
ns
ult
ing
.pl
Sinus Tachycardia
/ed
Figure 9.1
Conclusion:
u
1. Sinus Tachycardia wave is observedwith appropriate shape.

Fibrillation.
Questions:
2. What is the standard value of one complete cycle for T wave?

ST2362
Experiment 10
Objective: Study of Premature Ventricular Contraction (A Single Impulse Originate
at Right Ventricle).
Equipments Needed:
Procedure:
ww

5. Select Premature Ventricular Contraction Using Selection Switch.
w.
Observation:
hik
1. Observe the Premature Ventricular Contraction wave at OUTPUT terminal.

-co
3. Compare the Premature Ventricular Contraction with the shape given in the
manual.
ns
ult
ing
.pl
Premature Ventricular Contraction

/ed
Figure 10.1
u
Conclusion:
1. Premature Ventricular Contraction wave is observedwith appropriate shape.
2. Presence of additional large waves after the ventricular repolarization giving the
indication of Premature Ventricular Contraction.
3. Because of Presence of this additional wave there is an increase of time duration
between two successive R waves.
Questions:
1. What is PVC stands for?
2. What is the function of PVC?
Experiment 11

ST2362
Objective: Study of Accelerated idioventricular Rhythm

Equipments Needed:
Procedure:
5. Select Proximal Supra Ventricular Tachycardia Using Selection Switch.
ww
Observation:
1. Observe the Accelerated idioventricular Rhythm wave at OUTPUT terminal.
w.

hik
3. Compare the Accelerated idioventricular Rhythm with the Standard shape given
in the manual.
-co
ns
ult
ing
Accelerated idioventricular Rhythm

.pl
Figure 11.1
Conclusion:
/ed
1. Accelerated idioventricular Rhythm wave is observedwith appropriate shape.

u

Fibrillation.
Questions:
1. What is idioventricular rhythm?
2. Which situation is called accelerated idioventricular rhythm?

ST2362
Experiment 12
Objective: Study of Ventricular Tachycardia (Impulse Originated at Ventricular
Pacemaker)
Equipments Needed:
1. Arrhythmia ST2362.
Procedure:
ww
4. Put the toggle switch on the OFF position

5. Select Ventricular Tachycardia Using Selection Switch.
w.
Observation:
hik
1. Observe the Ventricular Tachycardia wave at OUTPUT terminal.

-co
3. Compare the Ventricular Tachycardia with the standards shape given in the
manual.
ns
ult
ing
.pl
/ed
Ventricular Tachycardia
u
Figure 12.1
Conclusion:
1. Ventricular Tachycardia wave is observedwith appropriate shape.
2. Presence of incomplete QRS Complex and negative T wave projections giving
the indication of Ventricular Tachycardia.
Questions:
1. What is ventricular tachycardia?
2. What is the amplitude of QRS Complex?

ST2362
Experiment 13
Objective: Study of Ventricular Fibrillation (Chaotic Ventricular depolarization)
Equipments Needed:
Procedure:
ww
5. Select Ventricular Fibrillation Using Selection Switch.

Observation:
w.
1. Observe the Ventricular Fibrillation wave at TP 2 terminal.

hik

3. Compare the Ventricular Fibrillation with the standard shape given in the
-co
manual.
ns
ult
ing
.pl
/ed
Ventricular Fibrillation
Figure 13.1
u
Conclusion:
1. Ventricular Fibrillation wave is observedwith appropriate shape.
2. Total absence of auricular and ventricular synchronization giving the indication
of Ventricular Fibrillation.
3. Because of chaotic ventricular depolarization atrial depolarization and
repolarization are also disturbed.
Questions:
1. What is the cause of ventricular fibrillation?
2. What is ventricular fibrillation?

ST2362
Experiment 14
Objective: Study of Polymorphic Ventricular Tachycardia
Equipments Needed:
1. Arrhythmia Monitor ST2362
2. Oscilloscope (DS1102C 100 MHz, 400MSa/s) or Equivalent
Procedure:
ww
5. Select Polymorphic Ventricular Tachycardia Using Selection Switch.

Observation:
w.
1. Observe the Polymorphic Ventricular Tachycardia wave at OUTPUT terminal.

hik

3. Compare the Polymorphic Ventricular Tachycardia with the Standard shape
-co
given in the manual.

ns
ult
ing
.pl
Polymorphic Ventricular Tachycardia

/ed
Figure 14.1
Conclusion:
u
1. Polymorphic Ventricular Tachycardia wave is observedwith appropriate shape.

Fibrillation.
Questions:

ST2362
Experiment 15
Objective: Study of Atrio-Ventricular Nodal Re-entrant Tachycardia
Equipments Needed:
Procedure:
ww
5. Select Atrio-Ventricular Nodal Re-entrant Tachycardia Using Selection

Switch.
w.
Observation:
hik
1. Observe the Atrio-Ventricular Nodal Re-entrant Tachycardia wave at OUTPUT

terminal.
-co

3. Compare the Atrio-Ventricular Nodal Re-entrant Tachycardia with the Standard
ns
shape given in the manual.

ult
ing
.pl
Atrio-Ventricular Nodal Re-entrant Tachycardia

/ed
Figure 15.1
Conclusion:
u
1. Atrio-Ventricular Nodal Re-entrant Tachycardia wave is observedwith

appropriate shape.
Fibrillation.
Questions:
1. What is Tachycardia?

ST2362
Experiment 16
Objective: Study of Wolf Parkinson Syndrome
Equipments Needed:
Procedure:
ww
5. Select Wolf Parkinson Syndrome Using Selection Switch.

Observation:
w.
1. Observe the Wolf Parskinsom Syndrome wave at OUTPUT terminal.

hik

3. Compare the Wolf Parskinsom Syndrome with the Standard shape given in the
-co
manual.
ns
ult
ing
.pl
Wolf Parskinsom Syndrome

/ed
Figure 16.1
u
Conclusion:
1. Atrial Fibrillation wave is observedwith appropriate shape.
Fibrillation.
Questions:
1. What P wave represents?
2. What T wave represents?

ST2362
Experiment 17
Objective: Study of Long QT Syndrome
Equipments Needed:
Procedure:
ww
5. Select Long QT Syndrome Using Selection Switch.

Observation:
w.
1. Observe the Long QT Syndrome wave at OUTPUT terminal.

hik

3. Compare the Long QT Syndrome with the Standard shape given in the
-co
manual.
ns
ult
ing
.pl
/ed
Long QT Syndrome
Figure 17.1
Conclusion:
u
1. Long QT Syndrome wave is observedwith appropriate shape.

Fibrillation.
Questions:
1. What is the amplitude of P wave?
2. What is the duration of T wave?

ST2362
Experiment 18
Objective: Study of Junction rhythm (Impulses originated at AV node with
retrograde and ante grade direction)
Equipments Needed:
Procedure:
1 Connect one end of the power supply to Arrhythmia monitor ST2362, while
2 Switch ON the Mains power supply, then ST2362 trainer
3 Connect one end of USB Cable to Trainer while other end to PC USB Port
ww
4 Put the toggle switch on the OFF position

5 Select Junction Rhythm Using Selection Switch.
w.
Observation:
hik
1 Observe the Junction Rhythm wave at OUTPUT terminal.

2 Observe the each Systolic action of the Heart by LED/Buzzer indication.
-co
3 Compare the Junction Rhythm with the standard shape given in the manual.
ns
ult
ing
.pl
/ed
Junctional Rhythm
Figure 18.1
u
Conclusion:
1. Junction Rhythm wave is observedwith appropriate shape.
2. Absence of P wave along with large delay between two successive R waves
giving the indication of Junction Rhythms.
3. Junction Rhythms are the indication of the diverse direction of electrical
voltages at the AV node.
Questions:
1. What is the phenomenon of junctional rhythm?
2. What are the characteristics of P wave?

ST2362
Experiment 19
Objective: Study of Junctional Tachycardia
Equipments Needed:
Procedure:
ww
5. Select Junctional Tachycardia Using Selection Switch.

Observation:
w.
1. Observe the Junctional Tachycardia wave at OUTPUT terminal.

hik

3. Compare the Junctional Tachycardia with the Standard shape given in the
-co
manual.
ns
ult
ing
.pl
/ed
Junctional Tachycardia
Figure 19.1
u
Conclusion:
1. Junctional Tachycardia wave is observedwith appropriate shape.
Fibrillation.
Questions:
2. What is Tachycardia?

ST2362
Experiment 20
st
Objective: Study of I Degree AV Block
Equipments Needed:
Procedure:
ww
5. Select Ist Degree AV Block Using Selection Switch.

Observation:
w.
1. Observe the Ist Degree AV Block wave at OUTPUT terminal.

hik

-co
3. Compare the Ist Degree AV Block with the Standard shape given in the manual.
st
I Degree AV Block
ns
ult
ing
.pl
Figure 20.1
/ed
Conclusion:
u
1. Ist Degree AV Block wave is observedwith appropriate shape.

Fibrillation.
Questions:
2. What do you mean by atrial fibrillation?

ST2362
Experiment 21
Objective: Study of II nd Degree AV Block (Sudden drop of QRS Complex)
Equipments Needed:
Procedure:
ww
5. Select II Degree AV Block Using Selection Switch.

Observation:
w.
1. Observe the II Degree AV Block wave at OUTPUT terminal.

hik

-co
3. Compare the II Degree AV Block with the shape given in the manual.
ns
ult
ing
.pl
II Degree AV Block
/ed
Figure 21.1
u
Conclusion:
1. II Degree AV Block wave is observedwith appropriate shape.
2. Total absence of QRS complex giving the indication of II Degree AV Block.
Questions:
1. Why QRS-complex is of relatively short duration?
2. What is the duration of QRS wave?

ST2362
Experiment 22
rd
Objective: Study of III degree AV Block (Impulses originate at AV node and
proceed to ventricles Atrial and ventricular activities are not synchronous)
Equipments Needed:
Procedure:
ww

5. Select III degree AV Block Using Selection Switch.
w.
Observation:
hik
1. Observe the III degree AV Block wave at OUTPUT terminal.

-co
3. Compare the III degree AV Block with the shape given in the manual.
ns
ult
ing
.pl
/ed
III degree AV Block

Figure 22.1
u
Conclusion:
1. III degree AV Block wave is observedwith appropriate shape.
2. No synchronization between atrial and ventricle depolarization is the indication
of III degree AV Block.
Questions:
1. What is the AV stands for?
2. What is the function of AV block?

ST2362
Frequently Asked Questions

1. What is the Anatomy of the human heart?
The heart is basically a hollow muscular pump, which pushes the blood through
out the body via the blood vessels. It is located between the lungs and slightly to
the left of centre.
2. How many contractions heart have?
The heart is an involuntary muscle that has approximately seventy to ninety
contractions per minute during a restful state. It begins to pump early in the life
of a fetus and will continue unceasingly until death.
3. In how many layers heart wall is divided, name them?
The heart wall is divided into three layers:
Pericardium
Myocardium
ww
Endocardium
4. How chamber is sub divided?
w.
The heart is divided by a partition or septum into two halves. The halves are in
hik
turn divided into chambers. The upper two chambers of the heart are called atria
and the lower two chambers are called ventricles.
-co
5. How many chambers does heart have?

The heart has four distinct chambers.
ns
1. Right atrium is the thin-walled area that receives the venous or "used"
ult
blood returning to the body by the veins.

2. Right ventricle is the "pump" area of the heart's right side. The atrium
ing
dumps the blood into the ventricle where it is then pumped out the
pulmonary arteries and to the lungs.
.pl
3. Left atrium receives the oxygenated blood returning from the lungs.
/ed
4. Left ventricle has the thickest walls of all. It is from this chamber the blood
is pumped out of the heart, into the aorta and out to the rest of the body.
u

ST2362
6. How many types of heart valves are there?

There are four types of heart valves which are as follows:
a. Tricuspid valve: is the one located at the entrance of the right
ventricle. It prevents the blood from washing back into the right
atrium.
b. Pulmonary semi lunar valve: is located between the right ventricle
and the pulmonary artery.
c. Mitral valve: is made of very heavy cusps and is located at the
entrance of the left ventricle. This is a powerful valve that closes as the
left ventricle begins each of its contractions to ensure the oxygenated
blood doesn't re-enter the left atrium.
d. Aortic valve: is located, as its name would imply, between the left
ventricle's exit and the aorta itself.
7. How right ventricle and left ventricle works?
ww
As the right ventricle contracts and sends blood to the lungs, the left ventricle
contracts and squeezes blood out to the body.
w.
8. What is systole and diastole?

hik
Systole occurs when the ventricles contract, and diastole when they relax. One
complete contraction and relaxation of the heart muscle makes up one heartbeat.
-co
9. How many components heart conduction system have?

There are four basic components to the heart's conduction system.
ns
i. Sino atrial node (SA node)

ult
ii. Inter-nodal fibre bundles

ing
iii. Atrioventricular node (AV node)

iv. Atrioventricular bundle
.pl
10. What is the function of natural pacemaker?

/ed
A natural pacemaker generates electrical impulses at regular rate. To initiate the

heartbeat the action potentials generated by the natural pacemaker or S.A. node
gets propagated in all directions along the surface of both atria and
u
atrioventricular node.
11. What is the full form of ECG?
Electrocardiogram
12. How the electrical activity of heart can be sensed?
This electrical activity generated by the heart can be measured by an array of
electrodes placed on the body surface.

ST2362
13. What P wave represents?

The P wave represents the wave of depolarization that spreads from the SA node
throughout the atria, and is usually 0.08 to 0.1 seconds (80-100 ms) in duration.
14. What QRS complex represents?
The QRS complex represents ventricular depolarization. The duration of the
QRS complex is normally 0.06 to 0.1 seconds. This relatively short duration
indicates that ventricular depolarization normally occurs very rapidly.
The T wave represents ventricular repolarization and is longer in duration than
depolarization (i.e., conduction of the repolarization wave is slower than the
wave of depolarization).
16. How much time period is required to complete one cycle by the heart?
The total time required for one complete cycle of the heart electrical activity
ww
ranges from approximately 0.4 to 0.6 second.

17. Define heart rate?
w.
The Heart-rate is a rate at which the heart beats per minute.

18 How the heart rate is controlled?
hik
It is controlled by the frequency at which the natural pacemaker generates

-co
electrical pulses.
19. What is the heart rate for various human beings?
ns
The bigger a person is, the slower the heart rate. A newborn baby's heart beats
about 120 times per minute. The typical rate for adults is 72 beats per minute.
ult
But doctors consider resting rates from 60 to 100 beats per minute within the
normal range.
ing
20. To measure the ECG signals where the electrodes are placed on human
body?
.pl
To record the ECG pattern of a subject (human body) it is necessary to apply

/ed
ECG metal electrodes to the patient's limbs in special formats called leads, on
each arm and leg, and six electrodes are placed at defined locations on the chest.
u
21. How electrical signals are generated through the heart?

As the heart undergoes depolarization and repolarization, the electrical currents
that are generated and spread not only within the heart, but also through out the
body.
22. How the electrical current is measured from the heart?
The electrical activity generated by the heart can be measured by an array of
electrodes placed on the body surface.
23. How different waves are generated?
The different waves that comprise the ECG represent the sequence of
depolarization and repolarization of the atria and ventricles.

ST2362
24. What P wave represent?

The P wave represents the wave of depolarization that spreads from the SA
node throughout the atria.
25. What is the duration of P wave?
The duration is usually of 0.08 to 0.1 seconds (80-100 ms).
26. What QRS complex represents?
The QRS complex represents ventricular depolarization.
27. What is the duration of QRS wave?
The duration of the QRS complex is normally 0.06 to 0.1 seconds.
28. What short duration indicates in QRS wave?
The relative short duration indicates that ventricular depolarization normally
occurs very rapidly.
ww

The T wave represents ventricular repolarization and is longer in duration than
w.
depolarization
30. What is the duration of T wave?
hik
Typically the total time required for one complete cycle of the heart electrical
-co
activity ranges from approximately 0.4 to 0.6 second.

31. What is the standard value of one complete cycle for T wave?
ns
0.8 seconds is the standard value of one complete heart cycle.

ult
This U wave represents the state of heart when all four chambers of heart
ing
receive the blood generally this wave is not present in the normal ECG graph.
33. Which type of activity is held during P,QRS and T wave?
.pl
During a normal sinus rhythm, the atria are contracting first (around the time of
the P wave), and the ventricles contract second (around the time of the QRS
/ed
complex). Ventricular relaxation occurs around the time of the T wave.

34. What heart's electrical axis refers?
u
The heart's electrical axis refers to the general direction of the heart's
depolarization wave front (or mean electrical vector) in the frontal plane.
35. What is the orientation of heart's electrical axis?
It is usually oriented in a right shoulder to left Leg direction, which corresponds
to the left inferior quadrant of the hex axial reference system, although -30o to
+90o is considered to be normal.
36. What the electric axis of the heart usually denotes?
The concept of the electric axis of the heart usually denotes the average
direction of the electric activity throughout ventricular (or sometimes atrial)
activation.

ST2362
37. What is the range of electric axis?

The normal range of the electric axis lies between +30 and -110 in the frontal
plane and between +30 and -30 in the transverse plane. The direction of the
electric axis may be approximated from the 12-Lead ECG by finding the Lead in
the frontal plane, where the QRS-complex has largest positive deflection. The
direction of the electric axis is in the direction of this Lead vector. The result can
be checked by observing that the QRS-complex is symmetrically biphasic in the
Lead that is normal to the electric axis.
38. What the deviation of the electric axis to the right indicates?
Deviation of the electric axis to the right is an indication of increased electric
activity in the right ventricle due to increased right ventricular mass.
39. Due to which types of diseases the deviation of the electric axis to the right
occurs?
This is usually a consequence of chronic obstructive lung disease, pulmonary
emboli, certain types of congenital heart disease, or other disorders causing
ww
severe pulmonary hypertension and corpulmonale.

40. What the deviation of the electric axis to the left indicates?
w.
Deviation of the electric axis to the left is an indication of increased electric

hik
activity in the left ventricle due to increased left ventricular mass.

41. Due to which types of diseases the deviation of the electric axis to the left
-co
occurs?
This is usually a consequence of hypertension, aortic Stenosis, ischemic heart
ns
disease, or some interventricular conduction defect.

42. What is the amplitude of P wave?
ult
Amplitude : 0.25mV
ing
43. What should be the dimensions of P wave?

The P wave in general should not be more than 1 box wide or 1 box tall. If it
.pl
exceeds these, it generally means that either or both atria is enlarged

(hypertrophied).
/ed
44. What are the characteristics of P wave?

u
Positive deflection of P wave greater than 1 box wide or 1 box in height

indicates right atrial hypertrophy
Negative deflection of P wave greater than 1 box wide or 1 box in depth
indicates left atrial hypertrophy.
45. What is the duration of PR-Interval?
Duration: 180-220 m sec
The distance from the beginning of the P wave to the beginning of Q wave is
PR interval. Its a period from the beginning of atria depolarization to the
beginning of ventricular depolarization.
46. What is PR-segment?
It is the distance from end of the P wave and beginning of Q wave.

ST2362
47. What is the duration of PR-segment?

Duration: 0.01 sec (approximately)
48. What is the amplitude of Q wave?
Amplitude : 0.2 mV
49. What normal Q wave represents?
Normal Q waves are small, less than 1 mm deep or wide and one fourth the
height of their R wave.
50. When Q wave Develops?
Pathological Q waves usually develop when ST segments are elevated and
appear several hours or days after the clinical manifestations of the Myocardial
Infarction.
51. What abnormal Q wave represents?
Abnormal Q must be one Small Square (0.04 sec) wide and greater than one-
ww
third of QRS height in Lead III. Myocardial infarction causes pathological Q

waves over the affected area of the ventricle. The age of the infection can be
w.
determined.
If only Q wave is present without elevated ST segment then it indicates old
hik
infarction while if ST segment is there (with or without T wave inversion) then

it indicates acute infraction. Q waves with inverted T waves may indicate
-co
undetermined age.
52. What is the amplitude of R Wave?
ns
Amplitude : 1mV
ult
53. What R wave represents?

ing
R wave is the largest wave of the ECG graph and it is always above is electric
line, No such thing as a "negative R-wave" exists.
.pl
54. What is the amplitude of S Wave?

Amplitude : 0.4 - 0.5 mV
/ed
55. What is the amplitude of QRS Complex?

u
Amplitude : 1.5 mV
56. What is the duration of ST-Segment?
Short segment from end of S wave to beginning of T wave and has duration of
about 0.07 sec.
57. What is the amplitude of T Wave?
Amplitude : 0.1 - 0.5 m sec
58. What normal T waves represents?
Normal T waves are in the same direction as their complex, wave is
asymmetrical and it peaks toward the end, instead of the middle. Normal T
wave in frontal plan is about 5 mm and in precordial plane 10 mm tall.

ST2362
59. What is the duration of ST-Interval?

Period from end of S wave to end of T wave and has the duration of about 0.20 -
0.27 m sec.
60. What QT-Interval represents?
It is the interval from beginning of Q wave to end of T wave, or we can say this
is the period from beginning of ventricular depolarization to the end of
repolarization.
61. What is the duration of QT-Interval?
It has the duration of about 0.26 - 0.49 m sec.
62. What RR-Interval represents?
This is the distance between QRS-complexes.
63. What is the amplitude of U Wave?
Amplitude : 0.15 mV
ww
64. Classify Cardiac Rhythm Diagnosis?

w.
Cardiac rhythms may be divided into two categories:

1. Supraventricular (above the ventricles)
hik
2. Ventricular rhythms.
-co
65. Which node triggers the cardiac activation?

The sinus node triggers the cardiac activation.
ns
66. How the cardiac activation is diagnosed?

ult
This is easily diagnosed by noting that the three deflections, P-QRS-T, follow in
this order and are differentiable.
ing
67. Give the frequency range of sinus rhythm?

.pl
The sinus rhythm is normal if its frequency is between 60 and 100/Min.

68. What is sinus Bradycardia?
/ed
Sinus rhythm having frequency less than 60/Min is called sinus Bradycardia.
This may be a consequence of increased vagal or parasympathetic tone.
u

The rhythm having frequency greater than 100/Min is called sinus tachycardia.
It occurs most often as a physiological response to physical exercise or
psychical stress, but may also result from congestive heart failure.
70. What is sinus arrhythmia?
If the sinus rhythm is irregular such that the longest PP- or RR-interval exceeds
the shortest interval by 0.16 s, the situation is called sinus arrhythmia.

ST2362
71. When the heart rate increase or decrease?

The nerve is active during respiration and, through its effect on the sinus node,
causes an increase in heart rate during inspiration and a decrease during
expiration. The effect is particularly pronounced in children.
72. What do you understand by atrial flutter?
When the heart rate is sufficiently elevated so that the iso-electric interval
between the end of T and beginning of P disappears, the arrhythmia is called
atrial flutter. The origin is also believed to involve a re-entrant atrial pathway.
73. What is frequency range of atrial flutter?
The frequency of these fluctuations is between 220 and 300/min. The AV-node
and, thereafter, the ventricles are generally activated by every second or every
third atrial impulse (2:1 or 3:1 heart block).
ww
Atrial fibrillation occurs as a consequence of rheumatic disease, atherosclerotic

disease, hyperthyroidism, and pericarditis (It may also occur in healthy subjects
as a result of strong sympathetic activation.)
w.
75. What is the phenomenon of junctional rhythm?

hik
If the heart rate is slow (40-55/Min.), the QRS-complex is normal, the P-waves
are possibly not seen, and then the origin of the cardiac rhythm is in the AV
-co
node. Because the origin is in the junction between atria and ventricles, this is
called junctional rhythm.
ns
76. Why QRS-complex is of relatively short duration?

In ventricular arrhythmias ventricular activation does not originate from the AV
ult
node and/or does not proceed in the ventricles in a normal way. If the activation
proceeds to the ventricles along the conduction system, the inner walls of the
ing
ventricles are activated almost simultaneously and the activation front proceeds
mainly radically toward the outer walls. As a result, the QRS-complex is of
.pl
relatively short duration.

/ed
77. What indicates abnormal ventricular activation?

A QRS-interval lasting longer than 0.1 s indicates abnormal ventricular
u
activation.
78. What is idioventricular rhythm?
If the ventricles are continuously activated by a ventricular focus whose rhythm
is under 40/Min, the rhythm is called idioventricular rhythm.
79. Which situation is called accelerated idioventricular rhythm?
The ventricular activity may also be formed from short (less than 20 s) bursts of
ventricular activity at higher rates (between 40 and 120/Min). This situation is
called accelerated idioventricular rhythm.

ST2362

A rhythm of ventricular origin may also be a consequence of a slower
conduction in ischemic ventricular muscle that leads to circular activation (re-
entry). The result is activation of the ventricular muscle at a high rate (over
120/Min.), causing rapid, bizarre, and wide QRS-complexes; the arrhythmia is
called ventricular tachycardia. As noted, ventricular tachycardia is often a
consequence of ischemia and myocardial infarction.
81. What is ventricular fibrillation?
When ventricular depolarization occurs chaotically, the situation is called
ventricular fibrillation.
The cause of fibrillation is the establishment of multiple re-entry loops usually
involving diseased heart muscle. In this arrhythmia the contraction of the
ventricular muscle is also irregular and is ineffective at pumping blood. The lack
of blood circulation leads to almost immediate loss of consciousness and death
ww
within minutes. The ventricular fibrillation may be stopped with an external

defibrillator pulse and appropriate medication.
w.
83. What are pacer rhythm and its frequency?

hik
A ventricular rhythm originating from a cardiac pacemaker is associated with

wide QRS-complexes because the pacing electrode is (usually) located in the
right ventricle and activation does not involve the conduction system. In pacer
-co
rhythm the ventricular contraction is usually preceded by a clearly visible pacer

impulse spike. The pacer rhythm is usually set to 72/min.
ns
84. On what basis sinus rhythm is diagnosed?

ult
If the P-waves always precede the QRS-complex with a PR-interval of 0.12-0.2

s, the AV conduction is normal and a sinus rhythm is diagnosed. If the PR-
ing
interval is fixed but shorter than normal, either the origin of the impulse is closer
to the ventricles or the atrioventricular conduction is utilizing an (abnormal)
.pl
bypass tract leading to pre-excitation of the ventricles. The latter is called the
Wolff-Parkinson-White syndrome and is discussed below. The PR-interval may
/ed
also be variable, such as in a wandering atrial pacemaker and multifocal atrial

tachycardia.
u
85. How first-degree atrioventricular block is diagnosed?

When the P-wave always precedes the QRS-complex but the PR-interval is
prolonged over 0.2 s, first-degree atrioventricular block is diagnosed.
86. What is Wenkebach phenomenon?
If the PQ-interval is longer than normal and the QRS-complex sometimes does
not follow the P-wave, the atrioventricular block is of second-degree. If the PR-
interval progressively lengthens, leading finally to the drop out of a QRS-
complex, the second degree block is called a Wenkebach phenomenon.

ST2362
87. What is third-degree atrioventricular block?

Bundle-branch block denotes a conduction defect in either of the bundle-
branches or in either fascicle of the left bundle-branch. If the two bundle-
branches exhibit a block simultaneously, the progress of activation from the
atria to the ventricles is completely inhibited; this is regarded as third-degree
atrioventricular block.
88. What is duration criterion for the QRS-complex bundle-branch block?
If the right bundle-branch is defective so that the electrical impulse cannot travel
through it to the right ventricle, activation reaches the right ventricle by
proceeding from the left ventricle. It then travels through the septal and right
ventricular muscle mass. This progress is, of course, slower than that through
the conduction system and leads to a QRS-complex wider than 0.1 s. Usually
the duration criterion for the QRS-complex in right bundle-branch block
(RBBB) as well as for the left bundle- branch block (LBBB) is >0.12 s.
88. Explain the working of pacemaker?
ww
The pacemaker essentially does two things, it senses the patients own rhythm
using a sensing circuit and it sends out electrical signals using an output circuit.
w.
If the patients intrinsic rhythm becomes too slow or goes away completely, the
electronic pacemaker senses that and starts sending out signals along the wires
hik
leading from the control box to the heart muscle. The electrical signal produced
by pacemaker properly provide a regular electrical stimulus, making the heart
-co
contract at a rate fast enough to maintain the patients blood pressure.

89. What pulse rate is used for pacemaker?
ns
The wave form used for pacing is round-topped rectangular pulses of 1-7 ms
ult
duration with rates adjustable from 50-150 pulses/min.

90. Give the types of pacemaker?
ing
There are two types of pacemaker, which are as follows:

.pl
1. External Pacemaker
2. Internal Pacemaker
/ed
91. In what situation external pacemaker is used?

u
External pacemakers are employed to restart the normal rhythm of the heart in
case of cardiac standstill, in situation where short term pacing is considered.
Frequently external pacemakers are used for patients recovering from cardiac
surgery to correct temporary conduction disturbances resulting from the surgery.
92. In what situation internal pacemaker is used?
Internal Pacemakers are used in cases requiring long term pacing because of
permanent damage that prevents normal self triggering of the heart.
93. What is the full form of NASPE?
North American Society of Pacing and Electrophysiology

ST2362
94. What is the full form of BPEG?

British Pacing and Electrophysiology Group
95. What is implantable pacemaker?
The implantable pacemaker, along with its electrodes, is designed to be entirely
implanted beneath the skin. Its output leads are connected directly to the heart
muscle. The pacemaker is a miniaturized pulse generator and is powered by
small batteries. The circuit is so designed that the batteries supply sufficient
power for a long time. Since the pacemaker is located just beneath the skin, the
replacement of the pacemaker unit involving relatively minor surgery has
become a routine procedure.
96 What are the basic requirements of implanted circuit?
1. The component used in the circuit should be highly reliable.
2. The power source should be in position to supply sufficient power to the
circuit over prolonged periods of a time.
ww
3. The circuit should be covered with a biological inert material so that

implant is not rejected by the body.
w.
4. The should be covered in such a way that the body fluids do not find a way
inside the circuit and thus short-circuit the batteries or result in other
hik
malfunctioning of the circuit.

97. What Trans-Venous pacing means?
-co
Trans-Venous means that the pacing wire is threaded down the jugular vein
through an introducer. The introducer is put in first, like any central neck IV
ns
line, and the wire is passed through it until it makes contact with the inner wall
of the RV. Then the wire is attached to a generator box and the heart is paced
ult
using the wire.

ing
98. What Trans-Cutaneous pacing means?

Trans-Cutaneous pacing means using external pacing pads connected to a device
.pl
like the Zoll machine or one of the defibrillators that has external pacing ability.
/ed
99. What Trans-Thoracic pacing means?

Trans-Thoracic pacing means using wires inserted during cardiac surgery. Small
u
wires that fit on the outer wall of the heart pericardium. Wires that lead out of
the chest to a control box or doing manoeuvres that involves pushing a pacing
wire into the RV up through the chest wall subxiphoid during a code.
100. What is the function of rate hysteresis?
Rate hysteresis allows the pacemaker to be inhibited at rate lower than
programmed basic rate, thus encouraging negative rhythm and possible
prolonging device life.
101. What is AV delay?
The AV Delay is the time interval between an atrial output pulses and the
corresponding ventricular output pulses in the absence of intrinsic activity.

ST2362
102. What is PV delay?

While PV Delay is the interval between an intrinsic atrial event and the
corresponding ventricular pulse in the absence in intrinsic ventricular activity.
103. Where myocardial electrode is connected?
Electrode connected to the outer wall of the heart muscle are called myocardial
electrode.
104. Where endocardiac electrode is connected?
Electrodes which are connected to the inner side of the heart chamber are known
as endocardiac electrodes.
105. Which types of vein are used for Endocardiac electrodes?
Endocardiac electrodes are inserted through suitable vein, preferably the jugular
vein and pushed directly into the heart. This method offers an advantage in that
open heart surgery is not necessary for the replacement of the myocardial
ww
electrode.
106. What are the characteristics of Porous Tip Electrode?
w.
It provides a high stability lead for the endocardiac method of pacemaker

implant. The porous lead has an 85-90 % porous platinum-iridium tip that
hik
stabilizes the porous quickly with little endocardiac irritation.

107. What are the characteristics of Steroid-eluting Electrodes?
-co
These electrodes have evolved fro large surface area (30-40mm2) than other
electrodes. In order to stimulate the heart an important consideration is density
ns
of the current at the electrode tissue interface and this is influenced by several
factors such as surface area of electrode, amount of fibrotic encapsulation,
ult
electrical material, pulse width and pulse amplitude.

ing
108. Give the types of Pacemaker Electrode System?

Two types of electrode systems are commonly used bipolar and unipolar system.
.pl
109. Give functional details of unipolar electrode system?

/ed
In the Unipolar system, one electrode (indifferent electrode) is usually a large

metal plate attached to the pulse generator. The indifferent electrode is much
larger in size than the pacing electrode. The current in this case flows between
u
the pacing electrode in the heart and indifferent electrode via the body tissue.
The batteries are so arranged that the pacing electrode is negative (cathode) and
indifferent electrode is positive.
110. Give functional details of bipolar electrode system?
In the bipolar electrode system, both electrodes are approximately of the same
size and both are placed inside or on the heart, so that the current flows between
the electrodes.

ST2362
111. What is operating sequence of Arrhythmia monitoring instrument?

Arrhythmia monitoring instrument will operate in the following sequence:
Stores a normal QRS for reference particularly QRS width and R-R
interval.
Initiates an alarm automatically, when ectopic beats are detected- either
the ventricular premature or widened varieties.
Gives alarm light signals whenever the premature or widened ectopic beats
exist up to the rate of 6/min or 12/min.
Detects and triggers alarm when artefacts are present at the source, e.g.
muscle more due to patient movement, base line shift and improperly
connected
ww
w.
hik
-co
ns
ult
ing
.pl
/ed
u

ST2362
Glossary of Human Cardiovascular System Terms

Artery: A muscular blood vessel that carries blood away from the heart.
Arrhythmia: Is an abnormal heart rhythm.
Atrium: One of the chambers of the heart that receives blood directly from a vein.
Bradycardia: When the heart-rate less than the normal heart-rate rhythm.
Circulatory System: The system of the body responsible for internal transport.
Composed of the heart, blood vessels, lymphatic vessels, lymph, and the blood
Cardiology: Is the branch of medicine that deals with the diagnosis and treatment of
disorders of the heart.
Diastole: Pronounced dy AS tuh lee, is the period of heart activity when the ventricles
relax.
Diastolic Pressure: The decreased pressure due to the relaxation of the ventricles is
called diastolic pressure.
ww
Electrocardiograph (ECG): Is an instrument used to detect heart damage or

diagnose heart disorders.
w.
Heart: The muscular organ composed of cardiac muscle that is responsible for
pumping blood throughout the body.
hik
Normal Sinus Rhythm: Normal pumping action of heart generates 60 -100

-co
heartbeats per minute.

Septum: The wall dividing the two ventricles.
ns
Systole: Is the period of heart activity when the ventricles contract.

ult
Systolic Pressure: The increased pressure due to the contraction of the ventricles is
called systolic pressure.
ing
Tachycardia: When the heart-rate exceeds than the normal heart-rate rhythm.
Ventricle: One of the muscular chambers of the heart that is responsible for pumping
.pl
blood from the heart into the arteries.

/ed
u

ST2362
Warranty
1. We guarantee this product against all manufacturing defects for 24 months from
the date of sale by us or through our dealers. Consumables like dry cell etc. are
not covered under warranty.
2. The guarantee will become void, if
a) The product is not operated as per the instruction given in the Learning
Material.
b) The agreed payment terms and other conditions of sale are not followed.
c) The customer resells the instrument to another party.
d) Any attempt is made to service and modify the instrument.
3. The non-working of the product is to be communicated to us immediately giving
full details of the complaints and defects noticed specifically mentioning the
type, serial number of the product and date of purchase etc.
ww
4. The repair work will be carried out, provided the product is dispatched securely
packed and insured. The transportation charges shall be borne by the customer.
w.
hik
-co
ns
ult
ing
.pl
/ed
u
List of Accessories
1. Power Supply.......................................................................................1 No.

2. Learning Material (CD)...............................................................................1 No.
3. USB Cable (Male to Male) A Type)...........................................................1 No.

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Arrhythmia Monitor

An ISO 9001:2008 company

Save paper, save trees, save earth

We request you to use the Learning material in the CD form

provided with this supply.

Your this act will help to save paper.

Your CD learning material has

detailed experiments with observation tables,

frequently asked questions, etc.

.. and more so sometimes videos as well.

- Scientech Eco Foundation

Scientech Technologies Pvt. Ltd. 2

Scientech Technologies Pvt. Ltd. 3

Study of Sick Sinus Syndrome

Scientech Technologies Pvt. Ltd. 4

10. Frequently Asked Questions 47

11. Glossary of Human Cardiovascular System Terms 60

13. List of Accessories 61

Scientech Technologies Pvt. Ltd. 5

For your safety:

the earth ground. Before making connections to the

marks on the instrument.

2. Do not operate in an explosive atmosphere.

3. Keep the product dust free, clean and dry.

Scientech Technologies Pvt. Ltd. 6

Scientech Technologies Pvt. Ltd. 7

Scientech Products are RoHS Complied.

Scientech products are Lead Free and Environment Friendly.

Scientech Technologies Pvt. Ltd. 8

Heartbeat Indication : Both visible (LED) and Audible

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Controls and Indicators

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up to the rate of 6/min or 12/min.

transformation, decision processors and template matching. Generally two or more of

approach in the detection of arrhythmia is based on template matching. A model of

ST/AR Arrhythmia Algorithm

Scientech Technologies Pvt. Ltd. 12

average P-R interval. P wave detection is used to differentiate between a Sinus

Scientech Technologies Pvt. Ltd. 13

2. Tachycardia- Any heart rate faster than 100beats/minute is labelled

necessarily an arrhythmia. Increased heart rate is a normal response to physical

increase sympathetic nervous system activity in the heart include ingested or

gland (hyperthyroidism).Tachycardia that is not sinus tachycardia usually results

Scientech Technologies Pvt. Ltd. 14

3. Atrial Fibrillation- Atrial fibrillation is the quivering, chaotic motion in the

spontaneously in people with otherwise normal hearts. It is typically not a stable

rarely persist for months to years.

5. Premature Atrial Contraction (PAC)- Premature atrial contractions (PAC) are

Scientech Technologies Pvt. Ltd. 15

Premature Atrial Contraction

6. Multifocal Atrial Tachycardia (MAT) - Multifocal atrial tachycardia is a

hypomagnesaemia. It is sometimes associated with digitalis toxicity in patients

pacemaker (WAP). The electrical impulse is generated at a different focus

Scientech Technologies Pvt. Ltd. 16

7. Paroxysmal Supra Ventricular Tachycardia (PSVT)-

Paroxysmal Supraventricular Tachycardia

uncommon syndrome. It can result in many abnormal heart rhythms

common in elderly adults, where the cause is often a non-specific, scar-like

degeneration of the cardiac conduction system. Cardiac surgery, especially to

Sick Sinus Syndrome

9. Sinus Tachycardia- Sinus tachycardia (also colloquially known as sinus tach or