Vectors and EKGs

Dr. Byron Reyes R3 Medicina Dr. Enrique Tllez R2 Medicina

Electrocardiogram (ECG)
Depolarization wave passes through the heart and the electrical currents pass into surrounding tissues. Small part of the extracellular current reaches the surface of the body. The electric potential generated can be recorded from electrodes placed on the skin An EKG is a comparison of two vectors It compares the heart vector showing current flow on the heart with the reference, recording lead vector on the body.

(Non-invasive) Heart Rate Signal conduction Heart tissue (enlarged) Conditions (MI) electrolyte and hormone imbalances

Vector diagrams
Vectors are used to describe depolarization and repolarization events Vectors are arrows which show two things:
Direction or pathway (of charge spread) Magnitude or size (amt of charge)

Vector analysis explains the waves on an EKG

Q S

EKG is Extracellular Recording

Only looks at the charge on the outside of fibers!
Resting cell: outside positive Depolarizing cell: outside negative Repolarizing cell: outside positive +++++++++++ -----------------+++++++++++ -----------------+++++++++++ ------------------

Depolarization: spread of surface neg charge Repolarization: spread of surface positive charge Vectors will always be positioned so that head of vector is in area of positive charge; tail is in area of negative charge.
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+++++++++++ ------------------

Rest
No current flow, no vector.

The following vectors represent the spread of negative charge during depolarization; Then the spread of positive charge during repolarization

= depol SA nodal fibers, spread of neg charge over atria

- +
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+
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+
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The atria would start to repolarize down and to the left, as the current continues downward to the ventricles We dont detect this on the EKG, but what would the repolarizing vector look like? (review your specialized cells/contractile cells lecture!)

+
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+
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Atria now have repolarized and now have positive surface charge again.

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Meanwhile, as the atria are repolarizing...... We turn to the Depolarizing AV node

These are small diameter fibers with few gap junctions; little or no detectable current flow

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IV Septal Depolarization
Moving down bundle of His; Current moves down R and L bundle branches from L toward Rwhy?

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Apex then Lateral walls

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Through the thickness of the heart, from endo- , to myo-, to epicardium

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Ventricles completely depolarized, negative surface charge No current No vector

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Begin Ventricular Repolarization

Spread of positive charge

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Rest
End of cycle;
No current flow, no vector.

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Recording from Lead II

Standard limb lead

II

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+
-

II

III

Einthovens Triangle Bipolar Limb Leads 32

Atrial depolarization

Pen here

II

V
T

The heart vector is parallel to the lead, but how can you confirm?33

II
1.

Atrial depolarization

2.

Draw a perpendicular line to the lead vector Draw a line toward from the perpendicular vector toward your cardiac vector
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Atrial depolarization

II

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AV nodal depolarization

II

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IV septal depol, from L to R

II

Anti-parallel! Pen deflects down

Draw it!

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IV septal depol, from base to apex

II

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Lateral walls depol

II

Draw it!

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Depolarization complete; no current flow; pen returns to baseline

II

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Waiting to begin repolarization; no current flow

II

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Ventricular Repolarization begins

II

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Ventricular Repolarization

II

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Ventricular Repolarization complete; no current flow; pen on baseline

II

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Ventricular Repolarization complete; waiting to start all over again

II

End of one cardiac cycle 45

Body Cross-section at Heart Level Heart

12 Lead EKGs
Read from each lead independently; one at a time over several heartbeats. See what each lead shows. 12 leads 3 bipolar limb leads (I, II, III) 3 augmented unipolar limb leads (aVR, aVL, aVF) 6 precordial leads (chest leads, V1V6)

V6 V4

V5

V1

V2

V3

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6 Leads- bipolar and augmented; all of these are in flat plane

Augmented- Obtained by using the average voltage of any two points on skin as ground (neg pole) and reading from the third electrode (pos pole.)

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Cardiac Arrhythmias
Tachycardia: abnormally fast heart rate Bradycardia: Abnormally slow heart rate Incomplete Atrioventricular Block: Prolonged P-R interval (1st degree) Complete Atrioventricular Block: P waves and QRS complexes become dissociated (3rd degree) Fibrillation: Complete lack of coordination
Arrhythmia: conduction failure at AV node

No pumping action occurs

No P waves
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Electrolyte imbalance
Hypernatremia:
Inhibits calcium entry into the cell Depresses overall heart activity and becomes flaccid; (negative inotropy)

Hypercalcemia:
(-, +) Increased heart irritability More calcium into cytoplasm What reflex could augment the decreased chronotropy?

Hyperkalemia:
Peaked T waves.

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Electrolyte imbalance
Hyponatremia:
Depolarization delay Decreased heart rate

Hypocalcemia:
(+,-) Less heart contractility What reflex could augment the increased chronotropy?

Hypokalemia:
Lowers RMP (makes it more negative) Decreases heart rate U waves
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