Basics of ECG

Dr. Loay Abudalu. MD. MSc (UK)

Definition of ECG

Basics of electrical activity in Cardiac cells

Electrical events of the heart during one cycle

Different electric Cardiac vectors

Basics of ECG

Difference between Waves , segments and intervals

Definition of ECG

ECG or electro cardiograph : it means the electricity of the heart which is presented graphically .

Basics of electrical activity in cardiac cells

If there is no action potential this state is called resting membrane potential .

This means the inside of the cells is negatively charged compared to the outside of the cells . We have 3 different ion gated channels for Na, K and Ca

During the stimulation of cardiac cells the Na channels start to open leading to entering sodium that causes increase of the positive charge inside the cells. Sodium continues entering causing a firing point or threshold at -70 mlv Sodium still entering until change the negative charge to positive charge inside the cells .

All sodium channels open at the peak .

This event called

Depolarization

After opening of all sodium channels ,sodium channels will not be entering any more , potassium channels open to get out side the cells and calcium channels open to enter inside this will cause a state of equalization between charges of the cells, its called plateau.

After calcium start entering inside the cells channels of calcium start to close and more and more potassium channels open to form what is called repolarization

Gab junction have electron windows in which myocytes stimulate the cell that is beside it

Resting Membrane Potential (RMP)

Depolarization

Repolarization

Basics of electrical activity in Cardiac cells

Galvanometer : to detect any change in current

RMP = 0

Myocardial cells

Na +

+ + + +
Myocardial cells

+ + + +

Na +

+ + + +
Myocardial cells

+ + + +

+ + + +

+ + + +

Na +

+ + + +
increase thickness of Myocardial cells

+ + + +

Na +

Myocardial cells

+ + + +

+ + + +

To sum up!
Normally the current moves from negative to positive During RMP reading is zero During depolarization the reading of galvanometer is not zero maybe positive or negative reading depending on current direction . During plateau with positive charges inside the cells no more change in currant so the galvanometer reading is zero . Increased thickness of cardiac muscle will increase the reading of galvanometer

Electrical events of the heart during one cycle

Different electric Cardiac vectors

Firing point

Depolarization of the atrium

Downward leftward

AV Node

It ensures that the atria have ejected their blood into the ventricles first before the ventricles contract

The arrangement in which there is a decrease in gab junction Less diameter Ca channel works slowly in comparison with other Ca channel gate

Depolarization of ventricles

Base

Apex

Septum

purkinje fibers
wider the gab junction

Na channel works faster than other cells

Septum is fibrous more than muscular this reduce the speed of conductivity in compare to the base of the ventricles which is muscular Fibrous tissue in the septum act as insulator for purkinje fibers Left ventricle is 3 times thicker than the right ventricle so it completes its depolarization faster . The direction of the vector in the septum from left to right. Depolarization of ventricles moves from inner layer to outer why ???

Basics of ECG

Quiz
P wave : ?? PQ or PR Segment: ?? Q wave: ?? R wave :?? S wave : ?? ST Segment:??

T Wave :?? U wave :??

Difference of Waves , segments and intervals