Basics of the

Resting ECG Recording

Basic Training
 Anatomy of the HEART
Basic ECG
 The Circulation

 The blood flows to the heart in veins

 The blood flows away from the heart in
arteries
 In the Large Circulation (Body)
Basic ECG

– Arteries contain arterial (oxygen enriched) blood

– Veins contain venous (oxygen poor) blood
– There is a high arterial and a low venous blood
pressure
 In the Small Circulation (Lungs)
– Arteries contain venous (oxygen poor) blood
– Veins contain arterial (oxygen enriched) blood
 The electrical Stimulation of the Heart
Basic ECG
 Cardiac Facts
 In 24 hours:
 The heart beats 100,800 times

(70 bpm x 60 minutes x 24 hours)

 The heart pumps 7,056 litres of blood
(100,800 x 70ml / 1000 )
Basic ECG

 In a year:
 The heart beats 36,792,000 times
 The heart pumps 2,575,440 litres
 In 80 years of life:
 The heart beats 2,943,360,000 times
 The heart pumps 206,032,000 litres
 Cardiac Facts
 In 80 years of life:
 The heart beats 2,943,360,000 times
 The heart pumps 206,032,000 litres
 That’s enough volume to:
Basic ECG

 Refuel a Boeing 747-400 950 times

 Fly to the moon and back 10 times
 The Electrical Signal

Atrial ECG Ventricular ECG

R
Basic ECG

J Point

Q
ST
P Wave
S Segment T Wave U Wave
 Components of the ECG Signal

 Desired Signal
Amplitude of 50µV up to approximately 1 mV

 Voltage Share
up to 300 mV
Basic ECG

 Interference Signals
up to 100 mV

 Extreme Noise Voltage

through Defibrillation or HR Surgery of up to 3000 V

 Pacemaker Impulses
up to several Volts
 The Recording Methods

Surface ECG
Standard Leads according to Einthoven
Extremity Leads according to Goldberger
Basic ECG

Unipolar Precordial Leads according to Wilson

Precordial Leads according to Nehb
Orthogonal Leads according to Frank

Intracardial ECG
HIS Bundle ECG

Oesophagus ECG
 The Leads according to Einthoven

I
Basic ECG

II III
 The Leads according to Goldberger

aVR aVL
Basic ECG

aVF
 The logical Lead Arrangement

aVR aVL
I
+aVR
Basic ECG

+aVL

+I
II III

-aVR

+III +II
aVF +aVF

Cabrera Circle
 The Colors of the Extremity Leads
Basic ECG
 The Precordial Leads according to Wilson

V3 V4
V2
V5
V1
V9
V8
V3r

V6
Basic ECG

V7
V4r

V6

V5

V4
V1 V2 V3
 The Electrode Placement acc. to Wilson
MCL=Medio Clarvicular Line

V1 right sternal border, 4. ICR

V2 left sternal border, 4. ICR

V3 between V2 and V4
Basic ECG

V4 5. ICR, intersection point with the

left MCL

V5 at the level of V4 in the

front axillary line

V6 at the level of V4 in the central

axillary line
 Signal Processing
Development of analog to digital signal processing
Analogue Signal Process 1V

Lead selection Potential

switch separation End-amplifier
Basic ECG

Difference Amplifier Registration

Pre-amplifier
per lead amplifier

Digital Signal Process

Creation of the
12 Leads Multiplexer

A C
P
D
U
Pre-amplifier Difference- Analogue / Thermal
per Lead amplifier Digital Printer
per Lead Changer
 Signal Processing in Schiller Devices

Digital Signal Process at Schiller

Basic ECG

Pre-amplifier LCD Monitor

Creation of the
per Lead 12 Leads

CPU
µP 68000
Galvanic
Separation
Schiller
ECG Controller Software
Thermal Printer
 Start of the ECG Recording
ECG Monitor
Basic ECG

Start
 Electrode Types used to Record an ECG

Clip electrodes & suction electrodes

Adhesive electrodes
Basic ECG

Vacuum Suction Unit

Elastic belt with plate electrodes
 Error Sources in the Electrode Material

Clip electrodes & suction electrodes

Electrodes are made of various metals
Rubber balls on suction electrodes are porous
No contact fluid

Adhesive electrodes
Basic ECG

Contact fluid is dried up

Vacuum Suction Unit

Electrodes are dirty or broken
No contact fluid

Rubber belt with plate electrodes

Electrodes are not lying directly on the skin – no skin
contact
 Other Error Sources

The patient is tense

The patient is restless and is moving
The bed is too narrow
Basic ECG

The patient is feeling cold, the room is too cold

Other electric/electronic devices emit interferences
The patient has a lot of hair
Wrong contact fluid
The recording device was started too soon