ELECTROCARDIOGRAM

BY: KEVERNE JHAY P. COLAS,

Electrocardiogram (ECG)
• a diagnostic tool that measures and records
the electrical activity of the heart in exquisite
detail. Interpretation of these details allows
diagnosis of a wide range of heart conditions.
These conditions can vary from minor to life
threatening.
• The term electrocardiogram was introduced
by Willem Einthoven in 1893 at a meeting of
the Dutch Medical Society. In 1924,
Einthoven received the Nobel Prize for his
life's work in developing the ECG.
• The 12- lead ECG that is used throughout the
world was introduced in 1942.
 Reasons to Have an ECG
Heart problems can produce a wide array of symptoms.
• Without the benefit of an ECG, it may be impossible to tell
whether these symptoms are being caused by a heart problem
or just mimicking one.

Common symptoms that frequently require an ECG include the

following:
• Chest pain or discomfort
• Shortness of breath
• Nausea
• Weakness
• Palpitations (rapid or pounding heartbeats or increased
awareness of heart beating)
• Anxiety
• Abdominal pain
• Fainting (syncope)
 The Heart
• The heart itself is made up of 4 chambers, 2 atria
and 2 ventricles. De-oxygenated blood returns to
the right side of the heart via the venous
circulation. It is pumped into the right ventricle
and then to the lungs where carbon dioxide is
released and oxygen is absorbed. The
oxygenated blood then travels back to the left
side of the heart into the left atria, then into the
left ventricle from where it is pumped into the
aorta and arterial circulation.
 The Heart
• Systolic blood pressure:
Is the pressure created in the arteries when the
ventricles contract

• Diastolic blood pressure:

When the ventricles starts to refill, the pressure
from the arteries falls simultaneously the atriums
contract creating pressure known as the diastolic
pressure.
 The Heart
• Image: The passage of blood through the heart
 The Heart
• Image: The cardiac conduction system
 The Heart
• Image: The cardiac conduction system
 Role of the ECG Machine
• The ECG machine is designed to recognise and record any
electrical activity within the heart. It prints out this
information on ECG paper made up of small squares 1mm
squared.
 Role of the ECG Machine
• Each electrical stimulus takes the form of a wave and so patterns
emerge made up of a number of connected waves. A standard
ECG is printed at 25mm per second or 25 small squares per
second (see above). In this way it is possible to calculate the
duration of individual waves.
• 10 small squares vertically is equal to 1 millivolt. So it is
possible to calculate the amount of voltage being released within
the heart. If the line is flat at any time in the duration of a series
of waves, it indicates no electrical activity at that particular
moment.
• The direction in which the waves point indicates whether
electricity is moving towards or away from a particular lead.
Role of the ECG Machine
 Sinus Rhythm

• Sinus rhythm is the name given to the normal rhythm of

the heart where electrical stimuli are initiated in the SA
node, and are then conducted through the AV node and
bundle of His, bundle branches and Purkinje fibres.
• Depolarisation and repolarisation of the atria and
ventricles show up as 3 distinct waves on ECG. A
unique labelling system is used to identify each wave.
• Less muscle means less cells which means less
voltage.
Sinus Rhythm
 The P Wave
• The first wave (p wave) represents atrial
depolarisation
 The QRS Complex
• After the first wave there follows a short period where the
line is flat. This is the point at which the stimulus is delayed
in the bundle of His to allow the atria enough time to pump
all the blood into the ventricles.
• As the ventricles fill, the growing pressure causes the valves
between the atria and ventricles to close. At this point the
electrical stimulus passes from the bundle of His into the
bundle branches and Purkinje fibres. The amount of electrical
energy generated is recorded as a complex of 3 waves known
collectively as the QRS complex. Measuring the waves
vertically shows voltage. More voltage is required to cause
ventricular contraction and therefore the wave is much
bigger.
 The Q Wave
• Q wave and represents depolarisation in the
septum.
 The R Wave
• R wave represents the ventricular
depolarisation
 The S Wave
• S wave represents depolarisation of the
Purkinje fibres.
 The T Wave
• T wave represents ventricular repolarisation.
 The ST Segment
• There is a brief period between the end of the QRS complex
and the beginning of the T wave where there is no conduction
and the line is flat. This is known as the ST segment and it is a
key indicator for both myocardial ischemia and necrosis if it
goes up or down.
• V1: 4th intercostal space right
sternal border
• V2: 4th intercostal space left sternal
border
• V3: halfway between V2 and V4
• V4: left 5th intercostal space,mid-
clavicular line
• V5: horizontal to V4, anterior
axillary line
 Points To Remember:
• Ask the patient to remove all metalic objects
including watches, rings, neclaces, pocketed
coins and phones etc…
• Let the patient relax before the procedure
starts and ask them to lay still for a minute
during the procedure.
• Explain the procedure and reassure them that
no pain will be felt during the procedure.
~END~
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