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SA Node
Intra-atrial conduction
AV Node
Bundle of His
Bundle branch
Purkinje Fibers
Purkinje fibers
Electrical Measurement
-Single Cell Model
Electrocardiographic Lead
Lead I
Lead II
Lead III
aVR
aVL
aVF
Precordial lead
V1
V2
V3
V4
V5
V6
(+) Electrode
(-) Electrode
LA
RA
II
LL
RA
III
LL
LA
Bipolar Lead
Unipolar lead
aVR
RA
aVL
LA
aVF
LL
V2
V3
V4
V5
V6
Hexadensial System
Vertically
3 sec
Every
3 sec
The PQRST
P
The PR Interval
Atrial depolarization
+
delay in AV junction
(AV node/Bundle of His)
Interpretation of The
Electrocardiogram
Calibration
Heart Rhytm
Regularity
Heart Rate
P wave
PR interval
QRS wave
QRS interval
Axis
Transition zone
Atrium Abnormality
Ventricular hipertrophy
Pathologic Q wave
ST Segment
T wave
Calibration
Heart Rhytm
Atrial rhytm
Junctional rhytm
Ventricular rhytm
Regularity
Regular
Regular-Irregular
Irregular-Irregular
Heart
Rate
of mm between beat)
Count-off methode: 300-150-100-75-60-50
Number of beat in 6 sec x 10
If regular
If irregular
R wave
3 1 1
0 5 0 7 6 5
0 0 0 5 0 0
Memorize
the sequence:
Interpretation?
3 sec
Count
3 sec
Interpretation?
9 x 10 = 90 bpm
wave
Inspect P in lead II and V1 for:
Right
PR
interval
QRS Wave
QRS interval?
NAD?
LAD?
RAD?
Transition zone?
Normal in V3 and V4
V1 and V2 counter clockwise
V5 and V6 clockwise
QRS Axis
ST
Infartion STEMI
what anatomic distribution?
wave amplitude
> 2.5 mm in leads II
P in V1
> 1 mm wide
> 1 mm deep
V1 & V2 demonstrate
the opposite
deeper than normal
S waves
Pathologic Q Wave
In Myocardial Infarction
Irreversible necrosis of the heart muscle
Width 1 small box and depth > 25% of total
height of QRS
Necrotic muscle does not generate electrical
force.
The ECG electrode over that region detects
electrical currents from the healthy tissue on
opposite regions of the ventricle inscribing the
downward deflection
Do not differentiated between acute event and
an MI that ocured week or years earlier
MI Locations
First, take a look
again at this
picture of the
heart.
Anterior portion
of the heart
Inferior portion
of the heart
Lateral portion
of the heart
MI location
Resource