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The electrocardiogram (ECG) is a noninvasive test that is used to reflect underlying heart conditions by
measuring the electrical activity of the heart in 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.
ECG waves
In standard ECG recording there are five electrodes connected to the patient: right arm (RA), left arm (LA), left
leg (LL), right leg (RL), and chest (C).
These electrodes are connected to the inputs of a differential buffer amplifier through a lead selector switch.
This set of waves, in turn, is recorded and analyzed from each of 12 points of view.
Six of these points of view are the locations of the 6 pads placed across your chest. These are called V1, V2, V3,
V4, V5, and V6 (pronounced Vee One, Vee Two, and so on).
The other points of view represent combinations of the pads placed on the arms and legs. These are called I, II,
III , aVR, aVL, and aVF.
The interpretation of the waves produced by each of these 12 views provides valuable information about the
functioning of your heart.
What is P Wave?
During normal atrial depolarization, the main electrical vector is directed from the SA node towards the
AV node, and spreads from the RA to LA.
This turns into P Wave on the ECG.
What reveals?
1. Relationship between P waves and QRT complexes helps distinguish various cardiac arrhythmias.
2. Shape and duration of the P waves may indicate atrial enlargement
What is PR Interval?
Interval between P waves and QRS complex.
It is usually 120 to 200 ms.
What reveals?
1. PR interval > 200 ms: First degree heart block
2. Shape and duration of the P waves may indicate atrial enlargement
What is ST segment?
The ST segment connects the QRS complex and the T wave and has a duration of 80 to 120 ms
What reveals?
1. Flat, downsloping, or depressed ST segments may indicate coronary ischemia.
What T wave?
T wave represents the repolarization (or recovery) of the ventricles.
Interval from QRS complex to the apex of the T wave is referred to as the absolute refractory period.
Last half of the T wave is referred to as the relative refractory period (or vulnerable period).
What reveals?
1. Inverted (or negative) T waves can be a sign of coronary ischemia, left ventricular hypertrophy.
2. Tall symmetrical T waves may indicate hyperkalemia.
3. Flat T waves may indicate coronary ischemia or hyperkalemia.
What is QT segment?
The QT interval is measured from the beginning of the QRS complex to the end of the T wave.
Normal values for the QT interval are between 0.30 and 0.44 (0.45 for women) seconds
What reveals?
1. QT interval varies based on the heart rate, and various correction factors have been developed to
correct the QT interval for the heart rate.
2. QT interval represents the time needed for the the ventricles to depolarize and repolarize.
What is U wave?
The U wave is not always seen. It is typically small, and, by definition, follows the T wave.
U waves are thought to represent repolarization of the papilary muscless.
What reveals?
1. Prominent U waves are most often seen in hypokalemia.
2. An inverted U wave may represent myocardial ischemia or left ventricular volume overload.
In standard ECG recording there are five electrodes connected to the patient: right arm (RA), left arm (LA), left
leg (LL), right leg (RL), and chest (C).
The potentials picked up by the patient electrodes are taken to the lead selector switch.
By means of capacitive coupling, the signal is connected symmetrically to a differential preamplifier.
Preamplifier gives a stabilizing effect.
The amplified output signal is picked up single-ended and is given to the power amplifier.
The power amplifier is generally of the push-pull differential type. The output of the power amplifier is single-
ended and is fed to the pen motor, which deflects the writing arm on the paper.
The auxiliary circuits provide a 1 mV calibration signal and automatic blocking of the amplifier during a change in
the position of the lead switch. It may include a speed control circuit for the chart drive motor.
Electrocardiograms are almost invariably recorded on graph paper wiith horizontal and vertical lines at 1 mm
intervals with a thicker line at 5 mm intervals.
Time measurements and heart rate measurements are made horizontally on the electrocardiogram.
For routine work, the paper recording speed is 25 mm/s. Amplitude measurements are made vertically in
millivolts. The sensitivity of an electrocardiograph is typically set at 10 mm/mV.
A more convenient approach is to use the ECG oscilloscope to continually monitor a patient.
It shows one to two cycles of the ECG, which is enough for a doctor or nurse to assess the patient's condition.
Modern monitors use a microcomputer to store the ECG information and use it to continually refresh the trace.
The trace slowly moves across the screen and never fades. In many intensive care units (ICUs) several patients
are monitored by the use of multiple traces on a single large oscilloscope.
Instalation in hospitals, allows long-term ECG monitoring of patients on bed or while moving.
BIO (BIO-MEDICAL) ENGINEERING – ECG
Prepared By: S. Ehtesham Al Hanif (Hridoy) [0510035]
On-line ECG data wireless transfer, real-time analysis, alarms, patient state detection, automatic data and event
record, history, patient data trends.