Normal ECG

Jan Christian Aramburo

Electrocardiography

 graphic recording of electric potentials generated
by the heart.
 the signals are detected by means of metal
electrodes attached to the extremities and chest
wall and are then amplified and recorded by the
electrocardiograph.
Conduction Pathway
 SA node -> atrial muscle -> AV node -> bundle
of His -> Left and Right Bundle Branches ->
Ventricular muscle

12 Lead ECG
 Standard ECG is recorded in 12 leads
 Six Limb leads – L1, L2, L3, aVR, aVL, aVF
 Six Chest Leads – V1 V2 V3 V4 V5 and V6

ECG placement
Deflections


 The rule states that if the electricity flows toward

the positive electrode, the patterns produced on
the graph paper will be upright.




 tilpmA sixA - Y ECG Graph Paper

X- Axis time in seconds

7
ECG waveforms
P wave: Atrial
depolarization
The normal atrial depolarization vector is
oriented downward and toward the
subject's left, reflecting the spread of
depolarization from the sinus node to the
right and then the left atrial myocardium
the normal P wave will be positive in lead II
and negative in lead aVR.
•



QRS complex: Ventricular
depolarization
This complex process can be divided into
two major, sequential phases,
The first phase is depolarization of the
interventricular septum from the left to the
right and anteriorly (vector 1).
The second results from the simultaneous
depolarization of the right and left
ventricles; it is normally dominated by the
more massive left ventricle, so that vector
2 points leftward and posteriorly.
QRS complex: Ventricular
depolarization
QRS complex: Ventricular
depolarization
• Its duration, amplitude, and morphology are
useful in diagnosing cardiac arrhythmias,
ventricular hypertrophy, MI, electrolyte
derangement, etc.

 T wave:
• Represents repolarization or recovery of
ventricles
• Interval from beginning of QRS to apex of T
is referred to as the absolute refractory
period



Four major ECG intervals:
R-R
PR
QRS
QT


The PR interval measures the time

(normally 120–200 ms) between atrial and
ventricular depolarization, which includes
the physiologic delay imposed by
stimulation of cells in the AV junction area.
ECG interval
The QRS interval (normally 100-110 ms or
less) reflects the duration of ventricular
depolarization.


The QT interval includes both ventricular

depolarization and repolarization times and
varies inversely with the heart rate.
A rate-related ("corrected") QT interval, QTc,
can be calculated as and normally is 0.44 s

Interpretation of ECG
Rate
Rythm
Axis
Hypertrophy
Ischemia
Heart Rate
 6 second count method
Heart Rate
Heart Rate

HR= 1500
 # of small boxes


HR= 300
 # of big boxes



Heart Rate
Measure ventricular rhythm by measuring
the interval between R R-to to-R waves and
atrial rhythm by measuring the P P-to to-P
waves.
Regular or irregular
Normal rate: 60-100 beats per minute
Bradycardia: < 60 beats per minute
Tacycardia: > 100 beats per minute

Heart Rhythm
Normal Sinus Rhythm
Cardiac Axis
 Lead I Lead AVF
Normal axis + +
Left axis deviation + -

Right axis - +
deviation
Indeterminate axis- -
Cardiac Enlargement