Dr.

Niranjan Murthy HL
Associate Professor
Dept of Physiology
SSMC, Tumkur
• Recording of the potential fluctuations during
cardiac cycle
• Body acts as volume conductor with heart at
the center
• Electrodes
• Leads
Normal ECG
Special conductile system of heart
 Leads

Bipolar Leads I,
II, III
 Augmented
Augmented
Unipolar
UnipolarLeads
Leads
AVR,AVL,AVF
AVR,AVL,AVF
Hexaxial system
 S
4 IC

MAL

MCL
AAL

Chest Leads V1-

5, Posterior, Right
 Recording
• Paper speed of 25mm/sec
Basis of wave formation
Vector: It is an arrow that points in the direction
of electrical potential generated in the heart,
the arrowhead indicating the positive
direction and the length indicating the
amplitude of potential developed.
Formation of QRS waves
Formation of T wave
 Determination of cardiac axis
• Mean axis of ventricular depolarization: 59⁰
(-30⁰ to +110⁰)
Left axis deviation: < -30⁰
Causes- lying down, deep expiration, obesity
- ascites, abdominal mass lesion
- left ventricular hypertrophy, left
bundle branch block
LAD in LVH
Right axis deviation: > +110⁰
Causes- standing, tall & lanky, deep inspiration
- right ventricular hypertrophy, right
bundle branch block
 Cardiac arrhythmias
• Abnormal sinus rhythms:
1. Sinus tachycardia
2. Sinus bradycardia:

3. Sinoatrial nodal block:

Abnormal rhythms due to conduction
block
• AV nodal block:
(i)Incomplete heart block- first degree and
second degree

(ii)Complete heart block- third degree-

idioventricular rhythm- stokes-adams
syndrome
 First degree
heart block

Second degree
heart block-
wenkebach
phenomenon

Third degree
heart block
 Premature contractions
• Ectopic beat, extrasystole, premature beat
Premature atrial contractions:
• abnormal P wave, compensatory pause
• Seen in healthy persons, smoking, lack of
sleep, athletes
AV nodal premature contractions:
• impulse travels in both directions
• P wave is superimposed onto QRS-T complex
Premature ventricular contraction:
• Prolonged and high-voltage QRS
• No P wave preceding ectopic QRS
• T wave is of opposite polarity that of QRS
 Paroxysmal tachycardias
• Heart rate become rapid paroxysms,
beginning suddenly, persisting for few
seconds to hours and ending suddenly
• Treated by vagal stimulation
• Lidocaine & Lignocaine- suppress sodium
permeability
Paroxysmal Atrial Tachycardia:
• Tachycardia with altered shape of P wave
Paroxysmal ventricular tachycardia:
• Appears like series of ventricular premature
beats
• Associated with considerable ischaemic
damage
• Can lead to ventricular fibrillation
• Digitalis toxicity
• Quinidine blocks irritable foci
 Atrial tachyarrhythmias
Atrial Tachycardia:
• Atrial rates upto 220/min
• All impulses travel across to ventricles
• PR and TP intervals are shortened
• T wave and next P wave merge
Atrial flutter:
• Atrial rate is 200-350/min
• Saw-tooth pattern waves
• Associated with 2:1 AV block
• AV node cant transmit > 230 impulses/min
Atrial fibrillation:
• Atrial rate is 300-500/min; irregular
• Atria show irregular oscillations- Fibrillations
• Ventricular rate is 80-160/min
• Treatment- digitalis/ electroshock
 Ventricular Tachyrrhythmias
Ventricular tachycardia:
• Upto 200/min
• Polymorphic QRS complexes
• Reduced cardiac output
Ventricular flutter:
• Rate- 200-350/min
Ventricular fibrillation:
• 350-500/min
• Irregular & ineffective ventricular contraction
• Quivering “bag of worms”
• Ineffective pumping of blood
Re-entry phenomenon- circus movements
• Increased length of pathway- dilatation
• Decreased velocity of conduction- blockage of
purkinje system, ischemia, hyperkalemia
• Shortened refractory period- drugs
(epinephrine)
 Chain reaction mechanism
• Demonstrated by applying 60-cycle electrical
stimulus
 Electroshock Defibrillation
• High voltage AC current or DC current is used
• Applied externally to chest wall for a short
duration
• 110v 60-cycle AC current for 0.1 sec
• 1000v DC for few thousandths of a second
• Heart quietens for 3-5 secs; SAN might take
over
 Cardiac massage
• Closed
• Open
 Long QT syndrome
• Irregular repolarization, increased incidence of
ventricular arrhythmias
• Congenital, electrolyte disturbances, drugs, MI
 Accelerated AV conduction
• Wolff-Parkinson-White syndrome
• Bundle of Kent- aberrant connection
• Conducts rapidly- one ventricle is activated
earlier
• Impulse pass retrograde to atria- circus
movements
• Short PR and prolonged QRS
 Sinus rhythm

WPW syndrome

Lown-Ganong-Levine
syndrome
 Lown-Ganong-Levine syndrome
• Aberrant bundle which enters conducting
system distal to AV node
• Short PR interval and normal QRS
• Attacks of PSVT, usually nodal tachycardia
• Radiofrequency catheter ablation
Effect of electrolyte imbalance on ECG