The Normal Electrocardiogram

-Chapter 11-

Dr Moni Nader
Assistant Professor of Physiology
Department of Physiological Sciences
College of Medicine, Alfaisal University
E-mail: mnader@alfaisal.edu
Phone: +966 11 215 7674

Figures were adapted from The Textbook of Medical Physiology, Guyton et al.
Students are responsible of the complete content of the materials in Chapter 11.

07.01.2019
Plan
1- Concepts of Voltage recording
2- Description of an ECG recording
3- Different methods for Recording an ECG
When the cardiac impulse passes through the heart, electrical current also spread
from the heart to the surface of the body and they can be recorded by placing
electrodes on the skins. The recording is called Electrocardiogram (ECG).

P wave: atrial depolarization

QRS complex: ventricular depolarization
T wave: ventricular repolarization
Depolarization versus repolarization waves

Single cardiac muscle fiber in four stages of

depolarization and repolarization.

A: The action potential is moving from left to right and

the right electrode is recording a change in potential
between the two electrodes (positive voltage). Left
electrode is in negative areas while right electrode is in
positive area.
B: Depolarization has extended on the whole muscle
fibers and both electrodes are in area of equal negativity,
thus depolarization wave is dropping to zero.
C: Repolarization starts and the opposite scenario as in B
is noted.
D: Both electrodes are in areas equally positive thus
there is no voltage to be recorded (zero).
Monophasic Action Potential and Ventricular Muscle ECG

Electrodes inserted in a single ventricular muscle fiber.

Action Potential

ECG

No potential was recorded in the ECG when the fiber is

completely repolarized or completely depolarized.
Only when the muscle fibers are partially polarized or partially
depolarized, the current flows from one part of the ventricles to
another as well as to the surface of the body to produce ECG.
 Relationship of Atrial and Ventricular Contraction to the Waves of the Electrocardiogram
Depolarization must spread to the muscle
fiber to initiate contraction.
P wave: atrial depolarization
Atria repolarize 0.15-0.20s after
depolarization (Atrial T wave obscured by
the QRS complex)
T wave: ventricular repolarization
Ventricles repolarize 0.20 s after the
beginning of the depolarization but can
extend to 0.35s.
This is why the T wave is wide (long
period 0.15s) but the voltage amplitude is
less that QRS.
1 mV
+
0.2s Speed 25mm/sec
The recoding method affects the voltage amplitude of ECGs.
Amplitudes of the QRS complex when electrodes are placed on:
 Two arms or one arm and one leg: s 1-1.5 mV vs.
 One arm and the ventricle: 3-4 mV
They are relatively low when compared to action potential voltage
directly recorded at the surface of heart muscle membrane (110 mV).
P wave (0.1-0.3 mV), t wave (0.2-0.3 mV).
P-Q or P-R interval (0.16s): Time between atrial and ventricular
depolarization (Q wave is often absent.
Q-T interval (0.35s): Ventricular contraction.
Heart rate: 60/P-P interval (two consecutive beats)
~60/0.83=72beats/min
 Flow of Current during Cardiac Cycle
Concept of electrical wave recordings Flow of electrical currents in the Chest around th

Recording of positive and negative voltages in

cardiac muscle depolarized at its most central
point.

When one portion of the ventricles depolarizes (becomes electronegative with respect to the remainder)
electrical current flows from the depolarized area to the polarized area in large circuits routes.
Depolarization starts with purkinge fibers (negative charges in the middle of the heart) and spread
outwards to the outer regions of the ventricle towards the apex and at the very end of the depolarization
it reverses going backward towards the base of the heart.
Electrocardiographic leads
• Three bipolar limb leads
Standard bipolar limb leads
Bipolar means that the ECG is recorded from
electrodes on both sides of the heart (on limbs).
Lead: combination of two wires and their electrodes
to make a complete circuit between the body and
the electrocardiograph.
Lead I: when right arm (-) and left arm (+) the
recorded voltage is positive and vice versa.
Lead II: right arm (-), left leg (+). Same scenario as
Lead I.
Lead III: Left leg (+), left arm (-), same scenario as
above in normal cardiac cycle.

Einthoven’s triangle/Law:
If the electrical potentials of two of the three bipolar
limb electrocardiographic leads are known at any
given time, the third one can mathematically
determined by simple summation and taking into
consideration the negative and positive signs of the
different leads.
Electrocardiographic leads
•Chest Leads (Pericordial Leads)
V1, V2, V3, V4, V5 and V6 are distributed on the chest.
Indifferent Electrode is on equal electrical resistances
at the right arm, left arm and left leg.
Why V1 and V2 QRS are negative?

•Augmented Unipolar Limb Leads (see next slide)

Two limbs are connected through electrical resistances
to negative terminal and the third is on the positive
terminal. The location of the third limb may be
different: right arm (aVR), left arm (aVL) and left leg
(AVF).
Why aVR is negative? (discussed in next chapter)
 Introduction to Vectorial analysis
Chapter 12

Dr Moni Nader
Assistant Professor of Physiology
Department of Physiological Sciences
College of Medicine, Alfaisal University
E-mail: mnader@alfaisal.edu
Phone: +966 11 215 7674

Figures were adapted from The Textbook of Medical Physiology, Guyton et al.
Students are responsible of the materials related to the figures in this presentation
from Chapter 12.
The “Resultant” Vector of the Heart
 ECG Leads

Gradient Vector
of the Heart
More examples of ECG Leads and Einthoven triangle
Gradient Vector Axes of the three bipolar and three unipolar leads
The angles of the different leads with respect to the heart positioning
Vectorial analysis of ECG
The end!