1.ECG Basic

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ECG BASIC dr. fikri Taufiq, M.Si.Med Physiology Department Hp: 08122519992 email: [email protected]

description

EKG

Transcript of 1.ECG Basic

  • ECG BASIC dr. fikri Taufiq, M.Si.Med

    Physiology Department

    Hp: 08122519992

    email: [email protected]

  • Cardiac Conduction Pathway

    SA Node

    Intra-atrial conduction Internodal tract: SA Node AV Node Bachman bundle: Right Atrium Left Atrium

    AV Node

    Bundle of His

    Bundle branch Left Bundle Branch Left anterior fasicular branch

    Left ponterior fasicular branch

    Right Bundle Branch

    Purkinje Fibers

  • Impulse Conduction & the ECG Sinoatrial node

    AV node

    Bundle of His

    Bundle Branches

    Purkinje fibers

    dellHighlight

  • Electrical Measurement

    -Single Cell Model- In the resting state the surface of the cell is

    positive charged relative to the inside because the surface is homogeneously charged the voltmeter electrodes outside the cell do not record any electrical potential different

    If depolarization current is directed toward the (+) electrode of the voltmeter an upward deflection is recorded

    If depolarization current is directed away from the

    (+) electrode of the voltmeter a downward deflection is recorded

  • Electrocardiographic Lead Bipolar limb lead

    Lead I

    Lead II

    Lead III

    Unipolar limb lead

    aVR

    aVL

    aVF

    Precordial lead

    V1

    V2

    V3

    V4

    V5

    V6

  • Position of ECG Limb Leads

    Lead (+) Electrode (-) Electrode

    Bipolar Lead

    I LA RA

    II LL RA

    III LL LA

    Unipolar lead

    aVR RA

    aVL LA

    aVF LL

  • Position of ECG Chest Electrodes

    V1 4th ICS, 2 cm to the right of sternum

    V2 4th ICS, 2 cm to the left of sternum

    V3 Midway between V2 and V4

    V4 5th ICS, left midclavicular line

    V5 5th ICS, left anterior axillary line

    V6 5th ICS, left midaxillary line

    dellHighlight

  • The axial reference system

  • Hexadensial System

  • The ECG Paper

  • The ECG Paper

    Horizontally

    One small box - 0.04 s

    One large box - 0.20 s

    Vertically

    One large box - 0.5 mV

  • Every 3 seconds (15 large boxes) is

    marked by a vertical line.

    This helps when calculating the heart rate.

    NOTE: the following strips are not marked

    but all are 6 seconds long.

    3 sec 3 sec

  • Sequence of Normal Cardiac

    Activation

  • The PQRST

    P wave - Atrial depolarization

    T wave Ventricular repolarization

    QRS Ventricular depolarization

    dellHighlight

  • The PR Interval

    Atrial depolarization

    +

    delay in AV junction

    (AV node/Bundle of His)

    (delay allows time for the

    atria to contract before

    the ventricles contract)

  • 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

    Check 1.0 mV vertical box inscription (normal standard = 10 mm)

    25 mm/second speed

    Heart Rhytm

    Sinus rhytm is present if

    Each P wave is followed by a QRS complex

    Each QRS is preceded by P wave

    P wave is upright in lead I, II, and III

    PR interval is >0.12 sec (3 small boxes)

    Atrial rhytm

    Junctional rhytm

    Ventricular rhytm

  • Regularity

    Regular

    Regular-Irregular

    Irregular-Irregular

    Heart Rate

    Use one of three methode:

    1500/(number 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

  • Find a R wave that lands on a bold line.

    Count total of large boxes to the next R wave. If the second R wave is

    1 large box away the rate is 300,

    2 boxes - 150,

    3 boxes - 100,

    4 boxes - 75, etc.

    R wave

    Example to count Heart Rate

  • Memorize the sequence:

    300 - 150 - 100 - 75 - 60 - 50

    Interpretation?

    3

    0

    0

    1

    5

    0

    1

    0

    0

    7

    5

    6

    0

    5

    0

    Approx. 1 box less than 100 = 95 bpm

    Example to count Heart Rate

  • Count total of R waves in a 6 second

    rhythm strip, then multiply by 10.

    Interpretation?

    9 x 10 = 90 bpm

    3 sec 3 sec

    Example to count Heart Rate

  • P wave

    Inspect P in lead II and V1 for:

    Right atrial enlargment (P pulmonal)?

    Left atrial enlargment (Pmitral)?

  • PR interval

    Normal PR interval = 0.12-0.20 sec (3-5 small

    boxes)

  • QRS Wave

    QRS interval?

    Normal QRS interval 0.10 sec (2.5 small boxes)

    Axis look at lead I and aVF

    NAD?

    LAD?

    RAD?

    Transition zone?

    Normal in V3 and V4 V1 and V2 counter clockwise

    V5 and V6 clockwise

    Inspect for left and right ventricular hypertrophy

    Inspect for pathologic Q wave: what anatomic distribution?

  • QRS Axis

  • ST segment or T wave abnormalities

    Inspect for ST elevation

    Myocard Infartion STEMI

    what anatomic distribution?

    Inspect for ST depressions or T wave

    inversion:

    Myocardial ischemia or Non-ST elevation MI

    what anatomic distribution?

  • Abnormalities of the P Wave

    P wave Represent depolarization of the right atrium followed quickly by the depolarization of the left atrium

    The two components are nearly superimposed on one another

    Right atrial enlargment best observed in lead II

    Left atrial enlargment best observed in lead V1.

    dellHighlight

  • Right atrial abnormality

    P wave amplitude

    > 2.5 mm in leads II

  • Left atrial abnormality

    Negative P in V1

    > 1 mm wide

    > 1 mm deep

  • Abnormalities of the QRS Complex

    For this Modul, we will discuse:

    1. Ventricular hypertrophy

    2. Pathologic Q wave

  • Right ventricular hypertrophy V1 & V2 record greater

    than normal upward deflections

    The R wave becomes taller than the S wave in V1 & V2

    The increased right ventricular mass shifts the mean axis of the heart RAD (mean axis > +900)

  • Left ventricular hypertrophy

    V5 & V6 show taller

    than normal R waves

    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

  • ST Segment and T Wave

    Abnormalities Acute ST Segment Elevation MI

    The initial abnormality is elevation of the ST segment, often with a peaked appearance of the T wave.

    Abnormality of injured myocardial cell The diastolic current theory Capable of depolarization but abnormally leaky Allowing ionic flow that prevents the cells from fully

    repolarization

    The systolic current theory

    Acute Non-ST Segment Elevation MI Result from an acute partially occlusive coronary

    thrombus ST segmen depression and T wave inversion

    The diastolic current theory

  • MI Locations

    First, take a look again at this picture of the heart.

    Anterior portion

    of the heart

    Lateral portion

    of the heart

    Inferior portion

    of the heart

  • MI location

  • Resource Pathophysiology of Heart Disease, Leonard S. Lilly

    Lange Instant Access EKGs and CARDIAC STUDIES, Anil M. Patel

    Kursus Elektrokardiografi, Perki