Basic ECGEducational Programmes

By

Dr. Abdelsalam SherifMD Cardiology

August 13, 2014RNH( 1st Lecture)

2

QUICK REVIEW OF HEART

Purpose • Pumps blood Basic Anatomy• 4 chambers• 2 sides • 4 valves

3

THE CONDUCTING SYSTEM

• SA Node• Inter-nodal

pathway• AV Node• Bundle of HIS• Bundle Branches• Purkinje Fibers

4

RELATIONSHIP

Relationship

Hold It!

SA NodeNormal Pacemaker

Activation Of The Heart

PQ ST

P QRS

T

PR interval

QT interval

Time

0.04 sec

1 sec

0.2 sec

Time

Volta

ge0.2

seconds

1 m

illiV

olt

0.1 mV

Cardiac Cycles

12

HOOKING UP THE 12-LEAD ECG

• Proper skin prep

• Placement of the limb electrodes

• Placement of the chest electrodes

13

ELECTRODE PLACEMENT

• LIMB LEADS

• CHEST LEADS

14

LIMB LEADS

• Bipolar leads I, II, III

• Augment leads AVR, AVl, AVF

  

15

RULING OUT LIMB LEAD REVERSAL

• AVR is always negative

• Lead I is always positive

• Lead II and III positive for the P wave and usually the QRS complex

Chest Leads

17

CHEST LEADS

6 UNIPOLAR LEADS

• V1• V2 • V3• V4 • V5• V6

18

CHEST LEADS CHEST LEADS

COLUMN III• R wave progression • Small to Tall

COLUMN IV• R wave progression • Tall to Small

20

Some Problems With The ECG

• Artifact• Electrical interference• Somatic tremor• Wandering baseline

21

ARTIFACT ON THE ECG

22

THE ARTEFACT

23

BASELINE WANDERING

24

SOMATIC TREMOR

25

ELECTRICAL INTERFERANCE

Method" of ECG Interpretation

1. Measurements.2. Rhythm Analysis.3. Conduction Analysis.4. Waveform description.5. ECG interpretation.6. Comparison with previous ECG ( if any ).

Determination OF Heart Rate

1st Method

2nd Method

2nd Method

Determination Of QRS axis

33

EINTHOVENS TRIANGLE

QRS Axis Determination

Axis in Normal range

Left Axis Deviation

Right Axis Deviation

Thanks