HST.582J / 6.555J / 16.456J Biomedical Signal and Image ... · HST.582J: Biomedical Signal and...
Transcript of HST.582J / 6.555J / 16.456J Biomedical Signal and Image ... · HST.582J: Biomedical Signal and...
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MIT OpenCourseWare http://ocw.mit.edu HST.582J / 6.555J / 16.456J Biomedical Signal and Image ProcessingSpring 2007 For information about citing these materials or our Terms of Use, visit: http://ocw.mit.edu/terms.
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Harvard-MIT Division of Health Sciences and TechnologyHST.582J: Biomedical Signal and Image Processing, Spring 2007Course Director: Dr. Julie Greenberg
Introduction to Clinical Electrocardiography
Andrew Reisner, MDMGH Dept. of Emergency MedicineVisiting Scientist, HST
Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
Electrocardiography
The heart is an electrical organ, and its activity can be measured non-invasivelyWealth of information related to:
The electrical patterns properThe geometry of the heart tissueThe metabolic state of the heart
Standard tool used in a wide-range of medical evaluations
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology . Downloaded on [DD Month YYYY].
A heart• Blood circulates, passing near every cell in the body, driven by this pump
• …actually, two pumps…
• Atria = turbochargers
• Myocardium = muscle
• Mechanical systole
• Electrical systoleCourtesy of Dr. Roger Mark. HST.542J Quantitative Physiology: OrganTransport Systems, Spring 2004. (Massachusetts Institute of Technology:MIT OpenCourseWare). http://ocw.mit.edu (accessed June 17, 2008).Figure adapted from Phillips RE, Feeney MK, 1980 The Cardiac Rhythms.Saunders, Philadelphia and from Hoffman BF, Cranefield PF 1960 Electrophysiologyof the Heart. McGraw Hill, New York.
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
To understand the ECG:
Electrophysiology of a single cellHow a wave of electrical current propagates through myocardiumSpecific structures of the heart through which the electrical wave travelsHow that leads to a measurable signal on the surface of the body
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
Part I: A little electrophysiology
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
Once upon a time, there was a cell:
ATPaseATPase
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
timetime
Intr
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--9090
Resting comfortably
a myocyte
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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Depolarizing trigger
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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Na channels
open, briefly
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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In: Na+
Mysterycurrent
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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In: Na+
Ca++ is in balancewith K+ out
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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In: Na+
Excitation/Contraction Coupling:Ca++ causes the Troponin Complex
(C, I & T) to release inhibitionof Actin & Myosin
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
timetime
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In: Na+
Ca++ in; K+ out
More K+ out;Ca++ flow halts
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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In: Na+
In: Ca++; Out: K+
Out: K+
Sodium channels reset
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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In: Na+
Higher resting potentialFew sodium channels reset
Slower upstroke
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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a pacemaker cell
Slow current of Na+ in;note the resting potential
is less negative in apacemaker cell
--5555
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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a pacemaker cell
Threshold voltage
--4040
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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Ca++ flows in
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
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. . . and K+ flows out
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. . . and when it is negativeagain, a few Na+
channels open
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
How a wave of electrical current propagates through myocardium
Typically, an impulse originating anywhere in the myocardium will propagate throughout the heart Cells communicate electrically via “gap junctions”Behaves as a “syncytium”Think of the “wave” at a football game!
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
The dipole field due to current flow in a myocardial cell at theadvancing front of depolarization.
Vm is the transmembrane potential.
Courtesy of Dr. Roger Mark. HST.542J Quantitative Physiology: Organ Transport Systems, Spring 2004. (MassachusettsInstitute of Technology: MIT OpenCourseWare). http://ocw.mit.edu (accessed June 17, 2008).
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
Cardiac Electrical Activity
Figure by MIT OpenCourseWare.
Q S
T
R
P
SA node(Pacemaker)
AV node(delay)
AV bundle& branches(Insulated)
Purkinje fibers (Activation)
Fibro-fatty atrioventriculargroove (Separates atrial andventricular tissue)
ContractileConductiveNonconductive
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
Important specific structuresSino-atrial node = pacemaker (usually)AtriaAfter electrical excitation: contractionAtrioventricular node (a tactical pause)Ventricular conducting fibers (freeways)Ventricular myocardium (surface roads)After electrical excitation: contraction
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
The Idealized Spherical Torso with the Centrally Located Cardiac Source (Simple dipole model)
Courtesy of Dr. Roger Mark. HST.542J Quantitative Physiology : Organ Transport Systems, Spring 2004 . (MassachusettsInstitute of Technology: MIT OpenCourseWare). http://ocw.mit.edu (accessed June 17, 2008).
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Figure by MIT OpenCourseWare. After F. Netter.
Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
Excitation of the Heart
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
Excitation of the Heart
Figure by MIT OpenCourseWare. After F. Netter.
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
Figure by MIT OpenCourseWare.
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
-1200
-1500
aVR
aVF
aVL
I
IIIII
-900
-800
-300
+300
+600
+900+1200
+1500
1800 00
Figure by MIT OpenCourseWare.
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
The temporal pattern of the heart vector combined with the geometry of the standard frontal plane limb leads.
Figure by MIT OpenCourseWare.
I
IIIII
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Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
Cardiac Electrical Activity
Figure by MIT OpenCourseWare.
Courtesy of Dr. Roger Mark. HST.542J QuantitativePhysiology: Organ Transport Systems, Spring 2004.(Massachusetts Institute of Technology: MIT OpenCourseWare).http://ocw.mit.edu (accessed June 17, 2008). Figure adaptedfrom Phillips RE, Feeney MK, 1980 The Cardiac Rhythms.Saunders, Philadelphia and from Hoffman BF, CranefielPF 1960 Electrophysiology of the Heart. McGraw Hill, New York.
Q S
T
R
P
SA node(Pacemaker)
AV node(delay)
AV bundle& branches(Insulated)
Purkinje fibers (Activation)
Fibro-fatty atrioventriculargroove (Separates atrial andventricular tissue)
ContractileConductiveNonconductive
![Page 33: HST.582J / 6.555J / 16.456J Biomedical Signal and Image ... · HST.582J: Biomedical Signal and Image Processing, Spring 2007 Course Director: Dr. Julie Greenberg Introduction to Clinical](https://reader034.fdocuments.us/reader034/viewer/2022042805/5f5ffe40c861260b5f0bdea8/html5/thumbnails/33.jpg)
Cite as: Andrew Reisner. Course materials for HST.582J / 6.555J / 16.456J, Biomedical Signal and Image Processing, Spring 2007. MIT OpenCourseWare(http://ocw.mit.edu), Massachusetts Institute of Technology. Downloaded on [DD Month YYYY].
Normal features of the electrocardiogram.
Figure by MIT OpenCourseWare. After p. 50 in Netter, Frank H. A Compilation of Paintings on the Normal and PathologicAnatomy and Physiology, Embryology, and Diseases of the Heart, edited by Fredrick F. Yonkman. Vol. 5 of The CibaCollection of Medical Illustrations. Summit, N.J.: Ciba Pharmaceutical Company, 1969.
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Normal sinus rhythm
Figure 15 - Normal Sinus Rhythm—Rate 85
Figure by MIT OpenCourseWare.
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What has changed?
Figure 16 - Sinus Tachycardia—Rate 122
Figure by MIT OpenCourseWare.
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Sinus bradycardia
Figure 17 - Sinus Bradycardia—Rate 48
V1
Figure by MIT OpenCourseWare.
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Neurohumeral factors
Vagal stimulation makes the resting potential
MORE NEGATIVE. . .
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Neurohumeral factors
. . . and the pacemakercurrent SLOWER. . .
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. . . and raise the THRESHOLD
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Catecholamines make the resting potentialMORE EXCITED. . .
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. . . and speed thePACEMAKER CURRENT. . .
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. . . and lower theTHRESHOLD FOR
DISCHARGE. . .
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Vagal Stimulation:
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Ricardo Montelban EffectVagal Stimulation:
Image removed due to copyright restrictions.Photo of actor Ricardo
Montelban.
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Adrenergic Stim. =
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Adrenergic Stim. =Potsy Effect
Image removed due to copyright restrictions.
Photo of characters from TV show “Happy Days,” including
Potsy.
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Sinus arrhythmia
Figure 18 - Sinus Arrhythmia
Figure by MIT OpenCourseWare.
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Atrial premature contractions (see arrowheads)
Figure by MIT OpenCourseWare.
Figure 25 - Atrial Premature Contractions
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Usually just a spark; rarely sufficient for an explosion“Leakiness” leads to pacemaker-like current Early after-depolarizationLate after-depolarization
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What’s going on here?
Figure by MIT OpenCourseWare.
Figure 36 - Ventricular Premature Contractions
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Wave-front Trajectory in a Ventricular Premature Contraction.
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Is this the same thing?
Figure by MIT OpenCourseWare.
Figure 24 - Ventricular Escape Beat
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What’s going on here?
Figure 50 - Complete A-V Block with Junctional Escape Rhythm
Figure by MIT OpenCourseWare.
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What’s going on here?
Figure 35 - Atrial Fibrillation (2 examples)
Figure by MIT OpenCourseWare.
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Non-sustained ventricular tachycardia (3 episodes)
Figure by MIT OpenCourseWare.
Figure 43 - Short Bursts of Ventricular Tachycardia
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Slow Refractory
Quick Refractory
KeyWords:Heterogeneous, Circus, Self-Perpetuating
Side “A” Side “B”
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No Longer Refractory
KeyWords:Heterogeneous, Circus, Self-Perpetuating
Side “A” Side “B”
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KeyWords:Heterogeneous, Circus, Self-Perpetuating
Side “A” Side “B”
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KeyWords:Heterogeneous, Circus, Self-Perpetuating
Side “A” Side “B”
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KeyWords:Heterogeneous, Circus, Self-Perpetuating
Side “A” Side “B”
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KeyWords:Heterogeneous, Circus, Self-Perpetuating
Side “A” Side “B”
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INCREASEDRefractory
Side “A” Side “B”
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INCREASEDRefractory
Side “A” Side “B”
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INCREASEDRefractory
Side “A” Side “B”
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INCREASEDRefractory
Side “A” Side “B”
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INCREASEDRefractory
Side “A” Side “B”
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INCREASEDRefractory
Side “A” Side “B”
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Ventricular Fibrillation
Figure 45 - Three Examples of Ventricular Fibrillation
Figure by MIT OpenCourseWare.
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Heart attack
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Figure by MIT OpenCourseWare.
-1200
-1500
aVR
aVF
aVL
I
IIIII
-900
-800
-300
+300
+600
+900+1200
+1500
1800 00
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Figure by MIT OpenCourseWare.
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Heart attack
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Hyperkalemia
See ECG Wave-Maven (http://ecg.bidmc.harvard.edu/maven/mavenmain.asp) for many other examples of how metabolic conditions can affect the ECG.
Courtesy of Ary Goldberger, M.D. Used with permission.Source: Nathanson L A, McClennen S, Safran C, Goldberger AL. ECG Wave-Maven: Self-Assessment Program for Students andClinicians. http://ecg.bidmc.harvard.edu. Case #164.
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Understanding the ECG: A Cautionary Note
Basic cell electrophysiology, wavefrontpropagation model, dipole model:
Powerful, but incompleteThere will always be electrophysiologicphenomena which will not conform with these explanatory modelsExamples:
metabolic disturbancesanti-arrhythmic medicationsneed for 12-lead ECG to record a 3-D phenomenon
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Questions?
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