ECG Lecture 1

Dr Ahmed Murtaz Khalid

Assistant Professor Physiology
CKMC
ECG

 ECG is produced only when current flows through the heart

 This occurs only when the heart is partially depolarized or

repolarized
To understand ECG:

 It is important to understand electrical activity of the heart

 So we recapitulate some of the basic ideas:

What is resting membrane potential:

Electrical voltage difference between inside and outside the cells

We know that normally myocardial cells are electrically negative inside

and positive outside
 ECG machine works on the principle of
galvanometer
0
+10 -10

When these charges

are moving there is
generation of
electromagnetic
force- Which is
generated by Vector
Now we take on which electrical vectors are produced in the heart in
one cardiac cycle and later will go through how ECG machine draw
these patterns of electrical events in the form of waves.
Electrical Events in heart during one
Cardiac Cycle
 Wave of Depolarization- Direction

 SA node is located- in the upper part

of wall of right atrium

 When SA Node fires, wave of

depolarization travels in the heart
downward and left

 This wave of depolarization travels to

the left atrium as well, and both
atrium contract as a syncytium
Atrial depolarization Vector

 Is small depolarizing vector which is moving downward and to the

left with moderate velocity

 Vector is small, since atrial myocardium is thin, and atrial cardiac

muscle are not specialized for conducting wave of depolarization
fast as the case with purkinje fibers
 Stimulation of AV Node
 Electrical wave of depolarization in
atria will die on reaching fibrous
tissue, separating atria and ventricle

 Only possible connection between

atria and ventricle i.e
AV node- specialized conducting node-
conducts wave of depolarization
slowly- delay of 0.1 second, facilitating
atria to contract and pump blood into
the ventricle before ventricle start
contractingf
Conduction of depolarization current through
AV node
 Is very slow, due to specialized
structure of AV node, since it
is small tissue and current
passes slowly, its vector will
be very small

 That it is not picked up by ECG

machine, and we get a straight
line
Sequence in which wave of depolarization
passes through ventricle

 Septal depolarization

 Ventricular muscle

 Base of heart
Depolarization of Interventricular Septum
Left bundle branch
 Septal myocardium is
depolarized by left bundle
branch, not right bundle
branch

 Depolarization is produced in
lower and left part of septum

 So depolarization wave in
septum moves from left to
right and down to up
Ventricular Myocardium via Purkinje Fibers
 After depolarizing septum, wave
of depolarizing will travel
through ventricular myocardium
via purkinje fibers
 Myocardium- Subendocardium,
middle part of myocardial
muscle, sup-pericardial
 First part of ventricular tissue
that is depolarized is
subendocardium
 Since left ventricle is thick,
stronger vector is produced
while right ventricle is thin, a
smaller vector is produced
Depolarization Wave and Vector in
Base of heart
 Due to depolarization of base
of the heart, wave of
depolarization travels upward
and to the right
Repolarization of Ventricle
 Repolarization wave starts from
outside to inside

 During QRS and ST segment, when

ventricle contracts, blood vessles
supplying the inner part of +++
myocardium are compressed ++ +++ +
++++
++++++
+++
+++++++++++++
++++++++++ +
++++++++++
 Blood flow to the outer part of +++++++++
myocardium is maintained in
systole, so repolarization starts in
outer myocardium
 Repolarization is a slow process,
repolarization of base of heart,
major ventricular tissue and
intraventricular septum merge with
one another and give one vector
Recording of these electrical potentials

 These electrical vectors and electrical potentials are conducted to

the body surface through body fluids

 So by applying electrodes to the body surface we can pick up this

electrical activity in the heart
 --
+

- -

+
ECG-Waves
 P wave- Atrial depolarization

QRS complex
 Q wave- ventricular septal
depolarization
 R wave- Ventricular muscle
depolarization
 S wave- Depolarization wave
through base of heart

 T wave- Ventricular
repolarization
 Segments (isoelectric lines)

 PR Segment (isoelectric)-
Showing AV nodal activity- AV
nodal delay

 ST Segment (isoelectric line)-

showing that whole ventricle
is depolarized-
Why it is a straight line?
 Intervals
 PR Interval
Include p wave and PQ segment
Starts with atrial depolarization (with P wave)
and culminates at the beginning of QRS complex
(Ventricular depolarization)

It include two events:

1. Atrial depolarization
2. Conduction through AV node
 QRS Interval

 During which current is

spreading over ventricular tissue
QT Interval

 It includes both Ventricular

depolarization and ventricular
Repolarization
U Wave- Repolarization of Papillary Muscles
 Timings and Duration of ECG Waves,
Segments and Intervals
Speed of rolling paper in ECG Machine
Is adjusted such that in one minute
electrical activity of the heart is drawn on 300
big squares

300 big squares= 1 minute

300 big squares=60 sec
1 big square= 60/ 300= 0.2 sec

1 big square is further divided into

5 small squares
So 1 small square= 0.04 sec
 Timings of Waves and Intervals
 P wave= 2 to 2 and half small
square = 0.08-0.10

 PR segment= 2 and half small

square= 0.10
 PR interval= 0.20 sec

 QRS complex= 2 and half small

squares
 QT interval= 10 small squares=
0.40 sec
Summarizing-Following waves are produced
In next lecture

How Bipolar and Chest Leads are applied, rate,

rythum, axis of ECG waves and how segments are
shifted in various clinical scenerios