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ECG

ECG. Dr. Bernhard Arianto Purba, M.Kes., AIFO. Textbooks. Guyton, A.C & Hall, J.E. 2006. Textbook of Medical Physiology . The 11 th edition. Philadelphia: Elsevier-Saunders: 918-930, 961-977.

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ECG

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  1. ECG Dr. Bernhard Arianto Purba, M.Kes., AIFO

  2. Textbooks • Guyton, A.C & Hall, J.E. 2006. Textbook of Medical Physiology. The 11th edition. Philadelphia: Elsevier-Saunders: 918-930, 961-977. • Brooks, G.A. & Fahey, T.D. 1985. Exercise Physiology. Human Bioenergetics and Sts Aplications. New York : Mac Millan Publishing Company: 122-143. • Foss, M.L. & Keteyian, S.J. 1998. Fox’s Physiological Basis for Exercise and Sport. 4th ed. New York : W.B. Saunders Company: 471-491. • Astrand, P.O. and Rodahl, K. 1986. Textbook of Work Pysiology, Physiological Bases of Exercise. New York : McGraw—Hill. • Braunwald, Pauci, et al.2008. Harrison's PRINCIPLES OF INTERNAL MEDICINE. Seventeenth Edition. New York : McGraw—Hill: Chapter 332, 333, 338. • Jardins, Terry Des. 2002. Cardiopulmonary Anatomy & Physiology. The 4th edition. USA: Delmar, A Division of Thomson Learning Inc.

  3. ELECTROCARDIOGRAPHY (ECG)

  4. ECG

  5. A Brief introduction to ECG • The electrocardiogram (ECG) is a time-varying signal reflecting the ionic current flow which causes the cardiac fibers to contract and subsequently relax. The surface ECG is obtained by recording the potential difference between two electrodes placed on the surface of the skin. A single normal cycle of the ECG represents the successive atrial depolarisation/repolarisation and ventricular depolarisation/repolarisation which occurs with every heart beat. • Simply put, the ECG (EKG) is a device that measures and records the electrical activity of the heart from electrodes placed on the skin in specific locations

  6. What the ECG is used for? • Screening test for coronary artery disease, cardiomyopathies, left ventricular hypertrophy • Preoperatively to rule out coronary artery disease • Can provide information in the precence of metabolic alterations such has hyper/hypo calcemia/kalemia etc. • With known heart disease, monitor progression of the disease • Discovery of heart disease; infarction, coronal insufficiency as well as myocardial, valvular and cognitial heart disease • Evaluation of ryhthm disorders • All in all, it is the basic cardiologic test and is widely applied in patients with suspected or known heart disease

  7. Each small box = 1 mm = .04 Sec. 5 small boxes = 1 large box = 0.2 Sec.

  8. Measuring ECG • ECG commonly measured via 12 specifically placed leads

  9. Lead Configurations for ECG Measurement • Bipolar Leads • Augmented Leads • Chest (V) Leads

  10. + _ Bipolar Leads: lead I + _

  11. + _ Bipolar Leads: lead II + _

  12. + _ Bipolar Leads: lead III + _

  13. ECG Limb Leads

  14. + _ Augmented Leads: aVR + _

  15. + _ Augmented Leads: aVL + _

  16. + _ Augmented Leads: aVF + _

  17. ECG Augmented Limb Leads

  18. Unipolar Chest Leads v1: fourth intercostal space, at right sternal margin. v2: fourth intercostal space, at left sternal margin. v3: midway between v3 and v4. v4: fifth intercostal space, at mid clavicular line. v5: same level as v4, on anterior axillary line. v6: same level as v4, on mid axillary line.

  19. + _ Unipolar Chest Leads (cont.) + _

  20. ECG Precordial Leads

  21. M V9 V8 H V7 V3R 6R V6R V5R V4R I E I 5R 3R E Current Lead Placement Conventions(22 Electrodes) Current clinical conventions may use 22 different leads

  22. ECG Lead Color Codes C (brown) LA (black) RA (white) RL (green) LL (red)

  23. Surface Cardiac Potentials taken at t = to suggests an equivalent dipole located within the heart

  24. Eindhoven’s Triangle -very crude solution to inverse problem using bipolar limb leads: lead I _ + RA LA _ _ lead II lead III + + LL

  25. Normal heartbeat and atrial arrhythmia Normal rhythm Atrial arrhythmia AV septum

  26. Ventri- cular depola- rization

  27. Ventri- cular depola- rization (cont’d)

  28. Ventri- cular depola- rization (cont’d)

  29. Ventri- cular repola- rization + - + - + - + - - + - - + - + - - + - + - - + - - - + + - - - + + - - - + + + + - + - +

  30. Lead I

  31. Lead II

  32. Lead III

  33. Limb Leads (bipolar) Lead I Lead II Lead III

  34. aVR

  35. aVL

  36. aVF

  37. Uni- polar Lead aVR aVL aVF

  38. Normal values Intrinsicoid deflection < 0.05” QT segment Men < 0.39” Wo < 0.40” ST segment Std: > 1mm Pre : > 2mm PR interval 0.12-0.20” U wave T wave P wave 00.8-0.11” QRS duration 0.06-0.10”

  39. V6 V5 V4 V1 V3 V2 Pre- cordial leads

  40. Hori- zontal vs Verti- cal heart

  41. Hori- zontal vs Verti- cal heart

  42. 3 3 1 1 2 2 4 4 4 4 2 2 1 1 3 3 Clock- wise vs Counter clock- wise rotation Viewed from below the heart looking towards the apex in vertical heart

  43. V1 P wave

  44. Left atrial enlargement P mitral Wide and notch V1 Biphasic with (-) terminal component Atrial Enlarge ment

  45. Right atrial enlargement Tall and peaked P wave V1 Tall and peaked P wave Atrial Enlarge ment (cont’d)

  46. Elec- trical axis qRS = +3 Lead I qRS = +1 aVF

  47. The QRS Bundle of His LBB Anterosuperior division Posteroinferior division RBB

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