electrocardiogram 2554

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  • 1. Tadsawiya Padkao, PT, M.Sc.School of Allied Health Sciences University of Phayao
  • 2. Course Outline () ECG for PT by Padkao T 2
  • 3. The Right and Left Heart ECG for PT by Padkao T 3
  • 4. Cardiac and Valvular Functions ECG for PT by Padkao T 4
  • 5. Cardiac Muscle1. Special or Electrical or Conductive Cell Impulse Formation: Sinoatrial node (SA node), Atrioventricular node (AV node) Impulse Conduction: His bundle, Purkinje fiber2. Working and Mechanical Cell cardiac myocyte both atrium and ventricle ECG for PT by Padkao T 6
  • 6. ECG for PT by Padkao T 7
  • 7. Cardiac Action Potential & Electrocardiogram ECG for PT by Padkao T 8
  • 8. ECG for PT by Padkao T 9
  • 9. (Electrocardiogram) (Electrocardiogram, ECG EKG) Action Potential (Electrocardiography) Electrocardiograph 10 ECG for PT by Padkao T
  • 10. Advantages of ECG (Rate and Rhythm) (Hypertrophy) (Ischemia or Infarct) *** Arrhythmia ECG for PT by Padkao T 11
  • 11. Willem Einthoven Willem Einthovens invention: ECG (1903) The Nobel Prize in Physiology or Medicine (1924) ECG for PT by Padkao T 12
  • 12. ECG for PT by Padkao T 13
  • 13. Einthovens Triangle: SA node (+) (-) Myocardium ECG for PT by Padkao T 14
  • 14. ECG graph paper ECG for PT by Padkao T 15
  • 15. ECG for PT by Padkao T 17
  • 16. ECG for PT by Padkao T 18
  • 17. ECG for PT by Padkao T 19
  • 18. ECG LeadsThere are 12 ECG leads - 6 limb leads (I, II, III, aVR, aVL, aVF); Frontal plane - 6 precordial leads (V1-V6); Horizontal planeEach lead has a (+)ve pole and (-)ve pole. - Limb leads: bipolar (I, II, III) & unipolar (aVR, aVL, aVF) - Precordial leads: unipolarElectrical activity approaching a (+)ve pole will as a (+)ve [upright] deflection on ECG tracing. ECG for PT by Padkao T 20
  • 19. 6 Limb Leads ECG for PT by Padkao T 21
  • 20. ECG for PT by Padkao T 22
  • 21. Einthovens Triangle: SA node (+) (-) Myocardium ECG for PT by Padkao T 23
  • 22. 6 Precordial Leads ECG for PT by Padkao T 24
  • 23. ECG for PT by Padkao T 25
  • 24. ECG for PT by Padkao T 27
  • 25. ECG for PT by Padkao T 28
  • 26. ECG for PT by Padkao T 29
  • 27. 1 = 1mm 25 mm/s 1 1/25 0.04 s 1 mV = 10 mm calibration signal ECG check paper Speed (ECG waveform ) calibration signal (tracings) X (duration), Y (amplitude) ECG for PT by Padkao T 31
  • 28. Before we get started Verify name, number, date and time. Is there an old ECG for comparison? Is the paper calibration standard? How old is the patient? What is going on with the patientclinically? ECG for PT by Padkao T 32
  • 29. General Tips There is no absolute right way to read an ECG. A prior ECG is your best friend. Knowing the patients clinical history is essential for correct ECG interpretation (ECG machines make squiggly lines on paper, doctors make diagnoses). ECG for PT by Padkao T 33
  • 30. : American Heart Association, 2000ECG for PT by Padkao T 34
  • 31. A Seven Step Approach1. Heart Rate2. The P wave3. The PR interval4. The QRS5. The ST segment6. T and U wave7. The QT interval 7 ECG for PT by Padkao T 35
  • 32. ECG for PT by Padkao T 36
  • 33. Step 1: Heart Rate 1. R1 R2 R-R interval ( ( 0.04 s ) ( 0.04 x 5 = 0.2 s ))2. 0.04 0.2 ( )3. ECG for PT by Padkao T 37
  • 34. ECG for PT by Padkao T 38
  • 35. Interval from R1 R2 = 20 small boxes ( 1 small box = 0.04 s) Then, duration (time) per beat = 20 x 0.04 = 0.8 s Then, in time duration 0.8 s heart rate = 1 beat -------------------- 60 s -----------= 60x1/0.8 = 75 beats Heat Rate = 75 beats per minute ECG for PT by Padkao T 39
  • 36. Step 1: Heart Rate (cont.) 2 HR = 300/N (beats/min) , N = = 1500/n (beats/min) , n = 3 300/150/100/75/60 QRS complex 1 HR = 300 beats/min 2, 3, 4 5 HR = 150, 100, 75 60 beats.min-1 ECG for PT by Padkao T 40
  • 37. HR > 100 beats/min = Sinus Tachycardia HR < 60 beats/min = Sinus Bradycardia ECG for PT by Padkao T 41
  • 38. Step 2: The P wave P Wave Atrial depolarization (smooth and round) 0.12 ( 3 ) 2.5 mV ( 3 ) Positive wave I, II, aVF V2-6 Negative wave aVR - Biphasic wave ( Positive, Negative) III, aVL V1 ECG for PT by Padkao T 42
  • 39. ECG for PT by Padkao T 43
  • 40. Step 2: The P wave (cont.) Morphology ( lead II) - P mitral: - Broad notched - LA enlargement secondary to mitral valve disease - P pulmonale:- Tall peaked - RA enlargement secondary to pulmonary hypertension Axis ( sinus rhythm ) - P wave wave QRS complex ? - P wave positive wave lead II, III, aVF ? ECG for PT by Padkao T 44
  • 41. Step 3: The PR Interval- PR PQ interval Time from atrium activation to ventricle activation (antrioventricular, AV, conduction time)- P wave QRS complex ( P wave QRS complex PR segment) - Duration: 0.12-0.20 (3 5 ), < 0.10 : short PR syndrome (pre-excitation), > 0