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Ulkumen Rodoplu, MD EuSEM

E LECTROCARDIOGRAPHY. Ulkumen Rodoplu, MD EuSEM. Plan. A Normal ECG Basic ECG Waveform Initiation of Spread of Electrical Activation in the Hearth The Magnitude and Direction of the Activation Process Activation Vectors. Introduction.

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Ulkumen Rodoplu, MD EuSEM

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  1. ELECTROCARDIOGRAPHY Ulkumen Rodoplu, MD EuSEM

  2. Plan • A Normal ECG • Basic ECG Waveform • Initiation of Spread of Electrical Activation in the Hearth • The Magnitude and Direction of the Activation Process • Activation Vectors

  3. Introduction • Essential tool in the investigation of heart disease. • No cardiological assessment is complete without a 12-lead ECG. • One hundred million ECGs are recorded worldwide each year.

  4. History • 19th century. The heart generated electricity. • Augustus Waller, working in St Mary's Hospital in London: The first systematical approach about the heart from an electrical point-of-view. • Willem Einthoven, working in Leiden, The Netherlands, invented the string galvanometer, which was much more precise than the capillary galvanometer that Waller used. • Einthoven assigned the letters P, Q, R, S and T to the various deflections, and described the electrocardiographic features of a number of cardiovascular disorders. He was awarded 1924Nobel Prize for Physiology and Medicine for his discovery.

  5. Initiation and Spread of Electrical Activation in the Heart • In normal circumstances the whole process begins in the sino-atrial node.

  6. Initiation and Spread of Electrical Activation in the Heart • SA Node normally initiates activation of the atrial myocardium • AV Node transmits activation received from the SA Node to the common bundle • HIS Bundle forms the electrical connection between the atria and the ventricles

  7. Initiation and Spread of Electrical Activation in the Heart • The right and left bundlebranches run below the endocardial surfaces of their respective ventricles • The Purkinje network spreads over the endocardial surfaces of the ventricles

  8. The Basic ECG Waveform • P wave - spread of electrical activation through the atrial myocardium. • QRS Complex – spread of electrical activation through ventricular myocardium. • T wave – electrical recovery of the ventricular myocardium.

  9. Electrical Activity & ECG

  10. <0.10 sec. wide <2.5 mm. amplitude (+)……DI, II, aVF (+) (-)… aVL (-)… aVR VI , biphasic or (-) P Wave

  11. 0.12 – 0.20 sec PR interval

  12. QRS • Depolarisation of ventricles • <0.10 sec. wide

  13. Repolarisation of ventricles 0.12-0.25 sec. wide (+)…DI, II, V2-6 (+) (-)…aVL, aVF (-)….aVR T Wave

  14. Calculation of Rate

  15. Activation Vectors • A vector is simply something which has magnitude and direction. • Direction in which the arrow points represents the direction of the vector. • Length of the arrow represents the magnitude of the vector. • The apparent magnitude of the activation wave will depend on the direction from which it is sensed.

  16. Polarisation and Depolarisation • Activation is actually the process of depolarisation and the spontaneous spread of this process over the myocardial cells. • Resting, healthy mycardial cells are polarised. • The surface membrane of each cell has an accumulation of charges – positive ones on the outside and an equal number of negative ones on the inside.

  17. The QRS Complex • The central oblong is the myocardial strip. • The arrow shows the depolarisation vector in magnitude and in direction. • The deflection recorded by each lead is shown at the side of that lead.

  18. A Normal 12 - Lead Electrocardiogram

  19. ECG Derivations • Bipolar…DI, DII,DIII • Unipolar…aVR, aVL, aVF • Precordial….V1….V6

  20. Precordial Electrodes

  21. Einthoven Triangle

  22. A Normal Vectorcardiogram

  23. Electrical Axis

  24. Electrical Axis-Triaxial Method

  25. Electrical Axis- Hexaxial Method

  26. Electrical Axis-Practical Method • I,II,III,aVF.. QRS(+).... Normal • I…QRS(-), aVR…QRS(+)…RAD • II,III,aVF.. QRS(-)....30º LAD

  27. Normal ECG Leads

  28. Normal Sinus Rhytm

  29. Sinus Tachycardia

  30. Sinus Bradycardia

  31. Sinus Arrhytmia

  32. Atrial Escape Beat

  33. Nodal Escape Beats

  34. Nodal Rhythm in Complete AV Block

  35. Atrial Tachycardia

  36. Supraventricular Tachycardia

  37. Atrial Flutter – atrial rate 300

  38. Atrial Flutter – 2:1 Conduction, Atrial rate 300

  39. Ventricular Premature Contractions

  40. Multiform VPBs

  41. Ventricular Couplets

  42. Ventricular Flutter

  43. Ventricular Fibrilation

  44. First degree AV Block

  45. Second degree AV BlockWenckebach or Mobitz Type I

  46. Second degree AV BlockMobitz Type II

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