UNDA P - depolarizarea atriala - unda rotunjita - durata 0.10-0.11s - amplitudinea 0.25-0.

30mV - pozitiva in deriv standard, amplitudinea max in DII - intotdeauna neg in aVR SEGM PQ - coresp inceputului fazei de repolarizare a atriilor (conducerea impulsului cardiac de la NSA-NAV) - segm care apare pe traseul ECG este doar inceputul repolarizarii atriale - durata aprox 0.10s (PTa 0.15-0.45s) INTERVALUL PQ - durata cuprinsa de la inceputul undei P pana la inceputul complexului QRS, corespunde timpului de la inceputul activarii atriale pana la inceputul activarii V - durata depinde de FC 0.12-0.21 s COMPLEXUL QRS - depolarizarea ventriculara - durata 0.10 s - amplitudinea 0.5-1.6mV SEGM ST - repolarizarea lenta la ventriculilor - durata depinde de durata undei T (0.15s) - normal segm este izoelectric - supra/subdenivelari de cel mult 1mm (0.1mv) in deriv standard(DI,DII,DIII,aVR,aVL,aVF) si deriv toracice stg V5,V6 - supradenivelari de cel mult 2mm in dervatiile drepte V1,V2 - subdeniv=ischemie - supradeniv=necroza UNDA T - faza rapida de repolarizare ventriculara - asimetrica ram asc mai prelungit fata de cel desc care este mai abrupt - durata 0.15-0.33s - aplitudinea se aprecieaza in rap cu cea a complexului QRS normal este egala cu 1/3 din amplit celui mai inalt complex QRS - amplitudine crescuta cand este >= cu din QRS - amplitudine scazuta cand este <= cu din QRS INTERVAL QT - reprezinta sistola ventriculara (depolarizare si repolarizare ventriculara) - durata depinde de FC cu cat FC este mai mare cu atat sistola electrica este mai mica si invers - pt o FC N de 70-80bat/min durata este intre 0.33-0.42s

UNDA U - unda pozitiva, f mica, inconstanta, ce apare dupa unda T mai ales in V2 si V3, dat fen de repolarizare tardiva a miocardului ventricular - durata 0.15-0.22s si scade odata cu cresterea FC RITM DE BAZA = ritmul care domina activitatea inimii pe un traseu electric CRITERII DE RITM SINUSAL 1. prezenta undei P inaintea fiecarui complex QRS in toate derivatiile 2. succesiunea undelor P este regulata, ritmica , intervalele P-P sunt egale 3. frecventa revolutiilor cardiace este N 70-80/min cu variatii fiziologice 60-120/min 4. PQ interval cu durata constanta in toate revolutiile cardiace, in toate derivatiile 0.12-0.21s in functie de FC. 5. undele P sunt pozitive in toate cele 3 derivatii standard DI,DII,DIII,aVL,aVF, intotdeuna neg in aVR. FRECVENTA CARDIACA 1500/R-R(mm) 6000/R-R(sutimi sec) DETERMINARE AXEI ELECTRICE 1.PROCEDEUL EINTHOVEN - se masoara amplit undelor QRS in 2 deriv standard suma algebrica - se aplica valorile in mijl laturii si cu vf spre segm poz sau neg in functie de suma algebrica - perpendiculare duse din cele 3 origini ale vectorilor se intalnesc in mijl triunghiului unde se afla originea vectorului QRS real - la locul de intersectie a celor 2 perpendiculare ridicate din varfurile vectorilor se afla vf vectorului QRS - dreapta care uneste centrul triunghiului cu acest punct indica directia, sensul si marimea axei electrice a inimii - se circumscrie triunghiul intr-un cerc si se masoara unghiul pe care il face axa electrica cu diametrul orizontal al cercului - val situate deasupra diam sunt considerate neg, cele situate dedesubt sunt considerate pozitive 2.PROCEDEUL BAILEY - printr-o miscare de translatie se aduc toate cele 3 laturi ale triunghiului echilateral in centrul acestuia, obtinandu-se un sistem triaxial - se face suma algebrica a amplit undelor QRS in DI si DII - originea este comuna - se ridica perpendiculare din varfurile vectorilor iar punctul de intersectie obtinut reprezinta varful vectorului QRS real - se uneste originea cu varful obtinut

3.PROCEDEUL SODI-PALLARES-CABRERA - daca la triaxa Bailey se suprapun si cele trei bisectoare ale triunghiului lui Einthoven obtinem un sistem de coordonate cu sase axe care impart cercul ce circumscrie triunghiul lui Einthoven in 12 segmente de cate 30 de grade. - DI pe directie +/-180 0 DII -120 +60 DIII -60 +120 aVR -150 +30 aVL -30 +150 aVF -90 +90 aVR perpendicular pe DIII aVL perpendicular pe DII aVF perpendicular pe DI se alege o deriv in care complexele QRS sunt echidifazice deci vectorul QRS are o directie perpendiculara fata de axa acestei derivatii apoi stabilim sensul poz sau neg N axa QRS oscileaza in jurul val de +45 putand fi situata mai la dreapta +120 (longilinii, copii, astmaticii, emfizematosii) sau spre stanga -30 (obezii,gravidele) axa intre 0 si -30 tendita la orizontalizare axa intre 90 si +120 tendinta la verticalizare >-30 deviere patologica la stanga >+120 deviere patologica la dreapta

Metoda rapida de calcul a axului electric al inimii: In derivatiile DI, DII, DIII, aVR, aVL, aVF, se determina un complex QRS echidifazic (suma algebrica a undelor din complex e 0. Axul electric va fi perpendicular pe derivatia in care complexul e echidifazic. Din sistemul hexaaxial, determinam ce derivatie e perpendiculara pe derivatia in care complexul e echidifazic. Axul electric va fi paralel cu aceasta derivatie. In final, pt. a interpreta valoarea pozitiva sau negative a axului, calculam suma algebrica a undelor din complexul qrs in aVf.

Derivatii laterale stangi : DI,aVL,V5,V6 Derivatii inferioare: DII,DIII,aVF Derivatii anterioare: V1,V2 Derivatii septale: V3,V4 Derivatii drepte: aVR,DIII,V1

P WAVE - atrial depolarisation - rounded wave (it may present a slight notch because of the asynchrony of the depolarisation of the 2 atrials) - duration 0.10-0.11 s - amplitude/ voltage 0.25-0.30 mV - positive in standard limb leads, maximum amplitude in lead II - always negative in aVR PQ SEGMENT - corresponds to the begining of the atrial repolarisation phase(represents the direction of the cardiac impulse from the SAN to the AVN) - the PQ segment that appers on the ECG trail is only the beginning of the repolarisation of the atriums - between the end of the P wave and the beginning of the QRS complex - duration is aprox 0.10s (PTa 0.15-0.45s) PQ INTERVAL - is between the beginning of P wave to the beginning of QRS complex - it corresponds to the early activtion of the atrials to the beginning of the ventricles activation - duration depends on the heart rate 0.12-0.21s QRS COMPLEX - represents the ventricular depolarisation - duration 0.10s - amplitude 0.5-1.6mV ST SEGMENT - slow repolarisation phase of the ventricles - duration depends on the duration of the T wave (0.15s) - normally ST segment is isoelectric - it is admitted elevation and depression of 1 mm (0.1mV) in the standard leads (LI, LII, LIII) and in the unipolar limb leads (aVR,aVL,aVF) and in V5,V6 chest leads - elevation of maximum 2mm (0.2mV) in V1,V2 chest leads - other deviation is considered abnormal: elevation= nerosis; depression = ischemia T WAVE - corresponds to te rapid repolarisation of the ventricles - it is asumetrical : the ascendent ram/branch it is extended upward from the descendent which is steeper - duraton 0.15-0.33 sec - amplitude is valued with the QRS complex - normally the T waves amplitude is equal to 1/3 of the highest amplitude of QRS complex - the amplitude is increased when >= then of QRS complex - the amplitude is decreased when <= then of QRS complex QT INTERVAL - represents the ventricular systole (depolarisation and repolarisation of the ventricles)

- beginning of the Q wave and the end of the T wave - depends on the heart rate, if the heart rate is high then the electrical systole is low - for a normal heart rate of 70-80 beats/min the interval duration is between 0.33-0.42 s U WAVE - positive wave, very small, inconstant, and it occurs after the T wave especially in V2 and V3 leads - it is due to a late phenomen of ventricular repolarisation - duration 0.15-0.22s and decreases with the increase of the heart beat BASIC RATE - is the rate that is dominating the electrical activity of the heart - normally the heart rhytm originates in the sinoatrial node THE SINUS RHYTM CRITERIA 1. the P wave appers before each QRS complex in all leads 2. the sequence of P waves is regular, rhytmical PP intervals are equal or almost equal 3. cardiac revolution frequency = 70-80 beats/min (variations between 60-120 / min) 4. PQ interval have a constant duration in all leads, duration 0.12-0.21 s depending on the heart rate. 5. P waves are positive in LI, LII, LIII,aVL,aVF, negative in aVR THE HEART RATE 1500/R-R (mm) 6000/R-R(hundredths of a second) normal values 70-80 beats/min <60 beats/min Bradycardia >80-90 beats/min Tachycardia The rapid method for determining the heart rate: - choose an R wave situated on a thick line on the ECG paper in any lead. - the R wave is used as the benchmark - the next thick line on the map is set to 300, next 150, 100, 75,60,50 DETERMINATION OF THE ELECTRICAL HEART AXIS 1. EINTHOVENS METHOD/PROCEDURE - all vectors have a cardiac point of application in the center of an equilateral triangle whose sides represent the three standard leads. - we make the algebrical sum of the three values of QRS complex in 2 of the 3 leads - we will obtain a positive or negative value that represents the QRS vector magnitude on the axis lead, then we apply the vectors values on the sides of the triangle corresponding to the axes LI, LII or LII with the origin in the middle of the side and the top is oriented to positive or negative side of the segment, depending on the value of the vector. - perpendiculars of the 3 vectors origins meet in the center of the triangle, where is the real origin of the QRS vector according to Einthovens hypothesis. - at the intersection of the two perpendicular raised from the peaks of the vectors is the real top of the QRS vector. - the line connecting the center of this triangle with this point indicates the direction, way and size of the electrical axis of the heart.

we circumscribe the triangle in a circle and measure the angle that electrical axis makes with the horizontal diameter of the circle - values above the diameter are considered negative (0-180) and those located in the opposite quadrant are considered positive(0+180) 2. BAILEYS METHOD - through a translation movement we bring all 3 sides of the equilateral triangle in its center,
achieving a Triaxial system we make the algebraic sum of the amplitude of waves Q , R , S of 2 leads of the 3 standard leads and the values obtained are applied to the corresponding sides/leads of the system, for each lead . T the sides/leads are having the same common point of intersection and this will be the real origin of the QRS vector will rise perpendicular lines form the tops /peaks of the vectors and the intersection point obtained it represent the top/peak of the real QRS vector well connect this point (the top of the QRS vector) with the point of intersection of the three axes , we obtain a vector whose direction , purpose/way and size defines the electrical axis of the heart

3.SODI-PALLARES-CABRERA METHOD - if on the Baileys triaxal system we overlap the three bisectors of Einthoven 's triangle , we will
obtain a coordinate system with 6 axes that divide the circle, which circumscribes the Einthoven 's triangle, in 12 segments of 30 g LI is the direction of + / -180 ... 0 LII : -120 ... +60 LIII : -60 ... +120 aVR : -150 ... +30 aVL : -30 ... +150 aVF : -90 ... +90

aVR perpendicular on LIII aVL perpendicular on LII aVF perpendicular on LI

we determine a lead in which the QRS complex is echidiphazic (the algebraic sum of the complex waves = 0), in this situation, the direction of QRS vector is perpendicular to the axis of the lead ( if we find a QRS complex 0 in LI it means the QRS vector on the direction ( -90 .. +90 ) then we must set a positive or negative direction of the vector Normally and frequently the QRS axis is around + 45 g and can be located at the right side up to maximum 120 g (children, asthmatics , emphysematous ) , or on the left side , up to a maximum of -30 ( obese, pregnant ) When the axis is in the range between -0 ... -30 = tendency to leveling (tendinta la orizontalizare = leveling, horizontally) - +90 ... +120 = Tendency to plumb (tendita la verticalizare = plumb, upstanding, verical ) When exceeds these values , we speak of a pathological deviation to the left (above - 30g ) or right ( over 120 g)

Fast method for calculating the electrical axis of the heart :

In leads LI , LII , LIII , aVR , aVL , aVF ,we determine a echidiphazic QRS complex ( the algebraic sum of the complex waves is 0). Electric axis is perpendicular to the lead of the complex were is echidiphazic . From the Hexaxial system we determine which lead is perpendicular on the lead where the complex algebrical sum is 0. The electric axis will be paralel to this lead . To determine the positive or negative value of the axis, we have to make the algebrical sum of the waves from the QRS complex in aVF lead.