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Introduction History Principle Anatomy and Physiology Application Types Of ECG Machine Operation Safety Precautions Preventive Maintenance Troubleshooting

History

Invented by Einthoven

Principle
The ECG is a medical device capable of recording the electrical activity of the heart from electrodes placed on the skin in specific locations

Einthoven Triangle
Lead I

Lead II

Lead III

First ECG machines were bulky, tablesized apparatus built around 1920

In the early 1900, hands and feet were placed in sodium chloride baths as a means of conduction. By 1940s, metal disks with wire leads were strapped to wrists and ankles

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Heart Rate Heart Rhythm Analysis of conduction abnormalities To check whether there has been a prior heart attack To check whether there may be coronary artery disease To check whether the heart muscle has become abnormally thickened

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HEART

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Cone shaped , muscular organ Base above and apex below Inclined at left side Approx weight300gms.

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Size - closed fist Lies in Thorax, between lungs and behind sternum

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Right side

Left side

Right Atrium Right Ventricle

Left Atrium Left Ventricle

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Pure Blood - RED COLOUR Impure blood - BLUE OLOUR

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PUMP THE BLOOD

Receives pure blood and pumps to different parts of the body. Receives impure blood sends to lungs purification and for

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Nodes - SA Node
- AV Node

Bundle of His Chordae Tendinea ( AV Valve - Ventricles) Right & Left Ventricle contraction

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Circulatory System

Pulmonary Circulation

Systemic Circulation

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Heart
Right Ventricle Aortic Valve Pulmonary Artery

Lungs
Pulmonary Vein

Right Atrium

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Heart Left Ventricle Aorta Body

Upper Part Lower Part

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Polarization Repolarization

Depolarization
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P Wave Depolarization of Atrium (0.08 to .1 Sec) QRS Wave Depolarization of Ventricles (0.06 to 0.1 Sec) T wave Ventricular Re-polarization ST segment - Abnormalities of the ST segment and the T waves are often seen when the heart muscle is ischemic (not getting enough oxygen, cause of a blockage in coronary artery.)

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Government Hospital
Casualty ICU, ICCU Wards

Private Hospital

Cardiac Dept

General Practitioner

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ECG MACHINE

Single Channel

Multichannel

Interpretation

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The ECG reveals the heart rate and rhythm only during the time ,when the ECG is taken. If intermittent cardiac rhythm abnormalities are present, the ECG is likely to miss them. Ambulatory monitoring is needed to record transient arrhythmias. The ECG can often be normal or nearly normal in patients with undiagnosed coronary artery disease or other forms of heart disease (false negative results.) Many abnormalities that appear on the ECG turn out to have no medical significance after a through evaluation is done (false positive results).

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Holter Recorder

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Stress Test Machine

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Pacemaker

Internal pacemaker

External pacemaker

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Power Supply ECG Acquisition Board Amplifier Board Digital Board (CPU) Display Speaker Recorder

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Preparation of Patient Placement of Electrode Bipolar Leads I, II, III Unipolar Leads aVR, aVL, aVF,

Pre-cordial Leads - V1 to V6

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Patient Preparation The patient or the person whose ECG is to be taken should be in supine position. Patient limbs, legs and chest should be exposed to fix ECG electrodes. Clean the portion where electrodes have to be attached. If patient's chest is hairy, shave the portion and clean the area by alcohol swab or spirit, till reddening of skin occurs so as to reduce the skin impedance. The skin or area where electrodes to be placed should be dry and clean.

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Placement of Electrodes Apply Gel on electrodes evenly. Place the limb electrodes to hand (near the wrist) and legs (near the ankle). The electrodes need to be in proper contact with the skin at all times to maintain a good reading throughout the ECG monitoring process. The patient is now ready for the electrode placement. Apply the electrodes and if needed add ECG conductive gel to the electrodes.

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The LEAD is used to measure the resulting tracing of voltage difference at any two sites due to electrical activity of Heart. There are two types of leadsBipolar Leads and Unipolar Leads.

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Bipolar Leads - In Bipolar

Leads, the ECG is recorded by using two electrodes and a reference point is conventionally taken as "Right Leg". The three standard bipolar leads are LEAD I, LEAD II, LEAD III. Each of these three leads forms one side of configuration known as Einthoven's triangle, as shown below

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It employs to record potential of Heart action on chest at six different positions. (designated as V1 to V6)

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1 large square = 0.2 sec 1 small square = 0.04 sec

There are five small boxes in one large box. Each small box on the vertical line equals 0.1 millivolts. 10 small boxes = 10 mm tall.

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Advantages Wave forms are recorded simultaneously and can be shown in their proper time relationship with respect to each other.

This reduces the time.

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This test will help the doctor to evaluate the patient's cardiac condition related to: If a heart attack has occurred What part of the heart was damaged If there are any irregular heart beats or rhythm If there is a decreased supply of blood and oxygen to the heart

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HR= R-R interval/minute

Speed x 60 --------------------------RR distance in mm

HR =

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First Degree Block

Second Degree Block Mobitz Type I Second Degree Block Mobitz Type II Complete Heart Block

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Eg :
1. 2. 3. 4.

Important clinical variables from ECG waveform includes the magnitude and polarity of these features as well as their relative time duration.Variations from these normal values may indicate illness.
An extended PR interval indicates prolonged conduction time of the AV Node and may be diagnosed as AV Block Widening of QRS complex may be due to bundle block. An elevated ST may indicate myocardial infraction has occurred. A negative polarity T wave form may be due coronary insufficiency

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Arrhythmias are disorders of the regular rhythmic beating of the heart.

Arrhythmias occurs as a result of changes in depolarization, repolarization or conduction properties of the conductive cells present in the heart.

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Normal heart rate of the human being is 60100bpm at rest.

Any excessive rate above 100is called as Tachycardia.

Any rate below 60 is called Bradycardia.

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