ECG

What does
"Electrocardiograph“
(ECG) mean?

Electro = electrical
activity

Cardio = heart

Graph = to record
The Heart
 ACTION POTENTIAL

• Almost all cells have electrical potentials across them, as a

result of active transport of ions across the cell membrane.

• Membranes are polarized or, exhibiting a RESTING

MEMBRANE POTENTIAL, meaning an unequal distribution of
ions (atoms with a positive or negative charge) on the two
sides of the cell membrane. This POTENTIAL generally
measures about 70 millivolts (Inside of the membrane
negative with respect to the outside). So, the RESTING
MEMBRANE POTENTIAL is expressed as -70 mV, and the minus
means that the inside is negative relative to (or compared to)
the outside. It is called a RESTING potential because it occurs
when a membrane is not being stimulated or conducting
impulses (in other words, it's resting).
CELL Factors contributing to membrane
potential:

Two ions are responsible: sodium (Na+)

and potassium (K+). An unequal
distribution of these two ions occurs on
the two sides of a nerve cell membrane
because carriers actively transport
these two ions: sodium from the inside
to the outside and potassium from the
outside to the inside. AS A RESULT of
this active transport mechanism
(commonly referred to as the Sodium
Potassium Pump), there is a higher
concentration of sodium on the outside
than the inside and a higher
concentration of potassium on the
inside than the outside.
NORMAL IMPULSE CONDUCTION
Sinoatrial node

AV node

Bundle of His

Bundle
Branches

Purkinje fibers
Impulse Conduction & the ECG
Sinoatrial node

AV node

Bundle of His

Bundle Branches

Purkinje fibers
Principles
ECG device detects and amplifies the tiny electrical changes on the
skin that are caused when the heart muscle depolarizes during each
heartbeat. At rest, each heart muscle cell has a negative charge,
called the membrane potential, across its cell membrane. Decreasing
this negative charge toward zero, via the influx of the positive cations,
Na+ and Ca++, is called depolarization, which activates the mechanisms
in the cell that cause it to contract. During each heartbeat, a healthy
heart will have an orderly progression of a wave of depolarisation that
is triggered by the cells in the sinoatrial node, spreads out through the
atrium, passes through the atrioventricular node and then spreads all
over the ventricles. This is detected as tiny rises and falls in the
voltage between two electrodes placed either side of the heart, which
is displayed as a wavy line either on a screen or on paper. This display
indicates the overall rhythm of the heart and weaknesses in different
parts of the heart muscle.
Usually, more than two electrodes are used,
and they can be combined into a number of
pairs (For example: left arm (LA), right arm
(RA), and left leg (LL) electrodes form the three
pairs LA+RA, LA+LL, and RA+LL). The output
from each pair is known as a lead.

Each lead looks at the heart from a different

angle. Different types of ECGs can be referred
to by the number of leads that are recorded, for
example 3-lead, 5-lead, or 12-lead ECGs
(sometimes simply "a 12-lead"). A 12-lead ECG
is one in which 12 different electrical signals are
recorded at approximately the same time and
printed out as a paper copy.

Three- and 5-lead ECGs tend to be monitored

continuously and viewed only on the screen of
an appropriate monitoring device, for example
during an operation or whilst being transported
in an ambulance. There may or may not be any
permanent record of a 3- or 5-lead ECG,
depending on the equipment used.
PHASES OF THE RESTING ECG
ECG
Waveforms and Intervals
 EKG Leads

Leads are electrodes which measure the

difference in electrical potential between either:

1. Two different points on the body (bipolar leads)

2. One point on the body and a virtual reference point with

zero electrical potential, located in the center of the heart
(unipolar leads)
 EKG Leads

The standard EKG has 12 leads: 3 Standard Limb Leads

3 Augmented Limb Leads
6 Precordial Leads

The axis of a particular lead represents the viewpoint from which

it looks at the heart.
 ECG

Human tissues are electrical conductors and when electrical current flows in the heart it can
be measured in the body surface through ECG skin electrodes made of silver-silver chloride
Units of measurement: mV
Typical values Adults: 50 – 90 BPM, Neonates: 120 – 180 BPM
Electrical signal produced by Heart and measured at electrodes is approx. 1 mV amplitude.
Precordial Leads
 ECG

• Equipment
– adhesive silver-silver chloride electrodes with
electrolyte gel or paste
– electrical wires
– amplifier
– monitor
– recording apparatus
– computer to program the treadmill
 Twelve views of the heart

• Lead - two or more electrodes placed on

the body in designated anatomical
locations
• 1. Standard Limb Leads (3)
• 2. Augmented Limb Leads (3)
• 3. Chest Leads (6)
• Use 10 electrodes
SIMPLIFIED ECG DIAGRAM