Introduction to ECG

Dr. Rashed J. Al-Hamdan

M.D. FRCP( C )

Introduction to ECG
ECG is short for ElectroCardioGram. The idea of ECG is to measure a surface electrical potential of the electrical activities occurring in the heart. This entails fitting leads to look at the currents from every possible angle. This emphasizes the need for standardizing the leads positions to be able to compare different ECGs.

An old ECG Machine

Conduction System

Normal ECG

Action Potential and ECG

Basic ECG Leads

Basic ECG Leads

Chest Leads

V1: 4th space, Rt parasternal line. V2: 4th space Lt parasternal line. V3: Between V2 and V3. V4: 5th Space Midclavicular line. V5: 5th space Anterior axillary line. V6: 5th space Midaxillary line.

Electro-Mechanical Coupling

Standard Limb Leads

Standard Limb Leads

Waves and Intervals

Axis Determination
The depolarization wave spreads in different directions through the ventricle. The term axis usually refers to the mean direction of the QRS wave in the frontal plane unless otherwise specified. This means that we are examining the QRS axis only in the standard limb leads.

Axis Determination

The way to determine the electrical axis is made easy by remembering few rules in ECG.

Axis Determination

Axis Determination

Axis Determination

Axis Determination

Common Mistakes
One of the commonest mistakes to be done by nurses and doctors is leads misplacement. The most common ones are 1- Right Arm Left Arm leads misplacement. 2- Arm Leg leads misplacement. 3- Reversal of 2 leads of the anterior chest leads V1 V3.

Common Mistakes: Rt - Lt Arm Leads Misplacement

Common Mistakes: Rt - Lt Arm Leads Misplacement

Common Mistakes: Leg - Arm Leads Misplacement

Common Mistakes: V1 V2 Leads Misplacement

Spot The Differences

What is that ???

What is that ???

Atrial and Ventricular Tachycardia

Atrial Flutter

Atrial Flutter

Atrial Flutter

Atrial Flutter

Flutter With High AV Block

Atrial Fibrillation

Fine Atrial Fibrillation

PSVT

A V N R T - Sinus Rhythm

A V N R T - Attack

Ventricular Tachycardia

Ventricular Tachycardia

WPW

Orthodromic WPW

Antidromic WPW

WPW with AFib

WPW with AFib

Atrio-Ventricular Block

st 1

Degree AV Block

Mobitz Type I

Mobitz Type II

rd 3

Degree AV Block

Bundle Branch Blocks

Right B B B

Left B B B

Torsade de Pointes

Torsade de Pointes

Hyperkalemia

Hyperkalemia

Hypokalemia

Hypokalemia

STEMI

STEMI

STEMI

STEMI

STEMI

STEMI

STEMI with LBBB

Single Chamber Pacemaker

Dual Chamber Pacemaker

I C D

Dangerous Patterns

Dangerous Patterns

Dangerous Patterns

Dangerous Patterns

Dangerous Patterns

Dangerous Patterns