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Graphic representation /recording of the electrical

activity of the heart

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Chest painMyocardial InfarctionPre-op Assessment

Effects of systemic diseasesAs differential diagnoses for MI,

Angina pectoris and Pericarditis

Guide for appropriate therapies(pacemakers, medications, electrical)

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Transient ECGContinuous resting ECG

Continuous ambulatoryExercise ECG

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V1 - 4TH ICSRIGHT OF

STERNUM

V2 - 4TH ICS Left

OF STERNUM

V3 halfway

between V2and V4

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V4 leftmidclavicular line

5th ICS

V5 left anterior

axillary line in 5th

ICS

V6 left midaxillaryline in the 5th ICS

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SA node AV nodeBundle of his Left and right bundlebranches Purkinje fibers

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SA node AVnode Bundle

of his Left and right

bundle branches

Purkinje fibers

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Electrical stimulation causesmechanical contraction

The electrical stimulation of the

muscle cells of the ventricles, in

turn, causes the mechanicalcontraction of the ventricles(systole). The cells repolarize and

the ventricles then relax (diastole).

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Cardiac electrical activity is theresult of the movement of ions

(charged particles such assodium, potassium, and

calcium) across the cellmembrane.

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Automaticity: ability to initiate anelectrical impulse

Excitability: ability to respond to anelectrical impulseConductivity: ability to transmit an

electrical impulse from onecell toanother

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represents the electrical impulsestarting in the sinus node and

spreading through the atria.Therefore, the P wave represents

atrial muscle depolarization. It is

normally 2.5 mm or less in heightand 0.11 second or less induration.

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represents ventricular muscle

depolarization.The first negative deflection after the P

wave is the Q wave, which is normally less

than 0.04 second in duration and less than25% of the R wave amplitude; the firstpositive deflection after the P wave is the R

wave;the S wave is the first negative deflection

after the R wave.

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When a wave is less than 5 mm inheight, small letters (q, r, s) are used;when a wave is taller than 5 mm,

capital letters (Q, R, S) are used.

The QRS complex is normally lessthan 0.12 seconds in duration.Electrical impulses spreading

through the ventricles (bundle of his)

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represents ventricular muscle

repolarization (when the cells

regain a negative charge; alsocalled the resting state). It followsthe QRS complex and is usually

the same direction as the QRScomplex.

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The U wave is thought to representrepolarization of the

Purkinje fibers, but it sometimes is seen in

patients with hypokalemia (low potassiumlevels), hypertension, or heart disease. Ifpresent, the U wave follows the T waveand is usually smaller than the P wave. If

tall, it may be mistaken for an extra Pwave.

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Ventricular and atrial rate: 60 to 100 in theadultVentricular and atrial rhythm: RegularQRS shape and duration: Usually normal, P

wave: Normal and consistent shape; alwaysin front of the QRS

PR interval: Consistent interval between 0.12

and 0.20 secondsP: QRS ratio 1:1

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Ventricular and atrial rate: Less than 60 inthe adult

Ventricular and atrial rhythm: RegularQRS shape and duration: Usually normal,P wave: Normal and consistent shape;

always in front of the QRS

PR interval: Consistent interval between0.12 and 0.20 seconds

P: QRS ratio: 1:1

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Ventricular and atrial rate: Greater than 100 in

the adultVentricular and atrial rhythm: RegularQRS shape and duration: Usually normal,P wave: Normal and consistent shape; always in

front of the QRS, but may be buried in thepreceding T wave

PR interval: Consistent interval between 0.12and 0.20 seconds

P: QRS ratio: 1:1

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Ventricular and atrial rate: 60 to 100 in theadult

Ventricular and atrial rhythm: IrregularQRS shape and duration: Usually normal,P wave: Normal and consistent shape;

always in front of the QRS

PR interval: Consistent interval between0.12 and 0.20 seconds

P: QRS ratio: 1:1

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Irregular rhythmRate is less than 60Upright P followed by QRS and T

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P wave is IndescernibleQRS is normalRate is 150 250 bpmRhythm is regular

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P waves No identifiable P waves only achaotic rhythm

QRS upright, normal in configurationT indiscernableRate Depends on ventricular responseRhythm is irregular

Rapid chaotic atrial depolarization Most often affects older people

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Controlled heart rate is less than 100bpm

Uncontrolled heart rate is more than 100

If no PULSE classified as Pulselesselectrical activity (PEA)

Continue compression & give medication

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P wave positive deflection, flutter wavesresembling saw tooth or picket fence

QRS - NormalT wave unidentifiableRate -40 -150 bpm

Fixed ratio & Varied ratio

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Any Rhythm occurring above the ventriclescan be safely SUPRAVENTRICULARTACHYCARDIA or SVT

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P wave is inverted, absent or buried in theQRS complex ( high mid or low)

Rhythm is regularRate is 40 60 bpm

Above 60 is accelerated junctional rhytm

Above 100 is Junctional tachycardia

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Rhythm is regularRate is 150 250 bpmP waves is absent including T waveQRS wide and bizarre amplitude is HIGH

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Rhythm is irregularRate 150-250 bpmNo P waves and T wavesQRS wide and bizarreAmplitude is LOW

COARSEFINE

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Rhythm is regularNo P waves, No T wavesQRS - wideRate is less than 40

Above 40 bpm is accelerated Idioventricularrhythm

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