Introduction to Electrocardiography

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Questions and Answers

Match the following ECG components with their corresponding time intervals:

P wave = 0.08-0.1 sec QRS complex = 0.12 sec ST segment = 0.2 sec PR segment = 0.12-0.2 sec

Match the following ECG intervals with their corresponding durations:

PR interval = 0.12-0.2 sec QT interval = not > 0.45 s ST segment = 0.2 sec QRS complex = 0.12 sec

Match the following ECG segments with their corresponding descriptions:

PR segment = Atrial depolarisation ST segment = Ventricular repolarisation QRS complex = Ventricular depolarisation QT interval = Repolarisation of ventricles

Match the following ECG leads with their corresponding types:

<p>Standard leads = Bipolar limb leads Augmented leads = Unipolar limb leads Precordial leads = Chest leads Limb leads = Arm and leg leads</p> Signup and view all the answers

Match the following heart rate conditions with their corresponding descriptions:

<p>Sinus tachycardia = &gt;100 beats/min (at rest) Sinus bradycardia = &lt;60 beats/min Normocardia = 60-100 beats/min Arrhythmia = Abnormal heart rhythm</p> Signup and view all the answers

Match the following ECG calibration settings with their corresponding values:

<p>1mm = 0.1 mV 5mm = 0.5 mV 1mV = 1cm 25mm/sec = Paper speed</p> Signup and view all the answers

Match the following ECG activities with their corresponding descriptions:

<p>Atrial depolarisation = P wave Ventricular depolarisation = QRS complex Ventricular repolarisation = ST segment Atrial repolarisation = T wave</p> Signup and view all the answers

Match the following ECG segments with their corresponding durations:

<p>PR segment = 0.12-0.2 sec QRS complex = 0.12 sec ST segment = 0.2 sec QT interval = not &gt; 0.45 s</p> Signup and view all the answers

Match the following ECG waves with their corresponding descriptions:

<p>P wave = Atrial depolarisation QRS complex = Ventricular depolarisation T wave = Ventricular repolarisation U wave = Papillary muscle repolarisation</p> Signup and view all the answers

Match the following ECG conditions with their corresponding descriptions:

<p>STEMI = Myocardial infarction Myocardial ischemia = ST segment elevation Hypertrophy = Increased muscle mass Infarction = Myocardial necrosis</p> Signup and view all the answers

Match the following ECG components with their functions:

<p>Electrodes = Detect electrical changes during a cardiac cycle Conducting system = Transmits electrical impulses through the heart Purkinje fibres = Initiate impulses in the cardiac cycle Bundle of His = Divides into bundle branches</p> Signup and view all the answers

Match the following ECG applications with their uses:

<p>Diagnose &amp; manage abnormal rhythms = ECG essential Diagnose cause of chest pain = ECG practical Assist in diagnosis of dizziness = ECG essential Early intervention in myocardial infarction = ECG practical</p> Signup and view all the answers

Match the following ECG preparation steps with their descriptions:

<p>Prepare skin = Shave hair from electrode sites Use quality electrodes = Use only electrodes specified by the manufacturer Correct placement of electrodes = Place 10 electrodes on specific sites Insure good electrode-to-patient contact = Tightly re-seal electrodes</p> Signup and view all the answers

Match the following ECG leads with their descriptions:

<p>Standard / Bipolar limb leads = Measures potential difference between 2 points Augmented / Unipolar limb leads = In practice, these are the same electrodes used for leads I, II and III Precordial / Chest leads = 6 leads placed on the chest 12 Leads = Comprehensive ECG recording</p> Signup and view all the answers

Match the following ECG components with their locations:

<p>S-A node = Spontaneously initiate impulses A-V node = Transmits electrical impulses through the heart Bundle of His = Divides into bundle branches Purkinje fibres = Initiate impulses in the cardiac cycle</p> Signup and view all the answers

Match the following ECG terms with their definitions:

<p>Lead = Electrical picture of the heart Electrode = Detects electrical changes during a cardiac cycle Rhythm = Pattern of heart beats Arrhythmia = Abnormal heart rhythm</p> Signup and view all the answers

Match the following ECG practical steps with their descriptions:

<p>Remove skin = Remove skin prep pad or paper towel Clean sites = Soap and water Dry skin = Prepare skin for electrode placement Shave hair = Shave hair from electrode sites</p> Signup and view all the answers

Match the following ECG components with their functions:

<p>Conducting system = Transmits electrical impulses through the heart Purkinje fibres = Initiate impulses in the cardiac cycle Bundle of His = Divides into bundle branches S-A node = Spontaneously initiate impulses</p> Signup and view all the answers

Match the following ECG lead types with their descriptions:

<p>Right arm = Used as earth Left arm = Part of the standard/bipolar limb leads aVRA = Part of the augmented/unipolar limb leads aVLL = Part of the augmented/unipolar limb leads</p> Signup and view all the answers

Match the following ECG components with their descriptions:

<p>ECG machine = Does the switching and rearranging of the electrodes Electrodes = Detect electrical changes during a cardiac cycle Leads = Electrical picture of the heart Conducting system = Transmits electrical impulses through the heart</p> Signup and view all the answers

Match the following ECG lead placements with their corresponding locations:

<p>V1 = Right mid clavicle V4 = 5th ICS V6 = Left mid axillary V2 = Left mid clavicle</p> Signup and view all the answers

Match the following ECG artefacts with their causes:

<p>Electrical interference = Cell phone Thickened baseline = Muscle tremor Muscle movement = Patient movement Rhythm strip = Electrode misplacement</p> Signup and view all the answers

Match the following ECG components with their descriptions:

<p>P wave = Most clearly seen in Lead II Rhythm strip = Long recording of ECG 12 lead ECG = Standard ECG test ECG practical = Hands-on ECG training</p> Signup and view all the answers

Match the following ECG paper characteristics with their values:

<p>Time (sec) = 5mm = 0.2 seconds Voltage (mV) = 1mV = 10mm Speed = 25mm/sec Standard ECG paper = 25mm = 1 second</p> Signup and view all the answers

Match the following ECG exercises with their descriptions:

<p>Exercise ECG = Stress test for heart conditions ECG practical = Hands-on ECG training 12 lead ECG = Standard ECG test Rhythm strip = Long recording of ECG</p> Signup and view all the answers

Match the following ECG parts with their locations:

<p>Limbs = Arms and legs Chest = Precordial / Unipolar chest leads Right = V1 lead placement Left = V6 lead placement</p> Signup and view all the answers

Match the following ECG artefact causes with their effects:

<p>Electrical interference = Thickened baseline Muscle movement = Artifact on ECG reading Cell phone = Electrical interference Patient movement = Artifact on ECG reading</p> Signup and view all the answers

Match the following ECG procedures with their descriptions:

<p>ECG practical = Hands-on ECG training 12 lead ECG = Standard ECG test Rhythm strip = Long recording of ECG Exercise ECG = Stress test for heart conditions</p> Signup and view all the answers

Match the following ECG components with their uses:

<p>P wave = Measuring atrial activity Rhythm strip = Monitoring heart rhythm 12 lead ECG = Diagnosing heart conditions ECG paper = Recording ECG readings</p> Signup and view all the answers

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Study Notes

Introduction to ECG

  • The electrocardiograph records the electrical changes during a cardiac cycle.
  • The first ECG recording was made by A. Waller in 1887.

ECG Essentials

  • ECG is essential for diagnosing and managing abnormal rhythms, diagnosing the cause of chest pain, and intervening early in myocardial infarction.
  • It assists in diagnosing dizziness, syncope, and breathlessness.

Conducting System

  • The conducting system consists of:
    • S-A node: spontaneously initiates impulses.
    • A-V node.
    • Bundle of His.
    • Bundle branches.
    • Purkinje fibres.

ECG Practical

  • Clinical diagnosis depends on history and evidence to support diagnosis.
  • ECG uses electrodes placed on the surface of the body to measure the sum of all cell activities.

Obtaining an ECG Recording

  • Prepare the skin by shaving hair from electrode sites, removing skin oils, and cleaning with soap and water.
  • Use quality electrodes, ensure good electrode-to-patient contact, and tightly re-seal electrodes to prevent drying out.

Placement of Electrodes

  • Place 10 electrodes on specific sites to obtain a 12-lead ECG recording.
  • The 12 leads include:
    • 3 standard/bipolar limb leads.
    • 3 augmented/unipolar limb leads.
    • 6 precordial/chest leads.

Leads and Electrodes

  • A lead refers to an electrical picture of the heart detected through electrodes.
  • The 12 leads are used as an earth to measure potential differences between points.

12 Lead ECG

  • The 12-lead ECG is a standard recording that includes a rhythm strip.
  • Lead II is usually used to clearly display the P wave.

Artefacts

  • Artefacts can be caused by:
    • Cell phones.
    • Electrical interference.
    • Muscle tremor.
    • Patient movement.

ECG Paper

  • Standard ECG paper has a voltage scale in millivolts (mV) and a time scale in seconds (sec).

  • The speed of the recording is usually 25mm/sec.### ECG Paper

  • 1mm on ECG paper represents 0.04 seconds

  • 5mm on ECG paper represents 0.2 seconds

  • Standard ECG paper has 1mm squares, with 1mm = 0.1mV calibration

Calibration

  • Calibration signal: 1mV = 1cm
  • Calibration example: 5mm = 0.5mV

Electrocardiogram - Waves

  • Check calibration (1mV = 1cm)
  • Check speed (25mm/sec)
  • P wave: atrial depolarization (0.08-0.1sec)
  • QRS complex: ventricular depolarization (0.12 sec / 3 small blocks)
  • T wave: ventricular repolarization (0.2 sec)

Electrocardiogram - Activity

  • Atrial depolarization (0.08-0.1sec)
  • Ventricular depolarization (0.12 sec / 3 small blocks)
  • Ventricular repolarization (0.2 sec)
  • Conduction problems: >>>

Electrocardiogram - Segments

  • PR segment: P to QRS complex
  • ST segment: QRS complex to T wave
  • ST elevation: Myocardial infarction (STEMI)
  • Depressed ST segment: Myocardial ischemia

Electrocardiogram - Intervals

  • PR interval: time from SA node to ventricular muscle (0.12-0.2 sec / 3-5 small blocks)
  • QT interval: time from ventricles to depolarize and repolarize (not > 0.45 s)

12 Leads ECG

  • 3 Standard/Bipolar limb leads
  • 3 Augmented/Unipolar limb leads
  • 6 Precordial/Chest leads
  • Check calibration (1mV = 1cm)
  • Check speed (25mm/sec)

Heart Rate

  • Normal heart rate: 60-100 beats/min
  • Sinus tachycardia: >100 beats/min (at rest)
  • Sinus bradycardia: <60 beats/min

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