Electrocardiography I
Electrocardiography I
Electrocardiography I
Lesson 5
ELECTROCARDIOGRAPHY I
Components of the ECG
PC running Windows
98SE, Me, 2000 Pro, XP Pro/Home/Media
William McMullen
Vice President
BIOPAC Systems, Inc.
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I.
INTRODUCTION
The main function of the heart is to pump blood through two circuits:
1. Pulmonary circuit: through the lungs to oxygenate the blood and remove carbon dioxide; and
2. Systemic circuit: to deliver oxygen and nutrients to tissues and remove carbon dioxide.
Because the heart moves blood through two separate circuits, it is sometimes described as a dual pump.
In order to beat, the heart needs three types of cells:
1. Rhythm generators, which produce an electrical signal (SA node or normal pacemaker);
2. Conductors to spread the pacemaker signal; and
3. Contractile cells (myocardium) to mechanically pump blood.
Lesson 5: ECG I
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increases, causing heart rate and strength of contraction to increase. Sympathetic influence increases during
inhalation.
The parasympathetic input acts like a brake, slowing down the heart. When you relax, the parasympathetic input
becomes dominant and the heart rate slows. Parasympathetic influence increases during exhalation.
The Electrocardiogram (ECG)
Just as the electrical activity of the pacemaker is communicated to the cardiac muscle, echoes of the depolarization and
repolarization of the heart are sent through the rest of the body. By placing a pair of very sensitive receivers (electrodes)
on other parts of the body, the echoes of the hearts electrical activity can be detected. The record of the electrical signal is
called an electrocardiogram (ECG). You can infer the hearts mechanical activity from the ECG.
Components of the ECG
The electrical events of the heart are usually recorded on the ECG as a pattern of a baseline broken by a P wave, a QRS
complex, and a T wave (Fig. 5.2).
An interval is part of the ECG containing at least one wave and a straight line. For example, the PR interval
includes the P wave and the connecting line before the QRS complex.
A segment is the period of time from the end of one wave to the beginning of the next wave. For example, the
PR segment represents the time of AV nodal delay and transmission to the ventricles.
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Measurement points
Represents
P wave
P-R Interval
P-R Segment
QRS complex
S-T Segment
T wave
Q-T Interval
Electrical activity varies through the ECG cycle as shown below (Fig. 5.3):
Because the ECG reflects the electrical activity, it is a useful picture of heart activity. If there are interruptions of the
electrical signal generation or transmission, the ECG changes. These changes can be useful in diagnosing changes within
the heart. During exercise, however, the position of the heart itself changes, so you cannot standardize or quantify the
voltage changes.
Leads
The particular arrangement of two electrodes (one positive, one negative) with respect to a third electrode (the ground) is
called a lead. The electrode positions for the different leads have been standardized. For this lesson, you will record from
Lead II, which has a positive electrode on the left ankle, a negative electrode on the right wrist, and the ground electrode
on the right ankle. Typical Lead II values are shown in Table 5.2.
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Table 5.2
P wave
P-R interval
P-R segment
QRS complex (R)
DURATION
(second)
AMPLITUDE
(millivolts)
0.06 0.11
< 0.25
0.12-0.20
0.08
< 0.12
S-T segment
0.12
Q-T interval
0.36-0.44
T wave
0.16
0.8 - 1.2
< 0.5
* Tabled values represent results from a typical Lead II setup (wrist and
ankle electrode placement); values for torso placement would be different.
Proper electrode attachment to the subject will influence the quality of data collected. In addition, many factorsnormal
and abnormaldetermine R wave amplitude.
Normal factors include body size (BSA) and distribution of body fat, heart size (ventricular mass), position of the
heart in the chest relative to lead locations, metabolic rate, and others.
Abnormal factors include hyper- and hypothyroidism, ventricular hypertrophy (observed for example, in chronic
valvular insufficiency), morbid obesity, essential hypertension and many other pathologic states.
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In this lesson, you will record the ECG under four conditions.
Because ECGs are widely used, basic elements have been standardized to simplify
reading ECGs.
ECGs have standardized grids of lighter, smaller squares and, superimposed on the
first grid, a second grid of darker and larger squares (fig. 5.5). The smaller grid
always has time units of 0.04 seconds on the x-axis and the darker vertical lines are
spaced 0.2 seconds apart. The horizontal lines represent amplitude in mV. The lighter
horizontal lines are 0.1 mV apart and the darker grid lines represent 0.5 mV.
Figure 5.5 standard ECG Grid
Lesson 5: ECG I
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III. MATERIALS
BIOPAC electrode gel (GEL1) and abrasive pad (ELPAD) or Skin cleanser or alcohol prep
Computer system
BIOPAC serial cable (CBLSERA) or USB cable (USB1W) if using a USB port
A.
For further explanation, use the online support options under the Help Menu.
SET UP
FAST TRACK Set Up
Fig. 5.6
4. Turn the BIOPAC MP35/30 unit ON.
Set Up continues
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right leg
BLACK lead
(ground)
left leg
RED lead
Fig. 5.7
Place one electrode on the medial surface of each leg, just above the
ankle. Place the third electrode on the right anterior forearm at the wrist
(same side of arm as the palm of hand).
Note: For optimal electrode adhesion, the electrodes should be placed
on the skin at least 5 minutes before the start of the Calibration
procedure.
6. Attach the electrode lead set SS2L to
the electrodes following Fig. 5.7.
Each of the pinch connectors on the ends of the electrode lead cables
needs to be attached to a specific electrode. The lead cables are each a
different color, and you should follow Fig. 5.7 to ensure that you connect
each cable to the proper electrode.
The pinch connectors work like a small clothespin, but will only latch
onto the nipple of the electrode from one side of the connector.
When the electrode leads are connected properly, the LEAD II electrode
configuration will be established.
Position the electrode cables such that they are not pulling on the
electrodes. Connect the electrode cable clip (where the cable meets the
three individual colored wires) to a convenient location (can be on the
Subjects clothes). This will relieve cable strain.
The Subject should not be in contact with nearby metal objects (faucets,
pipes, etc.), and should remove any wrist or ankle bracelets.
Type in a unique identifier.
The default lesson will display ECG data only, but the lesson can be set
up to calculate and display Heart Rate data as well. To calculate and
display Heart Rate data, the lesson Preference must be established prior to
Calibration.
END OF SET UP
When the Heart Rate Preference is established, Heart Rate data will be
calculated and displayed on CH 40 during the Recording and Analysis
modes (Heart Rate data is not displayed for Calibration).
Lesson 5: ECG I
B.
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CALIBRATION
The calibration procedure establishes the hardwares internal parameters (such as gain, offset, and scaling) and is critical
for optimum performance. Pay close attention to the following calibration steps.
FAST TRACK Calibration
1. Double check the electrodes, and make
sure the Subject is relaxed.
2. Click Calibrate.
The Calibrate button is in the upper left corner of the Setup window.
This will start the calibration recording.
The Subject needs to remain relaxed throughout calibration.
Fig. 5.8
If your data resembles Fig. 5.8 (with allowance for any difference in
vertical scaling), proceed to the Data Recording section.
If the data shows any large baseline drifts, you should check your
electrodes for good contact and redo the calibration by clicking Redo
Calibration and repeating the entire calibration sequence.
END OF CALIBRATION
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C.
Hints for obtaining optimal data:
a) The Subject should not talk or laugh during any of the recording
segments.
b) The Subject should be in a relaxed state for each recording segment
and in the position noted for each segment.
c) When asked to sit up, the Subject should do so in a chair, with arms
relaxed on the armrest (if available).
d) For Steps 6 and 7: Click Resume as soon as possible after the
Subject sits up in order to capture the heart rate variation, but not
while the Subject is in the process of sitting up or there will be
excessive motion artifact.
e) The Subject should be as still as possible during the recording
segment. The electrocardiograph is very sensitive to small changes
in voltage caused by contraction of skeletal muscles, and the
Subjects arms and legs need to be relaxed so that the muscle
(EMG) signal does not corrupt the ECG signal.
Segment 1 Lying down
2. Click Record.
When you click Record, the recording will begin and an append marker
labeled Lying down will automatically be inserted.
4. Click Suspend.
The recording should halt, giving you time to review the data and
prepare for the next recording segment.
If all went well, your data should look similar to Fig. 5.9 and you can
proceed to Step 6.
If correct, go to Step 6.
Recording continues
Lesson 5: ECG I
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When you click Resume, the recording will continue and an append marker
labeled After sitting up will be automatically inserted.
During this time, the Recorder should insert an event marker at the
beginning of an inhale and insert another event marker at the corresponding
Recorder should insert event markers at exhale. The Recorder should label these markers Inhale and Exhale.
a corresponding inhale and exhale.
These event markers will help you locate data to complete Table F in the
Data Report.
Inhale
Exhale.
9. Click Suspend.
The recording should halt, giving you time to review the data and prepare
for the next recording segment.
If all went well, your data should look similar to Fig. 5.10 and you can
proceed to Step 11.
Recording continues
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When you click Resume, the recording will continue and an append marker
labeled Deep breathing will be automatically inserted.
Subject is seated (seconds 41-60).
After the recording begins, the Subject should start a series of slow,
prolonged breaths, continuing for five cycles.
Inhale
Exhale
During this time, the Recorder should insert an event marker at the
beginning of each inhale and insert another event marker at the
corresponding exhale. The Recorder should label these markers Inhale
and Exhale.
These event markers will help you locate data to complete Table F in the
Data Report.
The recording should halt, giving you time to prepare for the next recording
segment.
If all went well, your data should look similar to the Fig. 5.11 and you can
proceed to Step 15.
Recording continues
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When you click Resume, the recording will continue and an append
marker labeled After exercise will be automatically inserted.
If all went well, your data should look similar to the Fig. 5.12 and you can
proceed to Step 20.
The After exercise recording may have some baseline drift (as
shown in Fig. 5.12 above). Baseline drift is fairly normal and,
unless excessive, does not necessitate redoing the recording.
If incorrect, you should redo the recording by clicking Redo and repeating
Steps 15-19. Note that once you press Redo, the data you have just
recorded will be erased.
20. Click Done.
A pop-up window with options will appear. Make your choice, and continue
as directed.
If choosing the Record from another Subject option:
a) Attach electrodes per Set Up Steps 5-7 and continue the entire
lesson from Set Up Step 9.
b) Each person will need to use a unique file name.
END OF RECORDING
Remove the electrode cable pinch connectors, and peel off the electrodes.
Throw out the electrodes (BIOPAC electrodes are not reusable). Wash the
electrode gel residue from the skin, using soap and water. The electrodes
may leave a slight ring on the skin for a few hours. This is normal, and does
not indicate that anything is wrong.
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V.
DATA ANALYSIS
In this section, you will examine ECG components of cardiac cycles and measure amplitudes (mV) and durations (msecs)
of the ECG components.
Note: Interpreting ECGs is a skill that requires practice to distinguish between normal variation and those arising from
medical conditions. Do not be alarmed if your ECG is different than the examples shown or from the tables and
figures in the Introduction.
FAST TRACK Data Analysis
ECG Lead II
Fig 5.13
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Measurement
CH 2
T (Delta Time)
CH 2
CH 2
(Delta Amplitude)
CH 2
max (Maximum
Amplitude)
The measurement boxes are above the marker region in the data window.
Each measurement has three sections: channel number, measurement type,
and result. The first two sections are pull-down menus that are activated
when you click on them.
A
Fig. 5.15
A
6. Zoom in on a single cardiac cycle
from Segment 1.
Be sure to stay in the first recorded segment when you select the cardiac
cycle.
Gather data for 3 cycles. You may paste the measurements into the Journal
by using the Edit > Journal > Paste measurement option.
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Durations
P wave
PR interval
QRS interval
QT interval
ST segment
T wave
Fig. 5.16 shows a sample setup for measuring P wave amplitude. Note that
the measurement shows the amplitude difference between endpoints in
the selected area.
Amplitudes
P wave
T wave
QRS complex
Time Interval
QT Interval (ventricular systole)
End of T wave to subsequent R
wave (ventricular diastole)
Note: See Fig. 5.2 in the Introduction for details of the components
of the ECG.
A
8. Repeat measurements as required for
the Data Report.
Fig. 5.16
A, B, C, D
9. Save or print the data file.
You may save the data to a drive, save notes that are in the journal, or print
the data file.
END OF LESSON 5
Complete the Lesson 5 Data Report that follows.
Lesson 5: ECG I
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ELECTROCARDIOGRAPHY I
ECG I
DATA REPORT
Students Name:
Lab Section:
Date:
Height
Age
Weight
From
Channel
CH 2
BPM
CH 2
Cardiac Cycle
2
Mean
Range
Table 5.4
ECG
Component
Cycle 1
Duration
T [CH 2]
Cycle 2 Cycle 3
Mean
Cycle 1
Amplitude (mV)
[CH 2]
Cycle 2 Cycle 3
Mean
P wave
PR interval
PR segment
QRS complex
QT interval
ST segment
T wave
Table 5.5
Ventricular Readings
QT Interval
(corresponds to Ventricular Systole)
End of T wave to subsequent R wave
(corresponds to Ventricular Diastole)
Cycle 1
CH 2 T
Cycle 2
Cycle 3
Mean
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CH #
Cycle 1
Cycle 2
Cycle 3
Mean
Cycle 2
Cycle 3
Mean
Inspiration
T
CH 2
BPM
CH 2
Expiration
T
CH 2
BPM
CH 2
C. Sitting
Table 5.7
Heart Rate
CH #
CH 2
BPM
CH 2
Cycle 1
D. After Exercise
Table 5.8
CH 2 T
Ventricular Readings
QT Interval
(corresponds to Ventricular Systole)
Cycle 1
Cycle 2
Cycle 3
Mean
II.
Mean
Range
Explain the changes in heart rate between conditions. Describe the physiological mechanisms causing these changes.
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F. Duration ( T)
Rhythm
Measurement
Mean
Range
Are there differences in the cardiac cycle with the respiratory cycle?
Measurement
Mean
Range
What changes occurred in the duration of systole and diastole between resting and post-exercise?