Electrocardiography Electrocardiography evaluation of heart work evaluation of heart work

(ECG) (ECG)

Analysis of ECGAnalysis of ECG

Plan of Lecture

1) determination of the excitation source2) evaluation of heart rate3) determination of heartbeating frequency4) evaluation of electrocardiogram voltage5) determination of the direction of the electrical axis6) analysis of ECG-elements

ElectrocardiogramElectrocardiogram

It is the method of registration of It is the method of registration of heart bioelectrical potential from the heart bioelectrical potential from the chest of patientchest of patient

To describe how elektrocardiograma in all areas of wave of de- and repolarization sending will look you must remember three rules

bull If the dipole vector directed towards the positive electrode of lead ndash ECG will show positive wave

bull If the dipole vector directed toward the negative electrode lead ndash elektrocardiogram will show negative wave

bull If the dipole vector is perpendicular to the axis of abduction then elektrocardiogram writes isoline

Positive lead-electrode

Isoline

Vector of dipole

Vector of dipole

Vector of dipole

ECG ELEMENTSWAVES OF

ECG

1 P wave ndash depolarization of atria precedes atria systole2 QRS wave is depolarization of ventricles precedes ventricular systole3 atria repolarization also occurs at QRS4 T wave indicates ventricular repolarization

ELECTROCARDIOGRAM

TRANSESOPHAGEAL ENDOKARDIOGRAM

Scheme of ECG

ECG leadsECG leads

Results of ECG

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

Plan of Lecture

1) determination of the excitation source2) evaluation of heart rate3) determination of heartbeating frequency4) evaluation of electrocardiogram voltage5) determination of the direction of the electrical axis6) analysis of ECG-elements

ElectrocardiogramElectrocardiogram

It is the method of registration of It is the method of registration of heart bioelectrical potential from the heart bioelectrical potential from the chest of patientchest of patient

To describe how elektrocardiograma in all areas of wave of de- and repolarization sending will look you must remember three rules

bull If the dipole vector directed towards the positive electrode of lead ndash ECG will show positive wave

bull If the dipole vector directed toward the negative electrode lead ndash elektrocardiogram will show negative wave

bull If the dipole vector is perpendicular to the axis of abduction then elektrocardiogram writes isoline

Positive lead-electrode

Isoline

Vector of dipole

Vector of dipole

Vector of dipole

ECG ELEMENTSWAVES OF

ECG

1 P wave ndash depolarization of atria precedes atria systole2 QRS wave is depolarization of ventricles precedes ventricular systole3 atria repolarization also occurs at QRS4 T wave indicates ventricular repolarization

ELECTROCARDIOGRAM

TRANSESOPHAGEAL ENDOKARDIOGRAM

Scheme of ECG

ECG leadsECG leads

Results of ECG

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

ElectrocardiogramElectrocardiogram

It is the method of registration of It is the method of registration of heart bioelectrical potential from the heart bioelectrical potential from the chest of patientchest of patient

To describe how elektrocardiograma in all areas of wave of de- and repolarization sending will look you must remember three rules

bull If the dipole vector directed towards the positive electrode of lead ndash ECG will show positive wave

bull If the dipole vector directed toward the negative electrode lead ndash elektrocardiogram will show negative wave

bull If the dipole vector is perpendicular to the axis of abduction then elektrocardiogram writes isoline

Positive lead-electrode

Isoline

Vector of dipole

Vector of dipole

Vector of dipole

ECG ELEMENTSWAVES OF

ECG

1 P wave ndash depolarization of atria precedes atria systole2 QRS wave is depolarization of ventricles precedes ventricular systole3 atria repolarization also occurs at QRS4 T wave indicates ventricular repolarization

ELECTROCARDIOGRAM

TRANSESOPHAGEAL ENDOKARDIOGRAM

Scheme of ECG

ECG leadsECG leads

Results of ECG

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

To describe how elektrocardiograma in all areas of wave of de- and repolarization sending will look you must remember three rules

bull If the dipole vector directed towards the positive electrode of lead ndash ECG will show positive wave

bull If the dipole vector directed toward the negative electrode lead ndash elektrocardiogram will show negative wave

bull If the dipole vector is perpendicular to the axis of abduction then elektrocardiogram writes isoline

Positive lead-electrode

Isoline

Vector of dipole

Vector of dipole

Vector of dipole

ECG ELEMENTSWAVES OF

ECG

1 P wave ndash depolarization of atria precedes atria systole2 QRS wave is depolarization of ventricles precedes ventricular systole3 atria repolarization also occurs at QRS4 T wave indicates ventricular repolarization

ELECTROCARDIOGRAM

TRANSESOPHAGEAL ENDOKARDIOGRAM

Scheme of ECG

ECG leadsECG leads

Results of ECG

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

ECG ELEMENTSWAVES OF

ECG

1 P wave ndash depolarization of atria precedes atria systole2 QRS wave is depolarization of ventricles precedes ventricular systole3 atria repolarization also occurs at QRS4 T wave indicates ventricular repolarization

ELECTROCARDIOGRAM

TRANSESOPHAGEAL ENDOKARDIOGRAM

Scheme of ECG

ECG leadsECG leads

Results of ECG

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

ELECTROCARDIOGRAM

TRANSESOPHAGEAL ENDOKARDIOGRAM

Scheme of ECG

ECG leadsECG leads

Results of ECG

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

TRANSESOPHAGEAL ENDOKARDIOGRAM

Scheme of ECG

ECG leadsECG leads

Results of ECG

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

Scheme of ECG

ECG leadsECG leads

Results of ECG

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

ECG leadsECG leads

Results of ECG

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

Results of ECG

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

SEQUENCE AND PROCEDURE OF ECG ANALYSIS1 Determination of the excitation source To determine the

excitation source (pacemaker) it is necessary to assess the progress of excitation within atrium and set the correlation between P-wave and ventricular complexes QRS Normally the electrical impulse arises in the sinus node and ECG standard lead II record positive P-wave before every complex QRS

2 Evaluation of correctness of heart rate ndash based on duration comparing of R-R-intervals Normally observed an insignificant difference of duration within 01 sec

3 Determination of heart rate With normal heart rate you should divide 60 seconds by the duration of R-R-interval in seconds

4 Evaluation voltage ECG It is necessary to evaluate the amplitude of R-wave in the standard leads If the amplitude of the R-wave in standard lead II more than 5 mm or if the amount of R-wave amplitudes in the I II and III standard leads is more than 15 mm the voltage of ECG is maintained

5 Determination of the electrical axis direction

6 Analysis of ECG elements

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

SIX-AXIS SYSTEM OF BAILEYSIX-AXIS SYSTEM OF BAILEY

Graphical method Calculate the algebraic sum of prongs amplitudes of the QRS-complexin I and III standard leadsAdd it to randomly selectedvalues on the axes of appropriateleads of 6-axis Bailey systemof coordinateFrom ends of these projections topostpone the perpendiculars The point of their crossing connect with the the center of system This line ndash is electric axis of the heart The angle α is determined between this line and positive part of the axes I of the standard lead

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vertical

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Intermediate

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

POSITIONS OF HEART ELECTRICAL AXIS IN NORM

Vehorisontal

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

ANALISIS OF ECG ELEMENTS

Analysis of P-wave includes a ) evaluation of wave forms b ) measuring the amplitude and c) determine the durationAnalysis of segment interval and P -Q segment is measured from the end of P before Q The interval is measured from the beginning of P to the QAnalysis of the QRS complex includes1 Assessment of wave Qa) measurement of its amplitude and compare it with the R wave amplitude in the same leadb) measuring the length of wave Q2 Assessment of wave R a) measuring the amplitude and b) comparing it with Q wave amplitude in the same tooth extraction and other R leads3 Assessment of wave S a) measuring the amplitude and b) comparing the amplitude of R wave in the same leadsAnalysis of S-T segment Analyzing segment you must set its deviation from the isolineAnalysis of wave T In the analysis of the T wave should a) identify the direction b) to assess its shape and c) to measure the amplitudeAnalysis of the QT interval is to measure its duration (from the beginning to the end of QT)

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE P -WAVE INTERVAL AND SEGMENT PQ

Prong R in leads I II aVF V2-V6 it is always positive in a healthy person In leads III aVL V1 ndash can be positive biphasic In lead aVR ndash always negative The amplitude of the P wave ndash to 25 mm and its duration does not exceed 01 s

Interval P -Q reflects a time of spread of excitation within atrium atrioventricular node Gis bundle and its branches The duration of the interval P -Q varies from 012 to 020 s depending on heart rate

Segment P -Q reflects a spread of excitation throuh the atrio -ventricular node Gis bundle and its branches Duration of segment P-Q is normal to 012 sec

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

Thank youThank you

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE Q R S-WAVESVentricular complexes ORST If the amplitude of prongs of ORS-complex more than 5 mm they are given uppercase alphabet (Q R S) if less than 5 mm - capital letters (q r s) Duration of ventricular complex is 006-009 s in the standard leads Wave Q displays spread of excitation through the middle and lower thirds of the interventricular septum It should not exceed 14 of prongs ʼ R amplitude in a healthy person and its duration ndash 003 sec But aVR-lead ndash is exception where deep and wide Q-prong registeredWave R normally registered in all standard and reinforced leads In lead aVR R-prong slightly expressed or absent completely In the precordial leads R-wavesʼ amplitude gradually increases from V1 - V4 and decreases in V5 - V6 Height of R wave does not exceed 20 mm in standard and reinforced leads and 25 mm ndash in thoracic (pectoral) It displays the spread of excitation through the side walls of the right and left ventriclesWave S Its amplitude in different leads varies in a wide range In a healthy person but not exceeding 20 mm Its duration ndash 003 s Wave S decreases from V1 to V6 in the precordial leads It displays the spread of excitation in the basal parts of the ventricles

FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

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FREQUENCY-AMPLITUDE CHARACTERISTICS OF THE T-WAVE ST-SEGMENT AND QT-INTERVAL

S-T segment ndash reflects full coverage of both ventricles with stimulation As usual segment S-T is on the isoline in standard and reinforced single-pole leads from limbs and its displacement is less than 05 mm In thoracalis leads lV1 - V3 may be a slight shift acording to the isoline up to 2 mm and in V4 56 - shift down less than 05 mmWave T ndash normally always positive in leads I II aVF V2 - V6 moreover T1 gt TIII and TV6 gt TV1 It has aslope ascending and slightly steeper downward knee In leads III aVL and V1 ndash T wave may be positive negative or biphasic In lead aVR negative T wave usually registers The amplitude of the T wave is less than 56 mm in leads from limbs and 15-17 mm in precordial leads The duration of the T wave ndash 016-024 sQ- T interval This is an electrical ventricular systole Duration of Q- T interval depends on heart rate The proper duration time of interval Q- T can be counted with the Bazett formula

Q- T = K radic R-R

where K - coefficient of 037 for men and 040 for womenRR - duration of one cardiac cycle or intercyclic іnterval

HOLTER MONITOR

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HOLTER MONITOR

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