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Session 6 Vectorial Analysis of Electrocardiograms Guyton 2011 Chapter 12, 13 1 Electrocardiogram Objects What is the ECG? How the ECG was recorded? What are the characteristics of ECG paper? What are the waves, intervals and segments of ECG? What is lead? How many lead are usually recorded? What is the Einthoven law? What is vector? What can we earn from ECG? 2 Vectorial Analysis of Electrocardiograms Mean Electrical Axis of the Ventricular QRS Normal Range –30 to +110 degrees Vectorial Analysis of Electrocardiograms Vectorial Analysis of the Normal Electrocardiogram Vectorial Analysis of Electrocardiograms Vectorial Analysis of the Normal Electrocardiogram 0.01 s 0.035 s 0.02 s 0.05 s 0.06 s Vectorial Analysis of Electrocardiograms Vectorcardiogram Vectorial Analysis of Electrocardiograms Vectorial Analysis of the Normal Electrocardiogram This sequence of repolarization is postulated to be caused by the high blood pressure inside the ventricles during contraction, which greatly reduces coronary blood flow to the endocardium, thereby slowing repolarization in the endocardial areas. Vectorial Analysis of Electrocardiograms Vectorial Analysis of the Normal Electrocardiogram Vectorial Analysis of Electrocardiograms Mean Electrical Axis of the Ventricular QRS Vectorial Analysis of Electrocardiograms Normal Ventricular Conditions That Cause Axis Deviation At the end of deep expiration To the Left When a person lies down In stocky, fat people At the end of deep inspiration To the Right When a person stands up In tall, lanky people Vectorial Analysis of Electrocardiograms Abnormal Ventricular Conditions That Cause Axis Deviation To the Left Hypertrophic left ventricle To the Right Hypertrophic right ventricle Also they cause a prolonged QRS complex Vectorial Analysis of Electrocardiograms Abnormal Ventricular Conditions That Cause Axis Deviation To the Left Left Bundle Branch Block To the Right Right Bundle Branch Block Also they cause a prolonged QRS complex Vectorial Analysis of Electrocardiograms Conditions That Cause Abnormal Voltages of the QRS Complex Increased Voltage Hypertrophic left ventricle Decreased Voltage Hypertrophic right ventricle Old infarction Fluid in the pericardium Pleural effusion Pulmonary emphysema Vectorial Analysis of Electrocardiograms Old infarction Normal tracing Very early pattern (hours after infarction) Later pattern (many hours to a few days) Late established pattern (many days to weeks) Late established pattern (many days to weeks) Arrhythmia Arrhythmia Abnormal Sinus Rhythms Tachycardia (> 100) Increased body temperature (up to 41 oC, 1 oC → 18 beat/min) Stimulation of the heart by the sympathetic nerves (heart failure and shock) Toxic conditions of the heart Bradycardia (<60) In athletes (physiologic) Vagal Stimulation (carotid sinus Syndrome) Arrhythmia Abnormal Sinus Rhythms Sinus Arrhythmia Quiet respiration Deep respiration Arrhythmia Block of Heart Signals Within the Intracardiac Conduction Pathways Atrioventricular Block First Degree Block Second Degree Block Third Degree Block Arrhythmia Premature Ventricular Contractions (PVC) • Prolonged QRS • High voltage QRS • T wave has opposite direction than QRS The End 20