경희대학교 의과대학·의학전문대학원

전체 글

(1)

EKG

EKG

순환기 내과

순환기 내과

김 수 중

김 수 중

(2)

Cardiac Conduction

Cardiac Conduction

System

System

(3)

Normal Waves of

Normal Waves of

EKG

EKG

(4)

ECG Waves

ECG Waves

  

P wave

P wave

: the : the sequentialsequential activation activation (depolarization) of the

(depolarization) of the right and then left atriaright and then left atria  

QRS complex

QRS complex

: :

1

1stst phase – Dep. of IVS from Lt. to Rt phase – Dep. of IVS from Lt. to Rt

2

2ndnd phase- Simultaneous Dep. of RV & LV phase- Simultaneous Dep. of RV & LV

T wave

T wave

: ventricular repolarization : ventricular repolarization

U wave

U wave

: origin for this wave is not clear : origin for this wave is not clear

probably represents "afterdepolarizations" in

probably represents "afterdepolarizations" in

the

(5)

P Wave

P Wave

It is important to remember that the P wave It is important to remember that the P wave represents the

represents the sequentialsequential activation of the activation of the right and left atria, and it is common to see right and left atria, and it is common to see notched or biphasic P waves of right and

notched or biphasic P waves of right and left atrial activation.

left atrial activation.

P duration < 0.12 secP duration < 0.12 sec

  P amplitude < 2.5 mm   P amplitude < 2.5 mm

  Frontal plane P wave axis: 0

  Frontal plane P wave axis: 0oo to +75 to +75oo

  May see notched P waves in frontal   May see notched P waves in frontal plane

plane

ECG Waves

(6)

ECG Waves

(7)

QRS Complex

QRS Complex

simultaneous

simultaneous

activation of the right and

activation of the right and

left ventricles, although most of the QRS

left ventricles, although most of the QRS

waveform is derived from the larger left

waveform is derived from the larger left

ventricular musculature.

ventricular musculature.

 

 

QRS duration

QRS duration

<

<

0.10 sec

0.10 sec

 QRS amplitude variable

 QRS amplitude variable

2 determinates of QRS voltages are:

2 determinates of QRS voltages are:

  Size of the ventricular chambers (i.e., the Size of the ventricular chambers (i.e., the

larger the chamber, the larger the voltage)

larger the chamber, the larger the voltage)

  Proximity of chest electrodes to ventricular Proximity of chest electrodes to ventricular

ECG Waves

(8)

ECG

ECG

Waves

Waves

Normal q-waves

Normal q-waves

reflect normal reflect normal

septal activation

septal activation they are narrow they are narrow

(<0.04s duration) (<0.04s duration) and small (<25% and small (<25% the amplitude of the amplitude of the R wave). the R wave).Should not Should not

confused with

confused with

path` Q wave

(9)

ECG ECG Waves Waves

R waves

R waves

- normal septal r - normal septal r wave wave in Rt. precordial in Rt. precordial leads leads - normal R wave - normal R wave progression progression - tall R wave in Lt. - tall R wave in Lt. precordial leads precordial leads

S wave

S wave

decrease decrease progressively from progressively from Rt.to Lt Rt.to Lt

(10)

ECG Waves

(11)

T wave

T wave

usually in the same direction as the QRS except in usually in the same direction as the QRS except in

the right precordial leads(reversed direction of

the right precordial leads(reversed direction of

Rep.).

Rep.).

In the normal ECG, the T wave is always upright in In the normal ECG, the T wave is always upright in

leads I, II, V3-6, and always inverted in lead aVR.

leads I, II, V3-6, and always inverted in lead aVR.

U wave

U wave

Small(<1mm), round deflection following T waveSmall(<1mm), round deflection following T waveSame polarity as T waveSame polarity as T wave

Abnormal inc. in hypokalemia or drug(quinidine,Abnormal inc. in hypokalemia or drug(quinidine,

procainamide,disopyramide)

procainamide,disopyramide)

Marker of inc. susceptibility to torsades de Marker of inc. susceptibility to torsades de

pointes

pointes

Best seen in Rt. precordial lead / slow HRBest seen in Rt. precordial lead / slow HR

ECG Waves

(12)

ECG Waves

(13)

Interval &

Interval &

Duration

Duration

(14)

PR interval: from onset of atrial PR interval: from onset of atrial

depolarization (P) depolarization (P)

to onset of ventricular depolarization (QRS) to onset of ventricular depolarization (QRS)

QRS duration: duration of ventricular QRS duration: duration of ventricular

muscle

muscle depolarizationdepolarization

QT interval: duration of ventricular QT interval: duration of ventricular

depolarization

depolarization and repolarizationand repolarization

RR interval: duration of ventricular cardiac RR interval: duration of ventricular cardiac

cycle cycle

(an indicator of ventricular rate) (an indicator of ventricular rate)

  PP interval: duration of atrial cycle PP interval: duration of atrial cycle

(an indicator or atrial rate) (an indicator or atrial rate)

Interval &

Interval &

Duration

(15)

Interval &

Interval &

Duration

Duration

 PR Interval : 0.12 - 0.20 sec  PR Interval : 0.12 - 0.20 sec

   

QRS Duration : 0.06 - 0.10 secQRS Duration : 0.06 - 0.10 sec

   

QT Interval (QTc QT Interval (QTc < 0.40 sec) < 0.40 sec)

   

Bazett's Formula: Bazett's Formula:

QTc = (QT)/SqRoot RR

(16)

Rate

Rate

(17)

Axis

Axis

(18)

Axis

(19)

Axis

(20)

Axis

(21)

Axis

Axis

Unipolar leads

(22)

Major ECG

Major ECG

Abnormalities

Abnormalities

Cardiac Enlargement &

Cardiac Enlargement &

Hypertrophy

Hypertrophy

Bundle Branch Block

Bundle Branch Block

(23)

Cardiac Enlargement &

Cardiac Enlargement &

Hypertrophy

Hypertrophy

RAE

RAE

Increase in P

Increase in P

wave amplitude

wave amplitude

(>2.5mm)

(>2.5mm)

LAE

LAE

Biphasic P wave

Biphasic P wave

in V1 broad (-)

in V1 broad (-)

component

component

Broad(>120ms)

Broad(>120ms)

notched P wave

notched P wave

in limb leads

in limb leads

(24)

Cardiac Enlargement &

Cardiac Enlargement &

Hypertrophy

Hypertrophy

(25)

Cardiac Enlargement &

Cardiac Enlargement &

Hypertrophy

Hypertrophy

LA

E

(26)

Cardiac Enlargement &

Cardiac Enlargement &

Hypertrophy

Hypertrophy

RVH

RVH

Tall R in V1(R/S>1)Tall R in V1(R/S>1)RADRAD

RV strain patternRV strain pattern

LVH

LVH

SV1 +(RV5 or SV1 +(RV5 or

RV6)>35mm RV6)>35mm

RV5 or RV6>25mmRV5 or RV6>25mmLV strain patternLV strain patternRaVL>11~13, RaVL>11~13,

RaVF>20mm RaVF>20mm

(27)

Cardiac Enlargement &

Cardiac Enlargement &

Hypertrophy

Hypertrophy

(28)

Cardiac Enlargement &

Cardiac Enlargement &

Hypertrophy

Hypertrophy

(29)

Bundle Branch Block

Bundle Branch Block

RBBB

RBBB

QRS vector toward Rt.QRS vector toward Rt.QRS-T wave discordanceQRS-T wave discordanceCong. Ht. dis, VHD, IHDCong. Ht. dis, VHD, IHDLBBBLBBB

QRS vector toward Lt.QRS vector toward Lt.Septal Dep. from Rt. to Septal Dep. from Rt. to

Lt.

Lt.

(30)

Bundle Branch Bundle Branch Block Block

RBB

B

(31)

Bundle Branch Bundle Branch Block Block

LBB

B

(32)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

Infarction

Factors

Factors

Nature of process : reversible vs Nature of process : reversible vs

irreversible

irreversible

Extent : trnasmural vs subendocardialExtent : trnasmural vs subendocardialDuration : acute vs chronicDuration : acute vs chronic

LocalizationLocalization

(33)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

Infarction

IschemiaIschemia

Resting membrane Resting membrane

potential decreaed potential decreaed

Shortening of action Shortening of action

potential potential

voltage gradient betw. voltage gradient betw.

normal normal

& ischemic zone & ischemic zone

Current Current

ST segment deviationST segment deviation

T wave inversion T wave inversion

Repolarizaion prolongedRepolarizaion prolongeda/w QT lengtheninga/w QT lengthening

(34)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

Infarction

ST

(35)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

Infarction

Exercise

ECG

(36)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

(37)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

(38)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

(39)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

(40)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

(41)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

(42)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

(43)

Myocardial Ischemia &

Myocardial Ischemia &

Infarction

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