10. They are placed on the body as follows:
V1 on the 4 th intercostal space, to the right of the sternum.
V2 on the 4 th intercostal space, to the left of the sternum.
V3 in-between V2 and V4.
V4 on the 5 th intercostal space in the midclavicular line (the
apex beat).
V5 in 5 th intercostal space in anterior axillary line
V6 5 th intercostal space in the midaxillary line,
11. Limb leads
• How to apply on the patient:
• Green lead-------left leg
• Yellow lead-----left wrist
• Red lead ------right wrist
• Black lead -----right leg
15. The ECG Paper
• Horizontally
– One small box - 0.04 s
– One large box - 0.20 s
• Vertically
– One large box - 0.5 mV
16.
17. • each small box is .04 seconds.
• Two small boxes would equal .08 seconds
• four small boxes equals .16 seconds
• five small boxes, which is one large box, equals .20
seconds
18. • The time lines in the top border of the paper.
The distance from one time line to the next is
three seconds.
19. Comment on ECG(10)
1. Rate
2. Rhythm
3. Axis
4. P wave
5. QRS complex
6. T wave
7. PR interval
8. ST segment
9. QT interval
10. Other
Conclusion (Diagnosis)
20. • Formation: Atrial depolarization
• Golden rule :
1-Rt atrium:
• SA node
• AV node
P wave
II
III
AvF
AvR
I
AvL
+ wave
21. P wave
• Formation: Atrial depolarization
• Golden rule :
1-Lt atrium:
• septum
• wall
IIIII
AvF
AvR
I
AvL
To the baseline
22. P wave
Lead II AvR
Rt atrium
Lt atrium
Total
Rt Lt Rt Lt
23. Normal P wave
• +ve in lead II
• – ve in AvR
• 2.5 x 2.5 ss
II
AvR
24. 1- P pulmonale : Rt atrial hypertrophy
Abnormal P wave
II
Increase amplitude = tall > 2.5 ss
26. 2- P mitrale : Lt atrial hypertrophy
Increase duration = width > 2.5 ss
Sometimes bifid
Always increased width
Abnormal P wave
II
+ wave
27. 2- P mitrale : Lt atrial hypertrophy
Abnormal P wave
28. 3- Replaced by f waves= fibrillation waves
In atrial fibrilation (AF) in which each muscle
fibrillate separately
Abnormal P wave
II
Irregular …..Why?
When become regular
29. 3- Replaced by f waves= fibrillation waves
Abnormal P wave
30. 4- Replaced by F waves
In atrial Flutter
Impulse from SA node with rapid rate =150-
300/m
AV node block some
of these to prevent
Vent. Tachy.
Abnormal P wave
II
P P P P P P
TT
34. 5- inverted P wave in lead II (+ve in AvR)
In impulse away from lead II i.e from AV node
II
-ve wave
P
35. P
P
NO P
Conditions of AV nodal impulse
1-AVN give atrium before ventricle
Inverted P wave then QRS
2-AVN give ventricle before atrium
QRS then Inverted P wave QRS
3-AVN give atrium and ventricle at same time
P wave masked in QRS( absent P)
av
II
38. 6- Absent P (see arrhythmia)
Masked in QRS
When atria depolarize with
ventricles
No atrial depolarization
AvN ectopy Ventr. ectopy SAN arrest SAN block
42. 8-Different shapes in same leads (II)
In multifocal atrial ectopics:
1- distorted P wave.
2- premature
3- normal QRS-T
4- incomplete
compensatory pause
5- multiple ectopics with different P shapes in
between sinus waves