ECG (electrocardiograph)

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1 ECG (electrocardiograph)

The Heart 1. Diastasis ( 심박정지기 ) : 심장의수축작용이끝난직후, A valve open 2.

entricular isometric contraction : 심실의압력증가 ( 체적은초기상태유지 ), A value close - 혈관압력 : Pulmonary Artery (from R)

entricular ejection - entricular Pressure 가 Aorta 압력 (80mmHg) 을초과하면 Aortic valve open - 최고압력이 125mmHg

2 The Heart 1. Diastasis ( 심박정지기 ) : 심장의수축작용이끝난직후, A valve open 2. Atrial contraction : 심방압력의증가, 심실용적과압력의증가, A valve open 3. entricular isometric contraction : 심실의압력증가 ( 체적은초기상태유지 ), A value close - 혈관압력 : Pulmonary Artery (from R) - 7mmHg, Aorta (from L) 80mmHg - Aortic valve, Pulmonary valve 는충분한압력이형성될때까지 closed 4. entricular ejection - entricular Pressure 가 Aorta 압력 (80mmHg) 을초과하면 Aortic valve open - 최고압력이 125mmHg 정도에달하면심실근섬유는더이상수축을못하고원상태로복귀 5. Isometric relaxation - aortic pressure 와 pulmonary pressure 가심실내의압력보다높아져 aortic valve 와 pulmonary valve closed 6. entricular filling : 심실압력이심방압력보다떨어지면 A valve open - 심실이최대용량에도달하면혈액의유압이감소 (Diastasis)

3 Action Potentials in the Heart and ECG

4 Myocardial Fibers Muscle fibers and Myofibrils entricular myocardium is composed of millions of individual cardiac cells RMP of approximately -90m Depolarization slope : greater than 150/sec Action potential lasts about msec

atrial, Purkinje, and ventricular tissue First activation starts

5 Isochronous Lines of entricular Activation The heart comprises several different types of tissues - SA and A nodal tissues - atrial, Purkinje, and ventricular tissue First activation starts on the septal surface of the left ventricle - 5 msec into the QRS complex

6 Cardiac Polarization and Repolarization

7 Body Surface Potentials Attenuation of the fields - with increasing distance from the source - ohmic potential drops between surface points, A and B - between a single surface point and an assigned reference point General volume conductor problem

8 ECG and Power Line Interface Patient is coupled by 5pF stray capacity to a 60Hz, 120 power line A different amplifier has a 10MΩ driving point Impedance at each lead 1 Compute the voltage and 2 7 ( 10 ) 8 ( 10 ) 7 10 M Ω = (120 ) = (120 ) = = M Ω + 10 j5.306 ( 10 ) jω C

9 Right Leg Driven Circuit Patient is coupled by 2 pf stray capacity to a 60Hz, 120 power line R1 = 10kΩ, R2 = 2kΩ, R3 = 30kΩ, R4 = 20kΩ R = 7MΩ, R = MΩ f OUT 7 Compute the voltage CM S S = + j ω C S I CM CM OUT S = + j ω R OUT C S CM R CM 4 + R CM 3 + R OUT f = 0 OUT = CM ( S CM ) jωrout C S CM R OUT OUT = I S j 2 π fr OUT C S S CM = = R f R f j 2 π fr OUT C S R R 3 4 m

10 ECG Standard Limb Lead I = II III

11 ECG Augmented Limb Lead a R = I 2 III a L = I 2 II a F = II 2 I

12 ECG Chest (Precordial) Lead

13 12 Lead ECG

14 Atrial Enlargement

15 Atrioventricular Block

16 Premature entricular Contraction

17 Tachycardia

18 Atrial Fibrillation

19 Action Potential from Normal and Ischemic Myocardium

20 ECG Diagnosis

21 ECG Diagnosis

22 ECG Diagnosis

23 ECG Diagnosis P : premature ventricular contraction L : left bundle branch block R : right bundle branch block F : fusion of ventricular and normal beat

24 ECG Diagnosis P : premature ventricular contraction L : left bundle branch block R : right bundle branch block F : fusion of ventricular and normal beat

25 ECG Diagnosis P : premature ventricular contraction L : left bundle branch block R : right bundle branch block F : fusion of ventricular and normal beat

26 ECG Diagnosis P P P P P P P P P : premature ventricular contraction L : left bundle branch block R : right bundle branch block F : fusion of ventricular and normal beat

27 ECG Diagnosis L P P P : premature ventricular contraction L : left bundle branch block R : right bundle branch block F : fusion of ventricular and normal beat

28 ECG Diagnosis F P P P P P F P : premature ventricular contraction L : left bundle branch block R : right bundle branch block F : fusion of ventricular and normal beat

29 ECG Diagnosis P P P P : premature ventricular contraction L : left bundle branch block R : right bundle branch block F : fusion of ventricular and normal beat

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