Electrocardiography Biomedical Engineering Kaj-Åge Henneberg
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1 Electrocardiography Biomedical Engineering Kaj-Åge Henneberg
2 Electrocardiography Plan Function of cardiovascular system Electrical activation of the heart Recording the ECG Arrhythmia Heart Rate detection methods Group Work
3 The Heart as a Pump
4 Internal View of Heart
5 Pulmonary Circulation
6 Arterial Circulation
7 Venous Circulation
8 Coronary Circulation
9 Heart Valves Mitral valve: Left AV valve Tricuspid valve: Right AV valve Pulmonary valve Aortic valve
10 Valve Sequence 1. Isovolumetric contraction period: Contraction of ventricles while all valves are closed. 2. Ejection period: Pulmonary and aortic valves open when the pressure in the ventricles exceed that in the lungs and aorta Inertia prolongs aortic valve open time
11 Valve Sequence 3. Isovolumetric relaxation period: All valves are closed until the ventricular pressure drops below atrial pressure 4. Filling period: Rapid filling phase Slow filling phase (diastasis) Atrial contraction ~ 8% of filling
12 Electrocardiography 10 min. Break
13 Conduction System
14 Cardiac Action Potentials Show overhead Pacemaker action potentials Propagated action potentials Ca induced plateau AP duration shortens as wave travels through the tissue types Refractory period
15 Wave propagation Show isochrone overhead Elementary dipole source Mean dipole source = Heart Vector
16 Autonomic Innervation Parasympathetic: Acetylcholine Right vagus nerve to SA node Left vagus nerve to AV node Sympathetic: Noradrenalin Nearly uniform innervation throughout the heart Both act simultaneously: Cutting both increases HR
17 Transmitter actions Acetylcholine: Noradrenalin: Increased gk Reduced gk More negative Vm More positive Vm Longer prepotential Shorter prepotential Slower HR Faster HR Earlier repolarization Increased gca Shorter AP duration Longer AP plateau Less Ca++ storage Weaker contraction Increased CA++ storage Stronger contraction
18 Lead Vectors Left Arm Heart Vector Lead Vector Left Leg
19 Lead Potentials Right Arm V I = H*L I Left Arm V II = H*L II V III = H*L III Left Leg
20 ECG Standard Limb Leads
21 Precordial Electrodes
22 ECG Segments and Intervals
23 Normal ECG Leads
24 Electrocardiography 10 min Break
25 Arrhythmia Abnormal ECG waveforms Atrial origin AV origin Ventricular origin
26 Atrial Flutter
27 Atrial Fibrillation
28 Premature Atrial Contraction The ectopic P wave is often hidden in the ST-T wave of the preceeding beat
29 Premature Junctional Complex Captures the atria retrograde and the ventricles antegrade
30 Premature Ventricular Contractions Unifocal or multifocal Singles, couplets, triplets or salvos (4-6)
31 PVC: Compensatory Pause Top: Normal Rhythm Middle: PVC Blocks next sinus impulse Next impulse arrives on time Bottom: PAC No compensating pause
32 R on T Phenomenon Vulnerable period R-on-T PVCs may be especially dangerous in an iscemic situation. Can lead to ventricular tachycardia or fibrillation
33 Ventricular Tachycardia
34 Ventricular Fibrillation No pumping action Fatal if not intervened by defibrillation
35 Ischemia Reduced blood supply Elevated membrane resting potential Shorter AP Steady injury current Elevated or depressed ST-segment
36 Concave and Convex ST segment
37 ST Segment Depression
38 ST Segment Sloping
39 Wolf-Parkinson-White Syndrome Abnormal pathway for impulse conduction between atrium and ventricle Atria to ventricles Ventricles to atria
40 Left Ventricular Hypertrophy Increased pump load Increased ventricular wall thickness Stronger electric sources
41 Right Ventricular Hypertrophy
42 Normal Electrical Axis 1. Find weakest lead axis 2. Find the two perpendiculars 3. Pick the one in agreement with the polarity of the other leads
43 Axis pointing to the left 1. avr is the weakest Perpendiculars: -60 or 120 deg. Negative leads II and III, so: -60 degree
44 Axis pointing to the right 1. avr is weakest Perpendiculars: -60 or 120 degrees Positive leads II and III, so 120 degrees
45 Electrocardiography 10 min Break
46 Monitoring Arrhythmia Two ECG leads Bandwidth: Hz Sampling frequency: 500 Hz Point-by-point sampling Online dual-lead display Online R-wave detection Online R-R interval charting Arrhrythmia alarms
47 R-R interval measurement 1. Bandpass filter: 5-15 Hz 2. Sum the square of lead signals 3. Lowpass filter the result ~6-8 Hz 4. Threshold the result 5. Calculate R-R intervals 6. Plot R-R intervals online 7. Calculate running average over 4-6 beats
48 Alarm Criteria Sinus Bradycardia: RR > 1000 ms Sinus Tachycardia: RR < 600 ms Ventricular Fibril.: RR > 1500 ms Ventricular Tachycardia: < 500 ms Skipped Beat: RR(t) > 1.9 AR(t-1) AR: Average of last 4-6 RR intervals
49 PVC Criteria 1. RR(t-1) < 0.9 AR(t-2) 2. RR(t-1) + RR(t) ~2 AR(t-2) 3. Rate > 10 per minute 4. Duration of QRS > 0.12 s
50 R-on-T Criteria 1. RR(t-1) < 0.33 AR(t-2) 2. RR(t-1) + RR(t) ~ 2 AR(t-2) 3. Duration of QRS > 0.12 s
51 Electrocardiography Labview demo
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