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Electrocardiography
(ECG)Dr.Shen-JiangHuTheFirstAffiliatedHospitalCollegeofMedicineZhejiangUniversityBasicKnowledgeECGwaveformsandintervalsBasicECGWaveformsandIntervalsWavesofQRSComplexBasicKnowledgeElectrocardiographicLeadSystemThreeBipolarLeadsinSixExtremityLeads
LeadI：leftarm（+）rightarm（-）
LeadII：leftleg（+）rightleg（-）
Lead
III：leftleg（+）leftarm（-）LeadsconnectionChestLeadsElectricalAxisHowtocalculateQRSmeanaxisLeadI:+15mmLeadIII:(+8mm)+(-2mm)=6mmTheQRSmeanAxisNormalrightleftaxisdeviationaxisdeviationMeasurementandNormalECGMeasurementandNormalECGPWaveinNormalECGPwaveduration：＜0.12s(120ms)Pwaveamplitude：＜0.25mV（limb），＜0.20mV（chest）PRinterval：0.12-0.20sQRSComplexinNormalECGQRScomplexduration：＜0.11s(0.06-0.10s)QRSComplexinNormalECGQRSpatterninleadsV1,V2：rS，noq；
r＜1.0mV，r/S＜1；QRSpatterninleadsV5,V6：qR、qRs、Rs、R；R＜2.5mV,R/s＞1;QRSComplexinNormalECGQRSpatterninlimbleads：R(I,II),S(aVR)andr(aVR)＜0.5mV;QRSamplitudeinlimbleads：R(I)＜1.5mV,R(aVL)＜1.2mV,R(aVF)＜2.0mVQRSComplexinNormalECGQRSamplitude：limbs:QRS＞0.5mV,chest:QRS＞0.8mV；Q:＜0.03s,＜1/4RSTSegment,TandUWave
inNormalECGSTsegment:①ST↓＜0.05mV;②ST↑0.2mV(V2,V3);ST↑＜0.1mV(V4～V6,limbleads)Twave:amplitude：＞1/10RQ-Tinterval:0.32-0.44s;QTc=QT/√RR:
≤0.45s(M),0.46s(F)
AtrialEnlargementand
VentricularHypertrophy
RightAtrialEnlargementPwaveinleadV1orV2≥
1.5mmPwaveinleadII,III,andaVF≥2.5mmPwaveispeaked(P"pulmonale")DurationofPwaveisnormalLeftAtrialEnlargementLeadIIDurationofPwave≥
0.12sec.Pwavebecomebifid(P"mitrale")Thedistanceoftwopeak≥
0.04sec.LeadV1Pwavebecomebiphasicterminalnegativewave＞1mmdeepand＞40mswide,Ptfv1
≥︱0.04︱mm·secLeftVentricularHypertrophyA.IncreasedvoltageRv5orRv6>2.5mV;RV5+SV1>3.5mV(female),4.0mV(male);
RI>1.5mV;
RaVL>1.2mV;
RaVF>2.0mV;RI+SIII>2.5mV;B.Leftaxisdeviation
C.STdepressionandTinversioninV5-6.RightVentricularHypertrophyA.Increasedvoltage(adultsover30)R/SratioinV1>1.0;R/SratioinV5orV6≤1.0;R/qorR/SratioinaVR
≥1;RV1+SV5>1.05mV(severe>1.2mV);RaVR>0.5mV;B.Rightaxisdeviation≥+900(severe>+1100).C.STdepressionandTinversionV1-2.BiventricularHypertrophyA.
NormalECG.B.
Oneventricularhypertrophy.C.
BiventricularHypertrophy.
MyocardialInfarctionMyocardialInfarction
(1)Basicchanges“Hyperacute”TWavesorTwaveinversion.STElevations
PathologicQWavesTWaveChanges(MyocardialIschemia)STSegmentChanges(MyocardialInjury)TheAbnormalQwaveandQSComplex(MyocardialInfarction)ECGChangesinMyocardialInfarctionMyocardialInfarction
(1)Basicchanges“Hyperacute”TWavesorTwaveinversion.TallpeakedTwaves,oftenappearastheearliestECGsignofacuteMI,thenTwavedownward.
STElevations.TheSTsegmentelevatedintwoormoreleadsandmaybestraightenedandfusewiththeTwave(mono-phasiccurve)
PathologicQWaves.thesuddendevelopedQwavemayindicateanacuteMI.(2)ProgressiveECGchangesProgressiveECGchanges
(3)LocalizationofMyocardialInfarction
LeadswithAbnormalQWavesinMILeadswithAbnormalQWavesLocationofMIV1
V3AnteroseptalV3
V5AnteriorI,aVL,V5
V6LateralV1
V5ExtensiveAnteriorII,III,aVFInferior
V7
V9
posterior
V3R
V4RrightventricleLocalizationofLimbLeads
(3)LocalizationofMyocardialInfarction
LeadswithAbnormalQWavesinMILeadswithAbnormalQWavesLocationofMIV1
V3AnteroseptalV3
V5AnteriorI,aVL,V5
V6LateralV1
V5ExtensiveAnteriorII,III,aVFInferior
V7
V9
posterior
V3R
V4RrightventricleLocalizationof
ChestLeads
(3)LocalizationofMyocardialInfarction
LeadswithAbnormalQWavesinMILeadswithAbnormalQWavesLocationofMIV1
V3AnteroseptalV3
V5AnteriorI,aVL,V5
V6LateralV1
V5ExtensiveAnteriorII,III,aV
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