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Lilly ecg

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In this webinar on. Contact lthay ecgmc. Right-sided precordial leads may be used to better study pathology of the right ventricle or for dextrocardia and are denoted with an R e.

Posterior leads V 7 to V 9 may be used to demonstrate the presence of a posterior myocardial infarction. A Lewis lead requiring an electrode at the right sternal border in the second intercostal space can be used to study pathological rhythms arising in the right atrium.

Two to four intracardiac leads are added via cardiac catheterization. The word "electrogram" EGM without further specification usually means an intracardiac electrogram.

A standard lead ECG report an electrocardiograph shows a 2. The tracings are most commonly arranged in a grid of four columns and three rows.

Additionally, a rhythm strip may be included as a fourth or fifth row. The timing across the page is continuous and not tracings of the 12 leads for the same time period.

In other words, if the output were traced by needles on paper, each row would switch which leads as the paper is pulled under the needle.

For example, the top row would first trace lead I, then switch to lead aVR, then switch to V 1 , and then switch to V 4 , and so none of these four tracings of the leads are from the same time period as they are traced in sequence through time.

Each of the 12 ECG leads records the electrical activity of the heart from a different angle, and therefore align with different anatomical areas of the heart.

Two leads that look at neighboring anatomical areas are said to be contiguous. In addition, any two precordial leads next to one another are considered to be contiguous.

For example, though V 4 is an anterior lead and V 5 is a lateral lead, they are contiguous because they are next to one another.

The study of the conduction system of the heart is called cardiac electrophysiology EP. An EP study is performed via a right-sided cardiac catheterization : a wire with an electrode at its tip is inserted into the right heart chambers from a peripheral vein, and placed in various positions in close proximity to the conduction system so that the electrical activity of that system can be recorded.

Interpretation of the ECG is fundamentally about understanding the electrical conduction system of the heart.

Normal conduction starts and propagates in a predictable pattern, and deviation from this pattern can be a normal variation or be pathological.

An ECG does not equate with mechanical pumping activity of the heart, for example, pulseless electrical activity produces an ECG that should pump blood but no pulses are felt and constitutes a medical emergency and CPR should be performed.

Ventricular fibrillation produces an ECG but is too dysfunctional to produce a life-sustaining cardiac output. Certain rhythms are known to have good cardiac output and some are known to have bad cardiac output.

Ultimately, an echocardiogram or other anatomical imaging modality is useful in assessing the mechanical function of the heart.

Like all medical tests, what constitutes "normal" is based on population studies. The heartrate range of between 60 and beats per minute bpm is considered normal since data shows this to be the usual resting heart rate.

Interpretation of the ECG is ultimately that of pattern recognition. In order to understand the patterns found, it is helpful to understand the theory of what ECGs represent.

The theory is rooted in electromagnetics and boils down to the four following points:. Thus, the overall direction of depolarization and repolarization produces positive or negative deflection on each lead's trace.

For example, depolarizing from right to left would produce a positive deflection in lead I because the two vectors point in the same direction.

In contrast, that same depolarization would produce minimal deflection in V 1 and V 2 because the vectors are perpendicular, and this phenomenon is called isoelectric.

Normal rhythm produces four entities — a P wave, a QRS complex, a T wave, and a U wave — that each have a fairly unique pattern. Changes in the structure of the heart and its surroundings including blood composition change the patterns of these four entities.

The U wave is not typically seen and its absence is generally ignored. Atrial repolarisation is typically hidden in the much more prominent QRS complex and normally cannot be seen without additional, specialised electrodes.

ECGs are normally printed on a grid. The horizontal axis represents time and the vertical axis represents voltage. The standard values on this grid are shown in the adjacent image:.

The "large" box is represented by a heavier line weight than the small boxes. Not all aspects of an ECG rely on precise recordings or having a known scaling of amplitude or time.

For example, determining if the tracing is a sinus rhythm only requires feature recognition and matching, and not measurement of amplitudes or times i.

An example to the contrary, the voltage requirements of left ventricular hypertrophy require knowing the grid scale. In a normal heart, the heart rate is the rate in which the sinoatrial node depolarizes since it is the source of depolarization of the heart.

Heart rate, like other vital signs such as blood pressure and respiratory rate, change with age. In adults, a normal heart rate is between 60 and bpm normocardic , whereas it is higher in children.

A complication of this is when the atria and ventricles are not in synchrony and the "heart rate" must be specified as atrial or ventricular e.

In normal resting hearts, the physiologic rhythm of the heart is normal sinus rhythm NSR. Generally, deviation from normal sinus rhythm is considered a cardiac arrhythmia.

Thus, the first question in interpreting an ECG is whether or not there is a sinus rhythm. Once sinus rhythm is established, or not, the second question is the rate.

For a sinus rhythm, this is either the rate of P waves or QRS complexes since they are 1-to If the rate is too fast, then it is sinus tachycardia , and if it is too slow, then it is sinus bradycardia.

If it is not a sinus rhythm, then determining the rhythm is necessary before proceeding with further interpretation.

Some arrhythmias with characteristic findings:. The heart has several axes, but the most common by far is the axis of the QRS complex references to "the axis" imply the QRS axis.

Each axis can be computationally determined to result in a number representing degrees of deviation from zero, or it can be categorized into a few types.

The QRS axis is the general direction of the ventricular depolarization wavefront or mean electrical vector in the frontal plane.

It is often sufficient to classify the axis as one of three types: normal, left deviated, or right deviated. The normal QRS axis is generally down and to the left , following the anatomical orientation of the heart within the chest.

An abnormal axis suggests a change in the physical shape and orientation of the heart or a defect in its conduction system that causes the ventricles to depolarize in an abnormal way.

All of the waves on an ECG tracing and the intervals between them have a predictable time duration, a range of acceptable amplitudes voltages , and a typical morphology.

Any deviation from the normal tracing is potentially pathological and therefore of clinical significance.

The animation shown to the right illustrates how the path of electrical conduction gives rise to the ECG waves in the limb leads.

Recall that a positive current as created by depolarization of cardiac cells traveling towards the positive electrode and away from the negative electrode creates a positive deflection on the ECG.

Likewise, a positive current traveling away from the positive electrode and towards the negative electrode creates a negative deflection on the ECG.

The magnitude of the red arrow is proportional to the amount of tissue being depolarized at that instance. The red arrow is simultaneously shown on the axis of each of the 3 limb leads.

Both the direction and the magnitude of the red arrow's projection onto the axis of each limb lead is shown with blue arrows.

Then, the direction and magnitude of the blue arrows are what theoretically determine the deflections on the ECG. For example, as a blue arrow on the axis for Lead I moves from the negative electrode, to the right, towards the positive electrode, the ECG line rises, creating an upward wave.

As the blue arrow on the axis for Lead I moves to the left, a downward wave is created. The greater the magnitude of the blue arrow, the greater the deflection on the ECG for that particular limb lead.

Frames 1—3 depict the depolarization being generated in and spreading through the Sinoatrial node. Frames 4—10 depict the depolarization traveling through the atria, towards the Atrioventricular node.

During frame 7, the depolarization is traveling through the largest amount of tissue in the atria, which creates the highest point in the P wave.

Frames 11—12 depict the depolarization traveling through the AV node. This creates the flat PR segment.

Frame 13 depicts an interesting phenomenon in an over-simplified fashion. It depicts the depolarization as it starts to travel down the interventricular septum, through the Bundle of His and Bundle branches.

After the Bundle of His, the conduction system splits into the left bundle branch and the right bundle branch. Interestingly, however, the action potential starts traveling down the left bundle branch about 5 milliseconds before it starts traveling down the right bundle branch, as depicted by frame This causes the depolarization of the interventricular septum tissue to spread from left to right, as depicted by the red arrow in frame In some cases, this gives rise to a negative deflection after the PR interval, creating a Q wave such as the one seen in lead I in the animation to the right.

Depending on the mean electrical axis of the heart, this phenomenon can result in a Q wave in lead II as well. Following depolarization of the interventricular septum, the depolarization travels towards the apex of the heart.

This is depicted by frames 15—17 and results in a positive deflection on all three limb leads, which creates the R wave. Frames 18—21 then depict the depolarization as it travels throughout both ventricles from the apex of the heart, following the action potential in the Purkinje fibers.

This phenomenon creates a negative deflection in all three limb leads, forming the S wave on the ECG. Repolarization of the atria occurs at the same time as the generation of the QRS complex, but it is not detected by the ECG since the tissue mass of the ventricles is so much larger than that of the atria.

Ventricular contraction occurs between ventricular depolarization and repolarization. During this time, there is no movement of charge, so no deflection is created on the ECG.

This results in the flat ST segment after the S wave. Frames 24—28 in the animation depict repolarization of the ventricles. The epicardium is the first layer of the ventricles to repolarize, followed by the myocardium.

The endocardium is the last layer to repolarize. The plateau phase of depolarization has been shown to last longer in endocardial cells than in epicardial cells.

This causes repolarization to start from the apex of the heart and move upwards. Since repolarization is the spread of negative current as membrane potentials decrease back down to the resting membrane potential, the red arrow in the animation is pointing in the direction opposite of the repolarization.

This therefore creates a positive deflection in the ECG, and creates the T wave. It may also affect the high frequency band of the QRS. The earliest sign is hyperacute T waves, peaked T waves due to local hyperkalemia in ischemic myocardium.

Over a period of hours, a pathologic Q wave may appear and the T wave will invert. Over a period of days the ST elevation will resolve.

The PR segment the portion of the tracing after the P wave and before the QRS complex is typically completely flat, but may be depressed in pericarditis. Help Learn to edit Community Rasierte votzen Recent changes Upload Fuck bees. Nov 12, Sex in dress J Physiol. Lilly, Asslicking. Lilly doesn't hold Asian accidental anal. It gets very graphic now. Xnxx.comi causes repolarization to start from the apex of the heart and move upwards. Atrial depolarization spreads from the SA node towards the Lilly ecg node, and from Lucie wilde facial right atrium to the left atrium. Posterior leads V Ver orgasmos de mujeres to V 9 may be used to Marina visconti dp the presence of a posterior myocardial infarction.

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