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ECG.. part 1 (normal ECG)
2 مرفق
What is meant by ECG Electrocardiography is the recording of the electric potential that occurs during the cardiac cycle.The changes are conducted by extracellular fluid to the whole body so can be taken by electrodes from the surface of the body The most common two methods of putting electrodes bipolar leads) OR standard limb leads) One positive and one negative lead or connection Types lead 1: the positive is connected to left and the negative to the right arm leadII: the negative is connected to the right arm while the positive to the left leg LeadIII: the negative to the left arm and the positive to the left leg unipolar leads; only one electrodes is positive exploring waves and the other electrode is zero potential and this method is also called V Types Augmented limb leads: one positive electrodes attached to a limb and the other electrode electrode attached to the other two limbs instead of a zero electrode.this method of connection increases the size of the potentials by about 50% without affecting the configuration of the record. The augmented limb leads are,Avr, Avl, and Avf unipolar chest leads: there are 6 unipolar chest leads designated v1tov6.they are V1 and v2: right ventricular chest leads, v3andv4: Septal, interventricular and transitional chest leads and v5and6: left ventricular chest leads esophageal lead's sometimes used to record the electric potential changes of the posterior surface of the atria And the recording taken by these leads then by special machine is printed on strip paper or seen on screen like that seen in intensive care unit The drawing seen is as fig 1 The question now is what PQRST, why some of them are longer and other are inverted The amount of electric activity is proportional to the mass of muscle from which it originates. Therefore atrial electric activity is smaller than ventricular one The time which an electric activity takes depends on the type of conduction which occurs. Conduction through the ventricular mass is through conducting system which shortens its time very much. While the small atrial mass takes longer time The sum of electric activity in any mass (not fibre) of muscle can be representated by an arrow or vector The vector of atrial activity is oblique downwards and to the left running in the middle of the direction of the two atria, because the two atria are nearly equal in masses The vector of the septal activity is obliquely upwards and to the right because it is supplied by separate branch of conducting fibres from the left bundle branch The vector of the ventricular activity is oblique downwards and to the left. it is representing the synchronous activity of the two ventricles. It is more inclined to the left than the direction of the atrial vector, because the left ventricular mass is larger than the right one And the direction of vector I described above make us draw the curve upwards or downwards...Forexample the B wave is up wards but the Q is downwards The base can be collected in the following rules if we know that Depolarization from right to left is up in drawing, depolarization from left to right is down in drawing,repolarization from right to left is down and repolarization from right to left is up so If I said to you that B wave is due to depolarization from SAN through both atria and the direction of vector is to the left and down wards so the curve of p wave is upwards (positive) and in the same role u can see rest R, T, U upwards or positive Q, S downwards or negative And we must know that P…depolarization through atria from SAN. Q…is through conduction of the depolarization through the interventricular septum. R…is due to conduction of depolarization through the two ventricles simultaneously. S…through conduction of the depolarization over the latest fibres of left ventricle. T…is the positive isoelectric wave following repolarization of ventricles through the myocardium. the amplitude of waves is through muscle mass and this is clear in R wave in comparison to others THE BIG QUESTION NOW HOW TO READ ECG We first must know how to read normal ECG In the drawing of ECG we must examine 9 points Heart rate rhythm wave voltage p wave , pr interval , ST segment , QRS complex QT interval , T wave -heart rate. in the paper in which THE ECG is drown it is devised into small divisions each space equals 0.04 second thus each 1500 small space equal one minute. The normal heart rate is range 72 cycle per minute (below 60 is bradycardia and above100 and up to 150 is tachycardia) rhythm..Means that there is regular beating of heart voltage..Horizontally each 10 spaces are equal 1 mv p wave…0.008 second PR interval from the beginning of P to the beginning of QRS complex...0.18 sec QRS complex.. Small QS and large R QT interval from beginning of Q to end of T ST segment. From end of S to begening of T...0.16 SEC T wave..0.16 sec. If we applied the nine previous points on the following ECG fig2: We will find that So heart rate is 60/(4.5x5x0.04) The rhythm is normal P wave is normal……etc All other points we defined above (the nine points are normal) So this is normal patient look at the first fig look at the 2nd fig |
احب ان اوضح ان هذا هو اول جزء فى موضوع رسم القلب وهو عن الشكل الطبيعى لرسم القلب وكيفيه قرائته وسوف يكون هناك حلقات متتاليه منى وممن يريد المشاركه لتوضيح ايضا الحالات المرضيه وكيفيه قرائتها ..ولكن ..
ارجو الان التعليق على هذا الجزء اولا واظهار ما به من عيوب لنقوم بتعديله سويا وانا فى انتظار اى سؤال فى الموضوع غير مفهوم كى اوضحه او اى خطا كى اصححه...... وشىء اخير ..يا ريت تسامحونى على الاخطاء النحويه فى الكتابه ..... ولكن لا تسامح فى الاخطاء العلميه (ارجو النقد ورد اى خطا) وجزاكم الله خيرا اخوكم خالد |
بص يا دوك انت بصراحة جامد
الموضع هايل في المضمون العلمي لكن تعليقي هيكون على العرض يعني الصور في موضع زي ده لازم تبقي في نص الموضوع وبالذات الحتة بتاعت ازا ي تقرا الرسمبتاع ا سي جي تاني حاجة يبقي اظرف بالنسبة للناس اللي مش دكاترة ولكن مهتمين بالطب وبيحبوا يقروا زي ما قلتلك قبل كده الترجمة والترجمة جزء جزء عشان متصعبش الموضوع ممكن تخش على youtube وتدور على فديوهات توضح الموضوع ده وتحطها وكمل وجوووووو اهيد زانا معاك ياboss |
شكرا على الاقتراحات الجميله اخى ...................
وكلها مقبوله والترجمه سوف انشرها قريبا وفى انتظار المزيد من الاقتراحات والتعديلات................... |
السلام عليكم و رحمة الله و بركاته,,,
أولا أتقدم بجزيل الشكر للأخ د.خالد على مبادرته الطيبة و تقديمه للشرح المفيد و المستوفي للموضوع... ثانياً أود تلخيص أهم نقطة قيما سبق شرحه و هي: اقتباس:
THE ELECTROCARDIOGRAM (ECG / EKG) *The aim of the first part is to recognize the normal ECG of the heart. *How to interpret ECG? *By ECG analysis: 1) RATE 2) RHYTHM 3) AXIS 4) P WAVE 5) P-R INTERVAL 6) QRS COMPLEX 7) ST SEGMENT 8) T WAVE 9) U WAVE 1*RATE: ECG paper http://http://www.liillas.com/up2//u...819ca0820a.png Dividing 300 by the number of big squares, OR 1500 by the number of small squares… NORMAL (60 – 100 beats / min) FAST (>100 beats / min) = TACHYCARDIA SLOW (< 60 beats / min) = BRADYCARDIA 2*The Rhythm:-We find it by looking to R-R interval, or P-P inter val… REGULAR or IRREGULAR There may be a combination of : Abnormal Rate + Abnormal Rhythm e.g. Atrial Fibrillation (fast and irregular) http://http://www.liillas.com/up2//u...ad4f0803fd.png 3*The axis: Determination of Electrical Axis of the Heart http://http://www.liillas.com/up2//u...0675c0bc75.png NORMAL AXIS http://http://www.liillas.com/up2//u...147837427a.png Positive R in I Positive R in II LEFT AXIS DEVIATION http://http://www.liillas.com/up2//u...43ce4a329a.png Tall R in I Deep S in AVF RIGHT AXIS DEVIATIONRIGHT AXIS DEVIATION http://http://www.liillas.com/up2//u...5ec8cdae2c.png Deep S in I (Small R ) Tall R in II http://http://www.liillas.com/up2//u...24479b55c4.png Axis___________ Lead I__________ Lead AVF Normal axis___________ Positive__________ Positive Left axis deviation__________ Positive __________Negative Right axis deviation__________ Negative__________ Positive Extreme right axis deviation___________ Negative __________Negative P Wave4*: http://http://www.liillas.com/up2//u...e93794520e.png http://http://www.liillas.com/up2//v...ile=333a387383 Duration: 0.08 – 0.12sec (2-3 small squares) Amplitude: 2 - 2.5mm (2 – 2.5small squares) Shape:• Rounded and upright, in Leads I, II, aVF, V4-V6. • Inverted in aVR. • Flat, inverted or biphasic in III, V1, V2 5*PR interval: http://http://www.liillas.com/up2//u...5953476658.jpg Normal - 0.12 – 0.20sec 6*QRS Complex: 1. Duration ( Normal 0.06 – 0.11sec.) 2. Components ( Q, R, S ) waves. 7*ST segment S-T Segment Changes ST segment Elevation ST Segment Depression Q – T Interval Measured from the beginning of Q to the end of T QT interval varies with age, sex, and HR QTc (QT interval corrected for HR) Drugs which increase QT interval induce arrhythmia 8*T Wave Normal T Wave Abnormal T Wave: Tall T wave http://http://www.liillas.com/up2//u...b3eb7d9b3a.png Inverted T wave http://http://www.liillas.com/up2//u...013ec9b695.png 9*U wave: -U waves are often so law in amplitude that they go unrecognized… -Usually easiest to see in Right sided precordial leads. -The origin of U wave is controversial but may represent repolarisation of the His- purkinje system of the papillary muscles. http://http://www.liillas.com/up2//u...dca8d183bc.jpg *و أخيراً أفيدكم علماً بأن ما نقدمه لكم اجتهاد شخصي فما كان من الصواب فمن الله و ما كان من الخطأ فمن أنفسنا و الشيطان.. هذا و لكم جزيل الشكر و الإمتنان. The References: -The Only EKG Book You'll Ever Need_ 5th Ed -The ECG made easy_6th Ed. -ECGs by example_2nd Ed. - Medical physiology _Boron_ updated Ed. - My notes at ECG course. |
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