An electrocardiogram (ECG) records the electrical activity of the heart over a period of time using electrodes placed on the skin, arms, legs and chest. It records the changes in electrical potential across the heart during one cardiac cycle. The special flap of muscle which initiates the heart beat is called as sinu-auricular node or SA node in the right atrium. It spreads as a wave of contraction in the heart. The waves of the ECG are due to depolarization and not due to contraction of the heart. This wave of depolarisation occurs before the beginning of contraction of the cardiac muscle. A normal ECG shows 3 waves designated as P wave, QRS complex and T wave as shown in Figure 7.9 and the stages of the ECG graph are shown in Figure 7.10.
It is a small upward wave and indicates the depolarisation of the atria. This is the time taken for the excitation to spread through atria from SA node. Contraction of both atria lasts for around 0.8-1.0 sec.
It is the onset of P wave to the onset of QRS complex. This is from the start of depolarisation of the atria to the beginning of ventricular depolarisation. It is the time taken for the impulse to travel from the atria to the ventricles (0.12-0.21sec). It is the measure of AV conduction time.
No separate wave for atrial depolarisation in the ECG is visible. Atrial depolarisation occurs simultaneously with the ventricular depolarisation. The normal QRS complex lasts for 0.06-0.09 sec. QRS complex is shorter than the P wave, because depolarisation spreads through the Purkinjie fibres. Prolonged QRS wave indicates delayed conduction through the ventricle, often caused due to ventricular hypertrophy or due to a block in the branches of the bundle of His.
It lies between the QRS complex and T wave. It is the time during which all regions of the ventricles are completely depolarised and reflects the long plateau phase before repolarisation. In the heart muscle, the prolonged depolarisation is due to retardation of K+ efflux and is responsible for the plateau. The ST segment lasts for 0.09 sec.
It represents ventricular depolarisation. The duration of the T wave is longer than QRS complex because repolarisation takes place simultaneously throughout the ventricular depolarisation.