The Normal ECG

In this course, we teach you the basic principles underlying the generation of the 12 lead ECG readout. We explain how the normal depolarization and repolarization events of the cardiac cycle result in a predictable readout recorded by the ECG.

2.0 x AMA PRA Category 1 Credits™
Available on the Pro Plan

PLAY INTRODUCTION

Overview

In this course, we teach you the basic principles underlying the generation of the 12 lead ECG readout. We teach you the basic vector principles relevant to understanding electrocardiography. We explain how the normal depolarization and repolarization events of the cardiac cycle result in a predictable ECG readout and we detail the terminology used to describe the deflections recorded on the readout. We illustrate the crucial geometrical relationship between the frontal leads of the ECG. We teach you how to measure a range of key variables, the PR interval, the qrs duration, the QT interval and how to calculate the heart rate on the ECG. We explain and describe normal ECG T wave polarity.

Faculty

Planner and Author: Dr John Seery MB PhD

  • Consultant Physician at St. Vincent's University Hospital, Dublin, Ireland
  • Lecturer at the School of Medicine and Medical Science, University College Dublin, Ireland
  • Studied medicine at the University of Cambridge, United Kingdom
  • A Natural Sciences graduate of Trinity College Dublin, Ireland
  • PhD in Cell Biology from University College London, United Kingdom

 

Planner: Dr Karen Strahan PhD (University of Cambridge), Head of Editorial
Planner: Tommy O'Sullivan, CME Manager
 

Estimated Time to Complete

2.0 hours

Target Audience

  • Physicians
  • Nurses
  • Nurse Practitioners
  • Physician Assistants
  • Paramedics

Learning Objectives

Upon successful completion of this activity, you will be able to:

  • Explain the basic principles which allow us to predict  the normal ECG readout
  • Determine the heart rate, the qrs duration, the PR interval and the QT interval from analysis of the ECG
  • Explain the values reported by the computer interpretation on the ECG
  • Identify a normal pattern of T wave polarity on the ECG
  • Identify a normal pattern of qrs morphology on the ECG

Course Content

  • Introduction
  • Cardiac Electrical Activity
  • ECG Generation
  • ECG Nomenclature
  • ECG Lead Perspectives
  • A Short Detour
  • Vectors - General Principles
  • Vectors - Vector Interactions
  • Predicted Normal ECG - Chest Leads
  • Predicted Normal ECG - Frontal Leads
  • Time & the ECG - Part 1
  • Time & the ECG - Part 2
  • Predicted Normal ECG - Refinements
  • Quiz
  • Essential Reading

Release date

30-JUL-2020

Expiration date

29-JUL-2023

Instructions for Participation

Participants must complete the online activity during the valid period as noted above.
Follow these steps:

  1. View videos in sequence
  2. Complete quiz
  3. Complete the activity evaluation form to provide feedback for continuing education purposes and for the development of future activities
  4. Download the Certificate of Completion

Relevant Financial Disclosures

Planners and faculty for this activity have no relevant financial relationships with commercial interests to disclose.

Bibliography

Hampton JR. (1973) The E.C.G. made easy. Churchill Livingston

Garcia T. (2000) 12 Lead ECG: The art of interpretation. Garcia T and Holtz NE Eds. Jones and Bartlett Publishers

Ganong WF. (1983) Review of Medical Physiology. 11th edition. Ed Ganong WF. Lange Medical Publications

Romanes GJ. (1977) Cunningham’s manual of practical anatomy. 14th edition. Oxford University Press

Williams PL. (1980) Gray’s Anatomy. Williams PL, Warwick R. Eds 36th Edition, London, Churchill Livingstone. 

Yanowitz FG. ECG Learning Centre.
https://ecg.utah.edu/

Vectors an introduction. Zona Land Education. Zonalandeducation.com
http://zonalandeducation.com/mstm/physics/mechanics/vectors/introduction/introductionVectors.html

Finding the components of a vector. Zona Land Education. Zonalandeducation.com
http://zonalandeducation.com/mstm/physics/mechanics/vectors/findingComponents/findingComponents.htm

Roche J. Introducing vectors. Macro-learnings.com
http://www.marco-learningsystems.com/pages/roche/introvectors.htm

Euclidean Vector. Wikepedia
https://en.wikipedia.org/wiki/Euclidean_vector

Ashley EA and Niebaur J. Chapter 3 Conquering the ECG (Web based material).
https://www.ncbi.nlm.nih.gov/books/NBK2214/

Suzuki J et al. Studies on the positive T wave on ECG in the rat-Based on the analysis for direct cardiac electrocardiograms in the ventricle. Adv Anim Cardiol. 1993;26(1) 24-32.
https://www.jstage.jst.go.jp/article/jsvc1984/26/1/26_1_24/_pdf/-char/en

Hurst JW. Naming the Waves in the ECG, With a Brief Account of Their Genesis. Circulation. 1998;98(18):1937-42. 
https://www.ahajournals.org/doi/full/10.1161/01.cir.98.18.1937

Susan Boyce Gilmore, Susan L Woods. (1995) Electrocardiography and vectorcardiography. In Cardiac Nursing, 3rd edition. SL Woods, E Sivarajan Froelicher, CJ Halpenny, S Underhill Motzer. JB Lippincott Company.

S.L. Woods, E.S. Sivarajan Froelicher, S. Underhill Motzer, E.J. Bridges. (2005) Cardiac nursing. 5th edition. Lippincott Williams and Wilkins

Goldenberg I et al. QT interval: How to Measure It and What Is Normal. J Cardiovasc Electrophysiol. 2006;17(3):333-6.
https://www.researchgate.net/publication/7138635_QT_Interval_How_to_Measure_It_and_What_Is_Normal

Additional Reading

Waller AD. A demonstration on man of electromotive changes accompanying the heart’s beat. J Physiol. 1887;8(5):229-234.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1485094/pdf/jphysiol02445-0001.pdf

Einthoven W. Die galvanometrische Registrirung des menschlichen Elektrokardiogramms, zugleich eine Beurtheilung der Anwendung des Capillar-Elektrometers in der Physiologie. Pflügers Arch ges Physiol. 1903; 99: 472-480.
https://link.springer.com/content/pdf/10.1007/BF01811855.pdf

Wilson FN et al. Electrocardiograms that represent the potential variations of a single electrode. Am Heart J. 1934;9:447-58.

Barold SS. Willem Einthoven and the Birth of Clinical Electrocardiography a Hundred Years Ago. Card Electrophysiol Rev. 2003;7:99-104.
https://link.springer.com/article/10.1023/A:1023667812925

Fisch C. Centennial of the String Galvanometer and the Electrocardiogram. J Am Coll Cardiol. 2000;36(6):1737-45.
https://www.onlinejacc.org/content/36/6/1737.abstract

ACCME Accreditation Statement

Acadoodle, Ltd is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement

AMA Physician’s Recognition Award

Acadoodle, Ltd designates this enduring material activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 
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