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± understand basic cardiac anatomy
± understand how cellular action potentials
give rise to a signal that can be recorded
with extracellular electrodes
± understand the path for action potential
propagation through the heart
± understand the origin of the main phases of
electrocardiogram (EKG)
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is a pump
has electrical activity
(action potentials)

generates electrical
current that can be measured
on the skin surface (the EKG)
 ˜

   

i piece of cardiac muscle
± it rest, Vm is constant
± No current flowing inside
± Inside of cell is at ------------------------------
constant potential ++++++++++++++++++
± Outside of cell is at outside
constant potential

- +
0 mV
 ˜

   

i piece of cardiac muscle
± ðuring i upstroke, i inside
Vm is NOT constant
± Current IS flowing ++++------------------------
------++++++++++++++
± Inside of cell is NOT outside
at constant potential
current
± Outside of cell is NOT
at constant potential
in action potential propagating
toward the positive ECG lead Some positive
produces a positive signal - potential
+
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i piece of cardiac muscle

inside

++++------------------------
in action potential propagating ------++++++++++++++
iway from the positive ECG lead outside
produces a negative signal

current

- +
i negative voltage reading
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ðuring Repolarization i piece of totally depolarized
i piece of cardiac muscle cardiac muscle

inside inside
------------+++++++++++ +++++++++++++++++++
+++++++------------------- -------------------------------
outside outside
Vm not changing
current No current
No ECG signal

Repolarization spreading toward

the positive ECG lead produces
a negative response
Some negative potential
- +
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± Can record a reflection of cardiac electrical
activity on the skin- EKG
± The magnitude and polarity of the signal
depends on
± what the heart is doing electrically
± depolarizing
± repolarizing

± whatever

± the position and orientation of the recording

electrodes
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Si node itrial muscle

Internodal itrial muscle

conducting
fibers

iV node (slow)

urkinje fiber
Ventricular muscle
conducting system
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Right irm ³Lead II´

0.12-0.2 s approx. 0.44 s

R
T

Left Leg
R

itrial muscle T
depolarization

S
Ventricular
Ventricular muscle
muscle
depolarization
repolarization
  
 



0.12-0.2 s approx. 0.44 s

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i 68 year old female arrives at the emergency room in an ambulance. That evening she had
been feeling ³weak and dizzy´ after ingesting a handful of her ³heart pills´ and later passed
out. Her heart rate was irregular but near 33 beats per minute.

Her patient records and talks with her family revealed that she is being treated for poorly
controlled hypertension and congestive heart failure. Her records indicate she has been
prescribed the following medications:

ðoxazosin
ivapro
Tiazac
Toprol
Lasix
otassium supplements
ðigoxin
Zyrtec, celebrex

Her EKG records displayed several arrhythmias and while efforts at treatment were being
made, she went into ventricular fibrillation.
 ˜



is noted, the patient¶s heart rate was irregular and so were her
EKG records. The figures below show two types of patterns seen: