What does a normal cardiogram look like? What ECG indicators are considered normal: deciphering the results of the examination

Electrocardiography is a method for diagnosing the state of the myocardium. This article will focus on the ECG norms in children, adults and women during pregnancy. In addition, the reader will learn about what cardiography is, how an ECG is done, what is the decoding of a cardiogram.

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Electrocardiography is a method used to record the electrical currents that occur when the heart muscle contracts and relaxes. For the study, an electrocardiograph is used. With the help of this device, it is possible to fix the electrical impulses that come from the heart and convert them into a graphic pattern. This image is called an electrocardiogram.

Electrocardiography reveals abnormalities in the work of the heart, malfunctions in the functioning of the myocardium. In addition, after deciphering the results of the electrocardiogram, some non-cardiac diseases can be detected.

How does an electrocardiograph work?

The electrocardiograph consists of a galvanometer, amplifiers and a recorder. Weak electrical impulses that originate in the heart are read by electrodes and then amplified. Then the galvanometer receives data on the nature of the pulses and transmits them to the registrar. In the registrar, graphic images are applied to special paper. Graphs are called cardiograms.

How is an EKG done?

Do electrocardiography according to established rules. The procedure for taking an ECG is shown below:

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• A person removes metal jewelry, removes clothes from the shins and from the upper part of the body, after which he assumes a horizontal position.
• The doctor processes the contact points of the electrodes with the skin, after which he applies the electrodes to certain places on the body. Further, fixes the electrodes on the body with clips, suction cups and bracelets.
• The doctor attaches the electrodes to the cardiograph, after which the impulses are registered.
• A cardiogram is recorded, which is the result of an electrocardiogram.

Separately, it should be said about the leads used in the ECG. Leads use the following:

• 3 standard leads: one of them is located between the right and left hands, the second is between the left foot and the right hand, the third is between the left foot and the left hand.
• 3 limb leads with enhanced character.
• 6 leads located on the chest.

In addition, if necessary, additional leads can be used.

After the cardiogram is recorded, it is necessary to decrypt it. This will be discussed further.

Deciphering the cardiogram

Conclusions about diseases are made on the basis of the parameters of the heart, obtained after deciphering the cardiogram. The following is the procedure for decoding the ECG:

1. The heart rhythm and myocardial conduction are analyzed. To do this, the regularity of contractions of the heart muscle and the frequency of contractions of the myocardium are evaluated, and the source of excitation is determined.
2. The regularity of heart contractions is determined as follows: R-R intervals are measured between successive heart cycles. If the measured R-R intervals are the same, then a conclusion is made about the regularity of contractions of the heart muscle. If the duration of the R-R intervals is different, then a conclusion is made about the irregularity of heart contractions. If a person has irregular contractions of the myocardium, then they conclude that there is an arrhythmia.
3. The heart rate is determined by a certain formula. If the heart rate in a person exceeds the norm, then they conclude that there is tachycardia, if the person has a heart rate below the norm, then they conclude that there is bradycardia.
4. The point from which excitation emanates is determined as follows: the movement of contraction in the atrial cavities is estimated and the relationship of the R waves to the ventricles is established (according to the QRS complex). The nature of the heart rhythm depends on the source that is the cause of the excitation.

The following patterns of heart rhythms are observed:

1. The sinusoidal nature of the heart rhythm, in which the P waves in the second lead are positive and are in front of the ventricular QRS complex, and the P waves in the same lead have an indistinguishable shape.
2. Atrial rhythm of the nature of the heart, in which the P waves in the second and third leads are negative and are in front of the unchanged QRS complexes.
3. The ventricular nature of the heart rhythm, in which there is a deformation of the QRS complexes and a loss of communication between the QRS (complex) and the P waves.

The conduction of the heart is determined as follows:

1. Measurements of P-wave length, PQ interval length, and QRS complex are evaluated. Exceeding the normal duration of the PQ interval indicates too low conduction velocity in the corresponding cardiac conduction section.
2. Myocardial rotations around the longitudinal, transverse, anterior and posterior axes are analyzed. To do this, the position of the electrical axis of the heart in a common plane is estimated, after which the presence of turns of the heart along one axis or another is established.
3. The atrial P wave is analyzed. To do this, the amplitude of the P bison is assessed, the duration of the P wave is measured. After that, the shape and polarity of the P wave are determined.
4. The ventricular complex is analyzed - For this, the QRS complex, the RS-T segment, the QT interval, the T wave are evaluated.

During the assessment of the QRS complex, do the following: determine the characteristics of the Q, S and R waves, compare the amplitude values ​​of the Q, S and R waves in a similar lead and the amplitude values ​​of the R/R waves in different leads.

At the time of evaluation of the RS-T segment, the nature of the displacement of the RS-T segment is determined. The offset can be horizontal, skew-down and skew-up.

For the period of analysis of the T wave, the nature of the polarity, amplitude and shape are determined. The QT interval is measured by the time from the beginning of the QRT complex to the end of the T wave. When assessing the QT interval, do the following: analyze the interval from the starting point of the QRS complex to the end point of the T wave. To calculate the QT interval, the Bezzet formula is used: the QT interval is equal to the product of the R-R interval and a constant coefficient.

The coefficient for QT depends on gender. For men, the constant coefficient is 0.37, and for women it is 0.4.

A conclusion is made and the results are summarized.

In conclusion, the ECG specialist draws conclusions about the frequency of the contractile function of the myocardium and heart muscle, as well as the source of excitation and the nature of the heart rhythm and other indicators. In addition, an example of the description and characteristics of the P wave, QRS complex, RS-T segment, QT interval, T wave is given.

Based on the conclusion, it is concluded that a person has heart disease or other ailments of internal organs.

Electrocardiogram norms

The table with ECG results has a clear view, consisting of rows and columns. In the 1st column, the rows list: heart rate, beat rate examples, QT intervals, axis displacement characteristics examples, P wave readings, PQ readings, QRS reading examples. ECG is carried out equally in adults, children and pregnant women, but the norm is different.

The ecg norm in adults is presented below:

• heart rate in a healthy adult: sinus;
• P-wave index in a healthy adult: 0.1;
• the frequency of contractions of the heart muscle in a healthy adult: 60 beats per minute;
• QRS rate in a healthy adult: from 0.06 to 0.1;
• QT score in a healthy adult: 0.4 or less;
• RR in a healthy adult: 0.6.

In the case of observation of deviations from the norm in an adult, a conclusion is made about the presence of the disease.

The norm of cardiogram indicators in children is presented below:

• P-wave score in a healthy child: 0.1 or less;
• heart rate in a healthy child: 110 beats per minute or less in children under 3 years old, 100 beats per minute or less in children under 5 years old, no more than 90 beats per minute in children in adolescence;
• QRS index in all children: from 0.06 to 0.1;
• QT score in all children: 0.4 or less;
• PQ in all children: if the child is under 14 years old, then the example PQ is 0.16, if the child is from 14 to 17 years old, then the PQ is 0.18, after 17 years the normal PQ is 0.2.

If in children, when deciphering the ECG, any deviations from the norm were found, then treatment should not be started immediately. Some disorders in the work of the heart disappear in children with age.

But in children, heart disease can be congenital. It is possible to determine whether a newborn child will have a heart pathology even at the stage of fetal development. For this purpose, electrocardiography is done to women during pregnancy.

The norm of electrocardiogram indicators in women during pregnancy is presented below:

• heart rate in a healthy adult child: sinus;
• P wave score in all healthy women during pregnancy: 0.1 or less;
• the frequency of contractions of the heart muscle in all healthy women during pregnancy: 110 or less beats per minute in children under 3 years old, 100 or less beats per minute in children under 5 years old, no more than 90 beats per minute in children in adolescence;
• QRS rate in all expectant mothers during pregnancy: from 0.06 to 0.1;
• QT score in all expectant mothers during pregnancy: 0.4 or less;
• PQ index for all expectant mothers during pregnancy: 0.2.

It is worth noting that in different periods of pregnancy, ECG indicators may differ slightly. In addition, it should be noted that ECG during pregnancy is safe for both the woman and the developing fetus.

Additionally

It is worth saying that under certain circumstances, electrocardiography can give an inaccurate picture of a person's health status.

If, for example, a person subjected himself to heavy physical exertion before an ECG, then an erroneous picture may be revealed when deciphering the cardiogram.

This is explained by the fact that during physical exertion the heart begins to work differently than at rest. During physical exertion, the heart rate increases, some changes in the rhythm of the myocardium may be observed, which is not observed at rest.

It should be noted that the work of the myocardium is affected not only by physical loads, but also by emotional loads. Emotional loads, like physical loads, disrupt the normal course of myocardial work.

At rest, the heart rhythm normalizes, the heartbeat evens out, therefore, before electrocardiography, it is necessary to be at rest for at least 15 minutes.

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An electrocardiogram is the first indicator of the state of the heart. It reflects all the problems of the human cardiovascular system, makes it possible to identify ailments at an early stage in order to take the necessary treatment. But in order to correctly diagnose, the cardiogram must be correctly interpreted.

What is a cardiogram

Deciphering an ECG requires a clear understanding of what this test is all about. An electrocardiogram schematically displays the electrical activity of the heart muscle on paper or electronic media. It is recorded on special calibrated paper. The length of the horizontal axis of the square (the smallest division) is 1 mm, in time it is 0.04 seconds, respectively, large blocks of 5 mm are equal to 0.2 seconds. The black marks at the top represent intervals of three seconds. A vertical line consisting of two blocks is equal to one millivolt - this is a unit of electrical voltage, a thousandth of a volt. To understand what is at stake, it is worth looking at the photo of the ECG transcript.

The cardiogram displays 12 leads: the first half comes from the limbs, and the second - chest. They depend on the location of the electrodes on the human body, so it is very important to place them correctly. These leads reflect the activity of different parts of the myocardium. The electrodes on the body are placed accordingly.

The propagation of an impulse through the heart on the cardiogram is displayed by intervals, segments and teeth. The latter are denoted in Latin letters: P, Q, R, S, T, U. The R wave is always negative, it displays indicators for the myocardium, Q and S are positive, they show the propagation of the impulse along the interventricular septum. As for the interpretation of the T and U waves, everything depends on their shape, amplitude and sign. The first reflects myocardial repolarization, and the value of the second for diagnosing does not play a special role. The normal interpretation of the ECG provides that all indicators must be calculated to a hundredth of a second, otherwise they can be misinterpreted.

What indicators are considered optimal

To effectively decipher the ECG, you need to study the indicators of the norm. First of all, you should pay attention to the heart rate. Normally, it should be sinus. This implies that the P waves should have a constant shape, the distance between the P-P and R-R indicators should be the same, and the number of contractions should be 60-80 per minute.

The electrical axis of the heart is a display of the ventricular excitation vector from an impulse, it is considered according to special medical tables, so deciphering an ECG for beginners may seem very difficult. EOS deviations are determined by the alpha angle. If the axis is in the normal position, the angle value is 50-70 degrees. It is worth paying attention: the R wave should be higher than the S. The intervals of the teeth show how the electrical impulse passes between the compartments of the heart. Each of them has specific indicators of the norm.

1. The width of the Q-R-S wave group under normal conditions is 60-100 ms.
2. The Q-T wave group displays the duration of the ventricular contraction. The norm is 390-450 ms.
3. For the Q wave, the optimal length is 0.04 s, and the depth is no more than 3 mm.
4. The S-tooth must not exceed a height of 20 mm.
5. The norm for the T wave is that in leads I and II it should go up, and in lead aVR it should have a negative indicator.

Identification of abnormalities and diseases

If you deal with the indicators of the norm, when deciphering the ECG, any pathology can be detected independently. Let's start with heart rate. If the electrical excitation does not start from the sinus node, this is an indicator of an arrhythmia. Depending on the branch of the heart in which depolarization begins, tachycardia (acceleration of the rhythm) or bradycardia (deceleration) is diagnosed. Another important indicator of deviations is abnormal teeth and intervals.

1. Prolongation of the interval between the Q and T waves indicates myocarditis, rheumatism, sclerosis, or coronary disease. When Q values ​​do not meet the norm, this signals myocardial pathologies.


2. If the R wave is not displayed in all leads, this indicates that ventricular hypertrophy is possible.
3. Deviations in the ST segment indicate myocardial ischemia.
4. A T wave that is out of range may indicate hypokalemia or hyperkalemia.
5. The expansion of the P wave, especially twice, indicates an atrioventricular block.
6. A sharp rise in the ST segment means that the patient is at risk of acute heart attack or pericarditis, and its descent indicates myocardial ischemia or that the person is taking cardiac glycosides.

This or that position of the electrical axis of the heart may indicate various diseases. When the EOS is horizontal or tilted to the left, we can talk about hypertension in the patient. If the axis deviates to the right, it is possible that the person has chronic lung disease. The doctor should be concerned if, within a short time, the electrical axis suddenly changed position. The peculiarity of the EOS is that its performance may depend on various factors. For example, the vertical position is often found in thin people, and the horizontal position is common in full people.

A cardiogram can indicate a number of diseases. But do not rush to diagnose yourself. It is very difficult to interpret the ECG for beginners, because not all indicators can be calculated independently. It is better to contact a professional who will interpret the cardiogram correctly and be able to make accurate diagnoses.

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Basic Rules

When examining the results of the examination of the patient, doctors pay attention to such components of the ECG as:

• teeth;
• intervals;
• Segments.

There are strict normal parameters for each line on the ECG tape, the slightest deviation from which may indicate violations in the work of the heart.

ECG analysis

The entire set of ECG lines is examined and measured mathematically, after which the doctor can determine some parameters of the heart muscle and its conduction system: heart rate, heart rate, pacemaker, conduction, electrical axis of the heart.

To date, all these indicators are investigated by high-precision electrocardiographs.

Sinus rhythm of the heart

This is a parameter that reflects the rhythm of heart contractions that occur under the influence of the sinus node (normal). It shows the coherence of the work of all parts of the heart, the sequence of processes of tension and relaxation of the heart muscle.

The rhythm is very easy to identify by the tallest R waves: if the distance between them is the same throughout the entire recording or deviates by no more than 10%, then the patient does not suffer from arrhythmia.

heart rate

The number of beats per minute can be determined not only by counting the pulse, but also by the ECG. To do this, you need to know the speed at which the ECG was recorded (usually 25, 50 or 100mm / s), as well as the distance between the highest teeth (from one peak to another).

By multiplying the recording time of one mm by length of segment R-R you can get your heart rate. Normally, its performance ranges from 60 to 80 beats per minute.

Source of excitation

The autonomic nervous system of the heart is designed in such a way that the process of contraction depends on the accumulation of nerve cells in one of the zones of the heart. Normally, this is the sinus node, the impulses from which diverge throughout the nervous system of the heart.

In some cases, other nodes (atrial, ventricular, atrioventricular) can take on the role of the pacemaker. This can be determined by examining the P wave is inconspicuous, located just above the isoline.

Conductivity

This is a criterion showing the process of momentum transfer. Normally, impulses are transmitted sequentially from one pacemaker to another, without changing the order.

Electric axis

An indicator based on the process of excitation of the ventricles. Mathematical analysis of Q, R, S waves in leads I and III allows you to calculate a certain resulting vector of their excitation. This is necessary to establish the functioning of the branches of the His bundle.

The obtained angle of inclination of the axis of the heart is estimated by the value: 50-70° normal, 70-90° deviation to the right, 50-0° deviation to the left.

Teeth, segments and intervals

Teeth - ECG sections lying above the isoline, their meaning is as follows:

• P- reflects the processes of contraction and relaxation of the atria.
• Q, S- reflect the processes of excitation of the interventricular septum.
• R- the process of excitation of the ventricles.
• T- the process of relaxation of the ventricles.

Intervals are sections of the ECG lying on the isoline.

• PQ- reflects the propagation time of the impulse from the atria to the ventricles.

Segments - sections of the ECG, including an interval and a wave.

• QRST- the duration of the contraction of the ventricles.
• ST- the time of complete excitation of the ventricles.
• TP is the time of electrical diastole of the heart.

Norm in men and women

The decoding of the ECG of the heart and the norms of indicators in adults are presented in this table:

Healthy Childhood Outcomes

Deciphering the results of ECG measurements in children and their norm in this table:

Dangerous diagnoses

What dangerous conditions can be determined by the ECG readings during decoding?

Extrasystole

This phenomenon characterized by irregular heartbeat. A person feels a temporary increase in the frequency of contractions, followed by a pause. It is associated with the activation of other pacemakers, sending along with the sinus node an additional burst of impulses, which leads to an extraordinary contraction.

Arrhythmia

Characterized change in the frequency of sinus rhythm when pulses arrive at different frequencies. Only 30% of these arrhythmias require treatment, because can lead to more serious illnesses.

In other cases, this may be a manifestation of physical activity, a change in hormonal levels, the result of a fever and does not threaten health.

Bradycardia

It occurs when the sinus node is weakened, unable to generate impulses with the proper frequency, as a result of which the heart rate also slows down, up to 30-45 beats per minute.

Tachycardia

The opposite phenomenon, characterized by an increase in heart rate over 90 beats per minute. In some cases, temporary tachycardia occurs under the influence of strong physical exertion and emotional stress, as well as during illnesses associated with fever.

Conduction disorder

In addition to the sinus node, there are other underlying pacemakers of the second and third orders. Normally, they conduct impulses from the first-order pacemaker. But if their functions weaken, a person may feel weakness, dizziness caused by depression of the heart.

It is also possible to lower blood pressure, because. the ventricles will contract less frequently or arrhythmically.

Why there might be differences in performance

In some cases, when re-analyzing the ECG, deviations from previously obtained results are revealed. With what it can be connected?

• different time of day. Usually, an ECG is recommended to be done in the morning or afternoon, when the body has not yet had time to be influenced by stress factors.
• Loads. It is very important that the patient is calm while recording the ECG. The release of hormones can increase heart rate and distort performance. In addition, before the examination, it is also not recommended to engage in heavy physical labor.
• meal. Digestive processes affect blood circulation, and alcohol, tobacco and caffeine can affect heart rate and pressure.
• electrodes. Improper overlap or accidental shifting can seriously change the performance. Therefore, it is important not to move during the recording and degrease the skin in the area where the electrodes are applied (the use of creams and other skin products before the examination is highly undesirable).
• Background. Sometimes other devices can interfere with the operation of the electrocardiograph.

Additional examination methods

Halter

Method long-term study of the work of the heart, made possible by a portable compact tape recorder that is capable of recording results on magnetic tape. The method is especially good when it is necessary to investigate recurrent pathologies, their frequency and time of occurrence.

Treadmill

Unlike a conventional ECG recorded at rest, this method is based on the analysis of the results after exercise. Most often, this is used to assess the risk of possible pathologies not detected on a standard ECG, as well as when prescribing a course of rehabilitation for patients who have had a heart attack.

Phonocardiography

Allows analyze heart sounds and murmurs. Their duration, frequency and time of occurrence correlate with the phases of cardiac activity, which makes it possible to assess the functioning of the valves, the risks of developing endocarditis and rheumatic heart disease.

A standard ECG is a graphic representation of the work of all parts of the heart. Its accuracy can be affected by many factors, so doctor's advice should be followed.

The examination reveals most of the pathologies of the cardiovascular system, however, additional tests may be required for an accurate diagnosis.

Finally, we suggest watching a video course on decoding “ECG for everyone”:

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What is an ECG, how is the procedure

The principle of obtaining an ECG is very simple. We are talking about the fact that sensors are attached to the skin of the patient, which record the electrical impulses that accompany the beating of the heart. Recording is done on a sheet of paper. A competent doctor can tell a lot about the patient's health from this diagram.

It depicts cyclical changes in the corresponding electrical impulses. It is important to note that this diagnostic method is not absolutely accurate and exhaustive. It can be considered, rather, as a basis for the main conclusions.

What exactly is shown in the ECG?

Suppose you need to take an electrocardiogram. How to do it right? Do I need to be a specialist in order to carry out this procedure, or if all the necessary rules are carefully followed, even a non-specialist can carry out the procedure? Let's try to answer these questions.

Interestingly, the electrocardiogram is used not only in the treatment of cardiac patients, but also in a number of other cases:

• This takes place not only during various medical examinations, but also for the diagnosis of those diseases that are not directly related to the heart, but can create complications in it.
• Also, when using those medicines that have a strong effect on the body, the state of health of the cardiovascular system is often checked in this way in order to prevent possible consequences of taking such medicines.
  In such cases, it is customary to check not only before, but also after the therapeutic course is completed.

The procedure itself is not very complicated. Its total duration does not exceed ten minutes. The room temperature must not be too low. At the same time, the room must be ventilated. Compliance with this and similar rules is very important for such a procedure. This is due to the fact that any change in the patient's physical condition will be reflected in the electrocardiogram.

Here are some other requirements:

1. Before starting the procedure, the patient must be given rest. Its duration should be at least a quarter of an hour.
2. During the reading procedure, the patient should lie on his back.
3. During work, he should have even breathing.
4. You also need to take into account the time of eating. Everything should be done either on an empty stomach or not earlier than two hours after the last meal. This reception should not be plentiful.
5. Of course, on the day of the procedure, it is not allowed to take any sedative or tonic drugs. Also, do not drink coffee or tea or other similar drinks. If the patient smokes, then he should refrain from this habit for at least an hour before the procedure.

Diagnostic technique including
It includes the attachment of four electrodes to the hands and ankles and the installation of six suction cups on the patient's chest.

Do it in the following order. Each electrode has a specific color. Put a damp cloth under them. This is done both to increase conductivity and to improve the adhesion of the electrode to the skin surface.

When installing suction cups on the chest, the skin is usually disinfected with an alcohol solution. The diagram will display several types of teeth that have a different shape.

To carry out diagnostics, it is enough to record data for no longer than four consecutive cycles.

So, in what cases does it make sense to go to the doctor and do a cardiogram?

There are several main options:

• This should be done if you clearly feel discomfort in the chest.
• With shortness of breath, although it may look familiar, it makes sense to see a doctor for an ECG.
• If you are overweight, then you are undoubtedly at risk for heart disease. It is recommended to do an electrocardiogram regularly.
• The presence of chronic and severe stress in your life is a danger not only to your heart, but also to other systems of the human body. An ECG in such a case is a matter of vital importance.
• There is such a chronic disease as tachycardia. If you suffer from it, then the ECG should be done regularly.
• Hypertension is considered by many as a possible step towards a heart attack. If at this stage you regularly diagnose using an ECG, then your chances of recovering will increase dramatically.
• Before performing a surgical operation, it is important for the doctor to make sure. That your heart can handle it. An ECG may be done to check.

How often is it necessary to resort to such a procedure? This is usually determined by the attending physician. However, if you are over forty, then it makes sense to carry out this procedure annually. If you are much older, then you should do an ECG at least once a quarter.

What does the ECG show

Let's see what we can see on the electrocardiogram:

1. First of all, she will tell in detail about all the features of the rhythm of the heartbeat. In particular, this will allow you to track the increase in heart rate or weak heartbeat. The diagram shows in what rhythm and with what force the patient's heart beats.
2. Another important advantage is that the ECG is able to show various pathologies that are inherent in the heart. This is due to the fact that any, say, tissue necrosis will conduct electrical impulses differently than healthy tissue. Such features will also help to identify those who are not yet sick, but have a tendency to do so.
3. There is an ECG under stress. This is useful in cases where a relatively healthy person wants to assess the health of their heart.

Principles for decoding indicators

A cardiogram is not one, but several different graphs. Since several electrodes are attached to the patient, electrical impulses can in principle be measured between each pair of them. In practice, the ECG contains twelve graphs. The doctor evaluates the shape and frequency of the teeth, and also considers the ratio of electrical signals on various graphs.

Each disease corresponds to specific signs on the ECG graphs. If they are determined, then this makes it possible to make the correct diagnosis to the patient. The norm and violations in the interpretation of the ECG are very important. Each indicator requires the most careful attention. A reliable result occurs when the analysis is carried out accurately and reliably.

reading teeth

There are five different types of waveforms on an ECG. They are designated in Latin letters: S, P, T, Q and R. Each of them characterizes the work of one of the sections of the heart.

Different types of intervals and segments are also taken into account. They represent the distance between certain types of teeth and also have their own letter designations.

Also, the analysis considers the QRS complex (it is also called the QRS interval).

In more detail, the elements of the ECG are shown in the figure given here. This is a kind of ECG decoding table.
First, the heart rate is assessed. As you know, it is usually 60-80 cuts per second.

How the doctor analyzes the results

The study of the electrocardiogram occurs in several successive stages:

1. At this stage, the doctor must calculate and analyze the intervals. The doctor examines the QT - interval. If there is an elongation of this segment, then this indicates, in particular, coronary heart disease, if we are talking about shortening, then we can talk about hypercalcemia.
2. After that, an indicator such as the electrical axis of the heart (EOS) is determined. This is done using a calculation based on the height of the different types of waves on the electrocardiogram.
3. After that, the complex is considered. We are talking about a tooth of the R type and its nearest sections of the graph on both sides.
4. Next is the interval. It is believed that for a normal heart, it should be in the midline.
5. After that, based on the studied data, a final cardiological conclusion is given.

• P - normally should be positive, shows the presence of bioelectricity in the atria;
• The Q wave is normally negative, it refers to the interventricular septum;
• R - characterizes the electrical potential in the ventricular myocardium;
• The S wave - in a normal situation, it is negative, shows the final process of electricity in the ventricles, normally such a tooth will be lower than the R wave;
• T - must be positive, here we are talking about the recovery process of biopotential in the heart.
• The heart rate should be between 60 and 80 per minute. If it goes beyond these boundaries, then this indicates violations in the work of the heart.
• QT - the interval is normal for an adult is 390-450 milliseconds.
• The width of the QRS interval should be approximately 120 milliseconds.

Possible errors in the result

Despite its obvious advantages, this procedure also has certain disadvantages:

Pathologies in the interpretation of the ECG can be determined according to the available descriptions of various variants of cardiograms. There are detailed tables that will help determine the type of pathology detected. To increase the reliability of the result, the cardiogram should be combined with other diagnostic methods.

Cost of the procedure

If we talk about prices in Moscow, then they are approximately in the range from 650 to 2300 rubles. Let's not forget that, when receiving a cardiogram, its analysis by a qualified doctor and the quality of the medical equipment itself are of great importance.

In St. Petersburg, the average price is about the same as in Moscow. ECG price with decoding is approximately 1500 rubles for this procedure.

There is also a service to call such a specialist at home. In Moscow, this service can be provided for 1500 rubles, in Khabarovsk - for 900 rubles, and in Saratov it can be done for 750 rubles.

Conclusion

An ECG is an important means of diagnosing your cardiovascular system. She has a lot to say about her. It makes sense to regularly, at least once every two years, seek an ECG from a doctor.

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ECG interpretation

Any electrocardiogram displays the work of the heart (its electrical potential during contractions and relaxations) in 12 curves recorded in 12 leads. These curves differ from each other, as they show the passage of an electrical impulse through different parts of the heart, for example, the first is the anterior surface of the heart, the third is the back. To record an ECG in 12 leads, special electrodes are attached to the patient's body in specific places and in a certain sequence.

How to decipher the cardiogram of the heart: general principles

The main elements of the electrocardiographic curve are:

ECG analysis

Having received an electrocardiogram in his hands, the doctor begins to evaluate it in the following sequence:

1. It determines whether the heart beats rhythmically, that is, whether the rhythm is correct. To do this, he measures the intervals between the R waves, they should be the same everywhere, if not, this is already the wrong rhythm.
2. Calculates the rate at which the heart beats (HR). This is easy to do, knowing the ECG recording speed and counting the number of millimeter cells between adjacent R waves. Normally, the heart rate should not go beyond 60-90 beats. per minute.
3. According to specific features (mainly by the P wave), it determines the source of excitation in the heart. Normally, this is the sinus node, that is, in a healthy person, sinus rhythm is considered normal. Atrial, atrioventricular and ventricular rhythms indicate pathology.
4. Assesses the conduction of the heart by the duration of the teeth and segments. For each of them there are indicators of the norm.
5. Determines the electrical axis of the heart (EOS). For very thin people, a more vertical position of the EOS is characteristic, for full people it is more horizontal. With pathology, the axis shifts sharply to the right or left.
6. Analyzes teeth, segments and intervals in detail. The doctor writes down their duration on the cardiogram by hand in seconds (this is an incomprehensible set of Latin letters and numbers on the ECG). Modern electrocardiographs automatically analyze these indicators and immediately provide measurement results, which simplifies the work of the doctor.
7. Gives a conclusion. It necessarily indicates the correctness of the rhythm, the source of excitation, heart rate, characterizes the EOS, and also highlights specific pathological syndromes (rhythm disturbance, conduction disturbance, the presence of overload of individual parts of the heart and myocardial damage), if any.

Examples of electrocardiographic findings

In a healthy person, the ECG conclusion may look like this: sinus rhythm with a heart rate of 70 beats. in min. EOS in the normal position, no pathological changes were detected.

Also, for some people, sinus tachycardia (acceleration of heart rate) or bradycardia (slow heart rate) can be considered a normal option. In elderly people, quite often, the conclusion may indicate the presence of moderate diffuse or metabolic changes in the myocardium. These conditions are not critical and after receiving appropriate treatment and correction of the patient's nutrition, they mostly always disappear.

In addition, in conclusion, we can talk about a non-specific change in the ST-T interval. This means that the changes are not indicative and it is impossible to determine their cause only by the ECG. Another fairly common condition that can be diagnosed by a cardiogram is a violation of repolarization processes, that is, a violation of the recovery of the ventricular myocardium after excitation. This change can be caused by both severe heart disease and chronic infections, hormonal imbalances and other causes that the doctor will subsequently look for.

Prognostically unfavorable conclusions are considered, in which there is data on the presence of myocardial ischemia, hypertrophy of the heart, rhythm and conduction disturbances.

Deciphering the ECG in children

The whole principle of deciphering cardiograms is the same as in adults, but due to the physiological and anatomical features of the child's heart, there are differences in the interpretation of normal indicators. This applies primarily to heart rate, since up to 5 years in children it can exceed 100 beats. per minute.

Also, sinus or respiratory arrhythmia (increased heart rate on inspiration and decrease on expiration) can be recorded in babies without any pathology. In addition, the characteristics of some teeth and intervals differ from those of adults. For example, a child may have an incomplete blockade of part of the conduction system of the heart - the right leg of the bundle of His. All these features are taken into account by pediatric cardiologists when they make a conclusion on the ECG.

Features of the ECG during pregnancy

The body of a pregnant woman goes through various processes of adaptation to a new position. Certain changes also occur with the cardiovascular system, so the ECG of future mothers may differ slightly from the results of a study of the heart of a healthy adult. First of all, in the later stages there is a slight horizontal deviation of the EOS, caused by a change in the relative placement of the internal organs and the growing uterus.

In addition, expectant mothers may have a slight sinus tachycardia and signs of overload of individual parts of the heart. These changes are associated with an increase in blood volume in the body and usually disappear after childbirth. However, their discovery cannot be left without detailed consideration and a more in-depth examination of the woman.

Deciphering the ECG, the norm of indicators

Deciphering the ECG is the business of a knowledgeable doctor. With this method of functional diagnostics, the following is evaluated:

• heart rhythm - the state of the generators of electrical impulses and the state of the heart system that conducts these impulses
• the state of the heart muscle itself (myocardium). the presence or absence of its inflammation, damage, thickening, oxygen starvation, electrolyte imbalance

However, modern patients often have access to their medical documents, in particular, to electrocardiography films on which medical reports are written. With their diversity, these records can bring even the most balanced, but ignorant person to a panic disorder. Indeed, often the patient does not know for certain how dangerous for life and health what is written on the back of the ECG film by the hand of a functional diagnostician, and there are still a few days before an appointment with a therapist or cardiologist.

To reduce the intensity of passions, we immediately warn readers that with no serious diagnosis (myocardial infarction, acute rhythm disturbances), the functional diagnostician of the patient will not let the patient out of the office, but at least send him for a consultation with a specialist colleague right there. About the rest of the "secrets of the Open" in this article. In all unclear cases of pathological changes on the ECG, ECG control, daily monitoring (Holter), ECHO cardioscopy (ultrasound of the heart) and stress tests (treadmill, bicycle ergometry) are prescribed.

Numbers and Latin letters in ECG decoding

PQ- (0.12-0.2 s) - time of atrioventricular conduction. Most often, it lengthens against the background of AV blockade. Shortened in CLC and WPW syndromes.

P - (0.1s) height 0.25-2.5 mm describes atrial contractions. Can talk about their hypertrophy.

QRS - (0.06-0.1s) - ventricular complex

QT - (no more than 0.45 s) lengthens with oxygen starvation (myocardial ischemia, infarction) and the threat of rhythm disturbances.

RR - the distance between the apexes of the ventricular complexes reflects the regularity of heart contractions and makes it possible to calculate the heart rate.

The decoding of the ECG in children is shown in Fig. 3

Options for describing the heart rate

Sinus rhythm

This is the most common inscription found on the ECG. And, if nothing else is added and the frequency (HR) is indicated from 60 to 90 beats per minute (for example, heart rate 68`) - this is the most successful option, indicating that the heart works like a clock. This is the rhythm set by the sinus node (the main pacemaker that generates electrical impulses that cause the heart to contract). At the same time, sinus rhythm implies well-being, both in the state of this node, and the health of the conduction system of the heart. The absence of other records denies pathological changes in the heart muscle and means that the ECG is normal. In addition to sinus rhythm, it can be atrial, atrioventricular or ventricular, indicating that the rhythm is set by the cells in these parts of the heart and is considered pathological.

This is a variant of the norm in young people and children. This is a rhythm in which impulses exit the sinus node, but the intervals between heartbeats are different. This may be due to physiological changes (respiratory arrhythmia, when heart contractions slow down on exhalation). Approximately 30% of sinus arrhythmias require observation by a cardiologist, as they are threatened by the development of more serious rhythm disturbances. These are arrhythmias after rheumatic fever. Against the background of myocarditis or after it, against the background of infectious diseases, heart defects and in people with a history of arrhythmias.

These are rhythmic contractions of the heart with a frequency of less than 50 per minute. In healthy people, bradycardia occurs, for example, during sleep. Also, bradycardia is often seen in professional athletes. Pathological bradycardia may indicate sick sinus syndrome. At the same time, bradycardia is more pronounced (heart rate from 45 to 35 beats per minute on average) and is observed at any time of the day. When bradycardia causes pauses in heart contractions of up to 3 seconds during the day and about 5 seconds at night, leads to disruptions in the supply of oxygen to tissues and manifests itself, for example, by fainting, an operation is indicated to install a heart pacemaker, which replaces the sinus node, imposing a normal rhythm of contractions on the heart.

Sinus tachycardia

Heart rate more than 90 per minute - is divided into physiological and pathological. In healthy people, sinus tachycardia is accompanied by physical and emotional stress, drinking coffee, sometimes strong tea or alcohol (especially energy drinks). It is short-lived and after an episode of tachycardia, the heart rate returns to normal in a short period of time after the cessation of the load. With pathological tachycardia, palpitations disturb the patient at rest. Its causes are temperature rises, infections, blood loss, dehydration, thyrotoxicosis, anemia, cardiomyopathy. Treat the underlying disease. Sinus tachycardia is stopped only with a heart attack or acute coronary syndrome.

Extrasystole

These are rhythm disturbances, in which foci outside the sinus rhythm give extraordinary heart contractions, after which there is a pause doubled in length, called a compensatory one. In general, heartbeats are perceived by the patient as uneven, rapid or slow, sometimes chaotic. Most of all, failures in the heart rhythm are disturbing. There may be discomfort in the chest in the form of jolts, tingling, feelings of fear and emptiness in the abdomen.

Not all extrasystoles are dangerous to health. Most of them do not lead to significant circulatory disorders and do not threaten either life or health. They can be functional (against the background of panic attacks, cardioneurosis, hormonal disruptions), organic (with IHD, heart defects, myocardial dystrophy or cardiopathy, myocarditis). They can also lead to intoxication and heart surgery. Depending on the place of occurrence, extrasystoles are divided into atrial, ventricular and antrioventricular (arising in a node on the border between the atria and ventricles).

• Single extrasystoles are most often rare (less than 5 per hour). They are usually functional and do not interfere with the normal blood supply.
• Paired extrasystoles of two accompany a certain number of normal contractions. Such a rhythm disturbance often indicates pathology and requires additional examination (Holter monitoring).
• Allorhythmias are more complex types of extrasystoles. If every second contraction is an extrasystole, it is bigymenia, if every third is trigynemia, and every fourth is quadrihymenia.

It is customary to divide ventricular extrasystoles into five classes (according to Laun). They are evaluated during daily ECG monitoring, since the indicators of a conventional ECG in a few minutes may not show anything.

• Class 1 - single rare extrasystoles with a frequency of up to 60 per hour, emanating from one focus (monotopic)
• 2 - frequent monotopic more than 5 per minute
• 3 - frequent polymorphic (of different shapes) polytopic (from different foci)
• 4a - paired, 4b - group (trigymenia), episodes of paroxysmal tachycardia
• 5 - early extrasystoles

The higher the class, the more serious the violations, although today even grades 3 and 4 do not always require medical treatment. In general, if there are less than 200 ventricular extrasystoles per day, they should be classified as functional and not worry about them. With more frequent, ECHO of the COP is indicated, sometimes - MRI of the heart. They do not treat extrasystole, but the disease that leads to it.

Paroxysmal tachycardia

In general, paroxysm is an attack. Paroxysmal acceleration of the rhythm can last from several minutes to several days. In this case, the intervals between heartbeats will be the same, and the rhythm will increase over 100 per minute (on average from 120 to 250). There are supraventricular and ventricular forms of tachycardia. The basis of this pathology is the abnormal circulation of an electrical impulse in the conduction system of the heart. Such a pathology is subject to treatment. From home remedies to eliminate an attack:

• breath holding
• increased forced cough
• face immersion in cold water

WPW syndrome

Wolff-Parkinson-White syndrome is a type of paroxysmal supraventricular tachycardia. Named after the names of the authors who described it. At the heart of the appearance of tachycardia is the presence between the atria and ventricles of an additional nerve bundle, through which a faster impulse passes than from the main pacemaker.

As a result, an extraordinary contraction of the heart muscle occurs. The syndrome requires conservative or surgical treatment (with ineffectiveness or intolerance of antiarrhythmic tablets, with episodes of atrial fibrillation, with concomitant heart defects).

CLC - Syndrome (Clerk-Levy-Christesco)

It is similar in mechanism to WPW and is characterized by an earlier excitation of the ventricles compared to the norm due to an additional bundle along which the nerve impulse travels. The congenital syndrome is manifested by attacks of rapid heartbeats.

Atrial fibrillation

It can be in the form of an attack or a permanent form. It manifests itself in the form of flutter or atrial fibrillation.

Atrial fibrillation

Atrial fibrillation

When the heart flickers, it contracts completely irregularly (intervals between contractions of very different durations). This is due to the fact that the rhythm is not set by the sinus node, but by other atrial cells.

It turns out a frequency of 350 to 700 beats per minute. There is simply no full-fledged atrial contraction; the contracting muscle fibers do not provide effective filling of the ventricles with blood.

As a result, the release of blood by the heart worsens and organs and tissues suffer from oxygen starvation. Another name for atrial fibrillation is atrial fibrillation. Not all atrial contractions reach the ventricles of the heart, so the heart rate (and pulse) will either be below normal (bradysystole with a frequency of less than 60), or normal (normosystole from 60 to 90), or above normal (tachysystole more than 90 beats per minute). ).

An attack of atrial fibrillation is difficult to miss.

• It usually starts with a strong heartbeat.
• It develops as a series of absolutely non-rhythmic heartbeats with a high or normal frequency.
• The condition is accompanied by weakness, sweating, dizziness.
• The fear of death is very pronounced.
• There may be shortness of breath, general arousal.
• Sometimes there is a loss of consciousness.
• The attack ends with the normalization of the rhythm and the urge to urinate, in which a large amount of urine leaves.

To stop the attack, they use reflex methods, drugs in the form of tablets or injections, or resort to cardioversion (stimulation of the heart with an electric defibrillator). If an attack of atrial fibrillation is not eliminated within two days, the risks of thrombotic complications (pulmonary embolism, stroke) increase.

With a constant form of heartbeat flicker (when the rhythm is not restored either against the background of drugs or against the background of electrical stimulation of the heart), they become a more familiar companion of patients and are felt only with tachysystole (rapid irregular heartbeats). The main task when detecting signs of tachysystole of a permanent form of atrial fibrillation on the ECG is to slow down the rhythm to normosystole without trying to make it rhythmic.

Examples of recordings on ECG films:

• atrial fibrillation, tachysystolic variant, heart rate 160 in '.
• Atrial fibrillation, normosystolic variant, heart rate 64 in '.

Atrial fibrillation can develop in the program of coronary heart disease, against the background of thyrotoxicosis, organic heart defects, diabetes mellitus, sick sinus syndrome, intoxication (most often with alcohol).

atrial flutter

These are frequent (more than 200 per minute) regular atrial contractions and the same regular, but more rare ventricular contractions. In general, flutter is more common in the acute form and is better tolerated than flicker, since circulatory disorders are less pronounced. Trembling develops when:

• organic heart disease (cardiomyopathies, heart failure)
• after heart surgery
• on the background of obstructive pulmonary disease
• it almost never occurs in healthy people.

Clinically, flutter is manifested by rapid rhythmic heartbeat and pulse, swelling of the jugular veins, shortness of breath, sweating and weakness.

Conduction disorders

Normally, having formed in the sinus node, electrical excitation goes through the conduction system, experiencing a physiological delay of a fraction of a second in the atrioventricular node. On its way, the impulse stimulates the atria and ventricles, which pump blood, to contract. If in some part of the conduction system the impulse lingers longer than the prescribed time, then the excitation to the underlying sections will come later, which means that the normal pumping work of the heart muscle will be disrupted. Conduction disorders are called blockades. They can occur as functional disorders, but are more often the result of drug or alcohol intoxication and organic heart disease. Depending on the level at which they arise, there are several types of them.

Sinoatrial blockade

When the exit of the impulse from the sinus node is difficult. In fact, this leads to a syndrome of weakness of the sinus node, a decrease in contractions to severe bradycardia, impaired blood supply to the periphery, shortness of breath, weakness, dizziness and loss of consciousness. The second degree of this blockade is called the Samoilov-Wenckebach syndrome.

Atrioventricular block (AV block)

This is a delay in excitation in the atrioventricular node of more than the prescribed 0.09 seconds. There are three degrees of this type of blockade. The higher the degree, the less often the ventricles contract, the more severe the circulatory disorders.

• At the first delay allows each atrial contraction to maintain an adequate number of ventricular contractions.
• The second degree leaves part of the atrial contractions without ventricular contractions. It is described in terms of PQ prolongation and ventricular beat prolapse as Mobitz 1, 2, or 3.
• The third degree is also called a complete transverse block. The atria and ventricles begin to contract without interrelation.

In this case, the ventricles do not stop, because they obey the pacemakers from the underlying parts of the heart. If the first degree of blockade may not manifest itself in any way and be detected only with an ECG, then the second is already characterized by sensations of periodic cardiac arrest, weakness, fatigue. With complete blockades, cerebral symptoms (dizziness, flies in the eyes) are added to the manifestations. Morgagni-Adams-Stokes attacks may develop (when the ventricles escape from all pacemakers) with loss of consciousness and even convulsions.

Conduction disturbance within the ventricles

In the ventricles to the muscle cells, the electrical signal propagates through such elements of the conduction system as the trunk of the bundle of His, its legs (left and right) and the branches of the legs. Blockades can occur at any of these levels, which is also reflected in the ECG. In this case, instead of being covered by excitation at the same time, one of the ventricles is delayed, since the signal to it goes around the blocked area.

In addition to the place of origin, a complete or incomplete blockade is distinguished, as well as permanent and non-permanent. The causes of intraventricular blockades are similar to other conduction disorders (IHD, myo- and endocarditis, cardiomyopathies, heart defects, arterial hypertension, fibrosis, heart tumors). Also, the intake of antiarthmic drugs, an increase in potassium in the blood plasma, acidosis, and oxygen starvation also affect.

• The most common is the blockade of the anteroposterior branch of the left leg of the bundle of His (BPVLNPG).
• In second place is the blockade of the right leg (RBNB). This blockade is usually not accompanied by heart disease.
• Blockade of the left leg of the His bundle is more typical for myocardial lesions. At the same time, complete blockade (PBBBB) is worse than incomplete blockade (NBLBBB). It sometimes has to be distinguished from the WPW syndrome.
• The blockade of the posterior inferior branch of the left leg of the bundle of His can be in persons with a narrow and elongated or deformed chest. Of the pathological conditions, it is more characteristic of right ventricular overload (with pulmonary embolism or heart defects).

The clinic of blockades at the levels of the bundle of His is not expressed. The picture of the main cardiac pathology comes first.

• Bailey's syndrome - two-beam blockade (of the right leg and posterior branch of the left leg of the bundle of His).

Myocardial hypertrophy

With chronic overloads (pressure, volume), the heart muscle in some areas begins to thicken, and the heart chambers stretch. On the ECG, such changes are usually described as hypertrophy.

• Left ventricular hypertrophy (LVH) is typical for arterial hypertension, cardiomyopathy, and a number of heart defects. But even in normal athletes, obese patients and people engaged in heavy physical labor, there may be signs of LVH.
• Right ventricular hypertrophy is an undoubted sign of increased pressure in the pulmonary circulation system. Chronic cor pulmonale, obstructive pulmonary disease, cardiac defects (pulmonary stenosis, Fallot's tetralogy, ventricular septal defect) lead to HPZh.
• Left atrial hypertrophy (HLH) - with mitral and aortic stenosis or insufficiency, hypertension, cardiomyopathy, after myocarditis.
• Right atrial hypertrophy (RAH) - with cor pulmonale, tricuspid valve defects, chest deformities, pulmonary pathologies and pulmonary embolism.
• Indirect signs of ventricular hypertrophy are the deviation of the electrical axis of the heart (EOC) to the right or left. The left type of EOS is its deviation to the left, that is, LVH, the right type is LVH.
• Systolic overload is also evidence of hypertrophy of the heart. Less commonly, this is evidence of ischemia (in the presence of angina pain).

Changes in myocardial contractility and nutrition

Syndrome of early repolarization of the ventricles

Most often, it is a variant of the norm, especially for athletes and people with congenitally high body weight. Sometimes associated with myocardial hypertrophy. Refers to the peculiarities of the passage of electrolytes (potassium) through the membranes of cardiocytes and the characteristics of the proteins from which the membranes are built. It is considered a risk factor for sudden cardiac arrest, but it does not give a clinic and most often remains without consequences.

Moderate or severe diffuse changes in the myocardium

This is evidence of myocardial malnutrition as a result of dystrophy, inflammation (myocarditis) or cardiosclerosis. Also, reversible diffuse changes accompany disturbances in the water and electrolyte balance (with vomiting or diarrhea), taking medications (diuretics), and heavy physical exertion.

This is a sign of deterioration in myocardial nutrition without pronounced oxygen starvation, for example, in violation of the balance of electrolytes or against the background of dyshormonal conditions.

Acute ischemia, ischemic changes, T wave changes, ST depression, low T

This describes the reversible changes associated with oxygen starvation of the myocardium (ischemia). It can be either stable angina or unstable, acute coronary syndrome. In addition to the presence of the changes themselves, their location is also described (for example, subendocardial ischemia). A distinctive feature of such changes is their reversibility. In any case, such changes require comparison of this ECG with old films, and if a heart attack is suspected, rapid troponin tests for myocardial damage or coronary angiography should be performed. Depending on the variant of coronary heart disease, anti-ischemic treatment is selected.

Developed heart attack

It is usually described as:

• by stages. acute (up to 3 days), acute (up to 3 weeks), subacute (up to 3 months), cicatricial (lifelong after a heart attack)
• by volume. transmural (large focal), subendocardial (small focal)
• according to the location of the infarction. are anterior and anterior-septal, basal, lateral, inferior (posterior diaphragmatic), circular apical, posterior basal and right ventricular.

All the variety of syndromes and specific ECG changes, the difference in indicators for adults and children, the abundance of reasons leading to the same type of ECG changes do not allow a non-specialist to interpret even a ready-made conclusion of a functional diagnostician. It is much more reasonable, having an ECG result in hand, to visit a cardiologist in a timely manner and receive competent recommendations for further diagnosis or treatment of your problem, significantly reducing the risks of emergency cardiac conditions.

How to decipher the ECG of the heart?

An electrocardiographic study is the simplest, but very informative method for studying the work of a patient's heart. The result of this procedure is an ECG. Incomprehensible lines on a piece of paper contain a lot of information about the state and functioning of the main organ in the human body. Deciphering ECG indicators is quite simple. The main thing is to know some of the secrets and features of this procedure, as well as the norms of all indicators.

Exactly 12 curves are recorded on the ECG. Each of them tells about the work of each specific part of the heart. So, the first curve is the anterior surface of the heart muscle, and the third line is its posterior surface. To record the cardiogram of all 12 leads, electrodes are attached to the patient's body. The specialist does this sequentially, installing them in specific places.

Decryption principles

Each curve on the cardiogram graph has its own elements:

• Teeth, which are bulges directed down or up. All of them are denoted by Latin capital letters. "P" shows the work of the heart atria. "T" is the restorative capacity of the myocardium.
• Segments are the distance between several ascending or descending teeth in the neighborhood. Doctors are especially interested in indicators of such segments as ST, as well as PQ.
• An interval is a gap that includes both a segment and a tooth.

Each specific ECG element shows a certain process that occurs directly in the heart. According to their width, height and other parameters, the doctor has the ability to correctly decipher the data received.

How are the results analyzed?

As soon as the specialist receives the electrocardiogram in his hands, its decoding begins. This is done in a certain strict sequence:

1. The correct rhythm is determined by the intervals between the "R"-teeth. They must be equal. Otherwise, it can be concluded that the heart rhythm is incorrect.
2. With the help of an ECG, you can determine the heart rate. To do this, you need to know the speed at which the indicators were recorded. Additionally, you will also need to count the number of cells between the two R waves. The norm is from 60 to 90 beats per minute.
3. The source of excitation in the heart muscle is determined by a number of specific features. This will be told, among other things, by the evaluation of the parameters of the “P” wave. The norm implies that the source is the sinus node. Therefore, a healthy person always has a sinus rhythm. If there is a ventricular, atrial or any other rhythm, then this indicates the presence of pathology.
4. The specialist evaluates the conduction of the heart. This happens according to the duration of each segment and tooth.
5. The electrical axis of the heart, if it shifts to the left or right sharply enough, may also indicate problems with the cardiovascular system.
6. Each tooth, interval and segment is analyzed individually and in detail. Modern ECG devices immediately automatically issue indicators of all measurements. This greatly simplifies the work of the doctor.
7. Finally, the specialist makes a conclusion. It indicates the decoding of the cardiogram. If any pathological syndromes were found, they must be indicated there.

Normal indicators of adults

The norm of all indicators of the cardiogram is determined by analyzing the position of the teeth. But the rhythm of the heart is always measured by the distance between the highest teeth "R" - "R". Normally they should be equal. The maximum difference can be no more than 10%. Otherwise, it will no longer be the norm, which should be within 60-80 pulsations per minute. If sinus rhythm is more frequent, then the patient has tachycardia. On the contrary, a slow sinus rhythm indicates a disease called bradycardia.

The P-QRS-T intervals will tell you about the passage of the impulse directly through all the cardiac departments. The norm is an indicator from 120 to 200 ms. On the graph, it looks like 3-5 squares.

By measuring the width from the Q wave to the S wave, one can get an idea of ​​the excitation of the ventricles of the heart. If this is the norm, then the width will be 60-100 ms.

The duration of ventricular contraction can be determined by measuring the Q-T interval. The norm is 390-450 ms. If it is somewhat longer, a diagnosis can be made: rheumatism, ischemia, atherosclerosis. If the interval is shortened, we can talk about hypercalcemia.

What do teeth mean?

Without fail, when deciphering the ECG, it is necessary to monitor the height of all teeth. It can indicate the presence of serious pathologies of the heart:

• The Q wave is an indicator of excitation of the left cardiac septum. The norm is a quarter of the length of the R wave. If it is exceeded, there is a possibility of necrotic pathology of the myocardium;
• The S wave is an indicator of the excitation of those partitions that are in the basal layers of the ventricles. The norm in this case is 20 mm in height. If there are deviations, then this indicates coronary disease.
• The R wave in the ECG tells about the activity of the walls of all the ventricles of the heart. It is fixed in all ECG curves. If there is no activity somewhere, then it makes sense to suspect ventricular hypertrophy.
• The T wave appears in the I and II lines, as directed upwards. But in the VR curve it is always negative. When the T wave on the ECG is too high and sharp, the doctor suspects hyperkalemia. If it is long and flat, then there is a possibility of developing hypokalemia.

Normal pediatric electrocardiogram readings

In childhood, the norm of ECG indicators may differ slightly from the characteristics of an adult:

1. The heart rate of babies under 3 years old is about 110 pulsations per minute, and at the age of 3-5 years - 100 beats. This indicator in adolescents is already lower - 60-90 pulsations.
2. The norm of QRS readings is 0.6-0.1 s.
3. The P wave should normally not be higher than 0.1 s.
4. The electrical axis of the heart in children should remain unchanged.
5. The rhythm is only sinus.
6. On the ECG, the Q-T interval e can exceed 0.4 s, and P-Q should be 0.2 s.

Sinus heart rate in the decoding of the cardiogram is expressed as a function of heart rate on respiration. This means that the heart muscle is contracting normally. In this case, the pulsation is 60-80 beats per minute.

Why are the scores different?

Often, patients are faced with a situation where their ECG readings are different. What is it connected with? To get the most accurate results, there are many factors to consider:

1. Distortions in recording an ECG may be due to technical problems. For example, with incorrect gluing of results. And many Roman numerals look the same both upside down and upside down. It happens that the graph is cut incorrectly or the first or last tooth is lost.
2. Preliminary preparation for the procedure is important. On the day of the ECG, you should not have a hearty breakfast, it is even advisable to completely refuse it. You will have to stop drinking liquids, including coffee and tea. After all, they stimulate the heart rate. As a result, the results are skewed. It is best to take a shower beforehand, but you do not need to apply any body products. Finally, during the procedure you need to relax as much as possible.
3. The incorrect position of the electrodes cannot be ruled out.

It is best to check your heart on an electrocardiograph. He will help to carry out the procedure as accurately and accurately as possible. And in order to confirm the diagnosis indicated by the results of the ECG, the doctor will always prescribe additional studies.

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An electrocardiogram (ECG) is an instrumental diagnostic method that determines pathological processes in the heart by recording cardiac electrical impulses. A graphical representation of the activity of the cardiac muscles under the influence of electrical impulses enables the cardiologist to detect the presence or development of cardiac pathologies in time.

ECG decoding indicators help to determine with great certainty:

1. Frequency and rhythm of cardiac contraction;
2. Timely diagnose acute or chronic processes in the heart muscle;
3. Disorders of the conducting system of the heart and its independent rhythmic contractions;
4. See hypertrophic changes in its departments;
5. To reveal violations in the water-electrolyte balance and non-cardiac pathologies (cor pulmonale) throughout the body.

The need for an electrocardiographic examination is due to the manifestation of certain symptoms:

• the presence of synchronous or periodic murmurs in the heart;
• syncopal signs (fainting, short-term loss of consciousness);
• attacks of convulsive seizures;
• paroxysmal arrhythmia;
• manifestations of coronary artery disease (ischemia) or infarct conditions;
• the appearance of pain in the heart, shortness of breath, sudden weakness, cyanosis of the skin in patients with cardiac diseases.

An ECG study is used to diagnose systemic diseases, monitor patients under anesthesia or before surgery. Before medical examination of patients who have crossed the 45-year milestone.

An ECG examination is mandatory for persons undergoing a medical commission (pilots, drivers, machinists, etc.) or associated with hazardous production.

The human body has a high electrical conductivity, which allows you to read the potential energy of the heart from its surface. Electrodes connected to various parts of the body help with this. In the process of excitation of the heart muscle by electrical impulses, the voltage difference fluctuates between certain points of abduction, which is recorded by electrodes located on the body - on the chest and limbs.

A certain movement and magnitude of tension during systole and diastole (contraction and relaxation) of the heart muscle changes, the tension fluctuates, and this is fixed on a chart paper tape by a curved line - teeth, convexity and concavity. Signals are created and the tops of triangular teeth are formed by electrodes placed on the limbs (standard leads).

Six leads located on the chest display heart activity in a horizontal position - from V1 to V6.

On the limbs:

• Lead (I) - displays the voltage level in the intermediate circuit of the electrodes placed on the left and right wrists (I=LR+PR).
• (II) - fixes on the tape the electrical activity in the circuit - the ankle of the left leg + the wrist of the right hand).
• Lead (III) - characterizes the voltage in the circuit of the fixed electrodes of the wrist of the left hand and the ankle of the left leg (LR + LN).

If necessary, additional leads are installed, reinforced - "aVR", "aVF" and "aVL".

Deciphering the ECG diagram, photo

The general principles for deciphering the cardiogram of the heart are based on the indications of the elements of the cardiography curve on the chart tape.

The teeth and bulges in the diagram are indicated by capital letters of the Latin alphabet - “P”, “Q”, “R”, “S”, “T”

1. The convexity (tooth or concavity) "P" displays the function of the atria (their excitation), and the entire complex of the upwardly directed wave - "QRS", the greatest spread of the impulse through the heart ventricles.
2. The bulge "T" characterizes the restoration of the potential energy of the myocardium (the middle layer of the heart muscle).
3. Particular attention when deciphering the ECG in adults is given to the distance (segment) between adjacent elevations - "P-Q" and "S-T", displaying the delay in electrical impulses between the heart ventricles and the atrium, and the "TR" segment - relaxation of the heart muscle in the interval (diastole) .
4. The intervals on the cardiographic line include both hills and segments. For example - "P-Q" or "Q-T".

Each element on the graphic image indicates certain processes occurring in the heart. It is by the indicators of these elements (length, height, width), location relative to the isoline, features, according to the various locations of the electrodes (leads) on the body, that the doctor can identify the affected areas of the myocardium, based on the indications of the dynamic aspects of the energy of the heart muscle.

Deciphering the ECG - the norm in adults, table

The analysis of the result of the ECG decoding is carried out by evaluating the data in a certain sequence:

• Determination of heart rate indicators. With the same interval between the "R" teeth, the indicators correspond to the norm.
• The rate of heart contraction is calculated. It is determined simply - the ECG recording time is distributed by the number of cells in the interval between the "R" teeth. With a good cardiogram of the heart, the frequency of contractions of the heart muscle should be within the limits not exceeding 90 beats / min. A healthy heart should have a sinus rhythm, it is determined mainly by the elevation of the "P", reflecting the excitation of the atria. For wave motion, this norm indicator is 0.25 mV with a duration of 100 ms.
• The norm of the size of the depth of the "Q" tooth should not be more than 0.25% of the fluctuations in the height of the "R" and the width of 30 ms.
• The fluctuation width "R" of the elevation, during normal heart function, can be displayed with a large range ranging from 0.5-2.5 mV. And the activation time of excitation over the zone of the right heart chamber - V1-V2 is 30 ms. Above the zone of the left chamber - V5 and V6, it corresponds to 50 ms.
• According to the maximum length of the “S” wave, its dimensions in the norm with the largest lead cannot cross the threshold of 2.5 mV.
• The amplitude of the "T" fluctuations of the elevation, which reflects the restorative cellular processes of the initial potential in the myocardium, should be equal to ⅔ of the fluctuations of the "R" wave. The normal interval (width) "T" of elevation can vary (100-250) ms.
• The normal ventricular firing complex (QRS) width is 100 ms. It is measured by the interval of the beginning of the "Q" and the end of the "S" of the teeth. The normal amplitude of the duration of the "R" and "S" waves is determined by the electrical activity of the heart. The maximum duration should be within 2.6 mV.

Deciphering the ECG in children, the norm of indicators

The electrocardiogram in children, as practice shows, is not much different from the norm in adult patients. But certain physiological age characteristics can change some indicators. In particular, the heart rate. In young children, up to 3 years, they can be from 100 to 110 contractions / minute. But, already at puberty, it is equal to adult indicators (60-90).

Normally, when deciphering the ECG of the heart in children, the passage of electrical impulses through the parts of the heart (in the interval of elevations P, QRS, T) varies 120-200 ms.

The indicator of ventricular excitation (QRS) is determined by the width of the interval between the "Q" and "S" waves and should not cross the boundaries of 60-100 ms.

Particular attention is paid to the size (excitation activity) of the right ventricle (V1-V2). In children, this figure is higher than in the left ventricle. With age, the indicators return to normal.

• Quite often on the ECG in babies there are thickenings, splitting or notches on the "R" hills. Such a symptom in the cardiogram of adults indicates tachycardia and bradycardia, and in children it is quite a common condition.

But there are indications of a bad cardiogram hearts, which indicate the presence or progression of pathological processes in the heart. Much depends on the individual performance of the child. In addition, interruption or slowing of the normal heart rate is seen in children with chest pain, dizziness, frequent signs of blood pressure instability or impaired coordination.

If during an ECG examination of a child, an excess of the heart rate of more than 110 beats / min is diagnosed. - this is an alarming signal that speaks of the development of tachycardia.

It is necessary to immediately reduce physical activity in a child and protect him from nervous overexcitation. In children, these symptoms may be temporary, but if you do not take action, tachycardia will develop into a permanent problem.

Example ECG - Atrial tachycardia

ECG is the most common method for diagnosing a cardiac organ. Using this technique, you can get enough information about various pathologies in the heart, as well as monitor during therapy.

What is electrocardiography?

Electrocardiography is a method of studying the physiological state of the heart muscle, as well as its performance.

For the study, an apparatus is used that registers all changes in the physiological processes in the organ and, after processing the information, displays it in a graphic image.

The chart shows:

• Conduction of electrical impulses by the myocardium;
• The frequency of contractions of the heart muscle (HR -);
• Hypertrophic pathologies of the cardiac organ;
• Scars on the myocardium;
• Changes in myocardial function.

All these changes in the physiology of the organ, and in its functionality, can be recognized on the ECG. The electrodes of the cardiograph record the bioelectric potentials that appear during the contraction of the heart muscle.

Electrical impulses are recorded in different parts of the cardiac organ, so there is a potential difference between the excited and non-excited areas.

Who is prescribed an ECG study?

This technique is used for the diagnostic study of certain cardiac disorders and abnormalities.

Indications for the use of ECG:

What is the verification for?

Using this method of checking the heart, it is possible to determine abnormalities in cardiac activity at an early stage in the development of pathology.

An electrocardiogram is able to detect the most insignificant changes occurring in an organ that exhibits electrical activity:

• Thickening and expansion of the walls of the chambers;
• Deviations from the standard size of the heart:
• The focus of necrosis in myocardial infarction;
• The size of ischemic myocardial damage and many other deviations.

It is recommended to conduct a diagnostic examination of the heart after the age of 45, since during this period changes occur in the human body at the hormonal level, which affects the functioning of many organs, including the functioning of the heart.

Types of diagnostics

There are several methods of diagnostic research Ekg:

• Resting technique. This is a standard technique that is used in any clinic. If the ECG readings at rest did not give a reliable result, then it is necessary to use other methods of ECG research;
• Load verification method. This method includes a load on the body (exercise bike, treadmill test). According to this method, a sensor for measuring cardiac stimulation during exercise is inserted through the esophagus. This type of ECG is able to detect such pathologies in the cardiac organ, in which it is not possible to recognize in a person at rest. Also, the cardiogram is done at rest after exercise;
• Monitoring within 24 hours (Holter study). According to this method, a sensor is installed in the chest area, which records the functioning of the cardiac organ for 24 hours. A person with this method of research is not released from his daily household duties, and this is a positive fact in this monitoring;
• ECG through the esophagus. This test is performed when it is impossible to obtain the necessary information through the chest.

With pronounced symptoms of these diseases, it is worth coming to an appointment with a therapist or cardiologist and undergoing an ECG.

• Pain in the chest around the heart;
• High blood pressure - hypertension;
• Heart pain with temperature changes in the body;
• Age over 40 calendar years;
• Inflammation of the pericardium - pericarditis;
• Rapid heartbeat - tachycardia;
• Non-rhythmic contraction of the heart muscle - arrhythmia;
• Inflammation of the endocardium - endocarditis;
• Inflammation of the lungs - pneumonia;
• Bronchitis;
• Bronchial asthma;
• Angina pectoris - ischemic heart disease;
• Atherosclerosis, cardiosclerosis.

And also with the development of such symptoms in the body:

• Dyspnea;
• head spinning;
• Headache;
• fainting state;
• Palpitation.

Contraindications for ECG use

There are no contraindications for ECG.

There are contraindications for stress testing (stress ECG method):

• Cardiac ischemia;
• Exacerbation of existing cardiac pathologies;
• Acute myocardial infarction;
• Arrhythmia in a severe stage;
• Severe form of hypertension;
• Infectious diseases in acute form;
• Severe degree of heart failure.

If an ECG is needed through the esophagus, then a disease of the digestive system is a contraindication.

Study preparation

This test does not require the necessary preparation before studying.

But there are some rules for carrying out:

• Before the procedure, you can take food;
• Water can be taken without limiting oneself in quantity;
• Do not take drinks containing caffeine before the cardiogram;
• Before the procedure, refuse to take alcoholic beverages;
• Do not smoke before the ECG.

Execution technique

An electrocardiogram is carried out in every clinic. If an emergency hospitalization has occurred, then the ECG can be done within the walls of the emergency room, and the ECG can also be brought by an ambulance doctor upon arrival at the call.

Technique for performing a standard ECG at a doctor's appointment:

• The patient needs to lie down in a horizontal position;
• The girl needs to take off her bra;
• Areas of the skin on the chest, on the hands and on the ankles are wiped with a damp cloth (for better conductivity of electrical impulses);
• Electrodes are attached to the ankles and hands on a clothespin, and 6 electrodes on suction cups are put on the chest;
• After that, the cardiograph is turned on, and the recording of the functioning of the cardiac organ on the thermal film begins. The cardiogram graph is written as a curve;
• The procedure is carried out in time - no more than 10 minutes. The patient does not feel discomfort, there are no unpleasant feelings during the ECG;
• The cardiogram is decoded by the doctor who performed the procedure and the decoding will be transmitted to the patient's doctor, which allows the doctor to learn about the pathologies in the organ.

It is necessary to correctly apply the electrodes according to the colors:

• On the right wrist - a red electrode;
• On the left wrist, a yellow electrode;
• Right ankle - black electrode;
• The left ankle of the leg is a green electrode.

Indication results

After the result of the study of the cardiac organ is obtained, it is deciphered.

The result of an electrocardiographic study includes several components:

• Segments - ST, as well as QRST and TP- this is the distance that is noted between the teeth located nearby;
• Teeth - R, QS, T, P- these are angles that have a sharp shape, and also have a downward direction;
• PQ interval is a gap that includes teeth and segments. The intervals include the time interval for the passage of an impulse from the ventricles to the atrial chamber.

The waves on the electrocardiogram record are indicated by the letters: P, Q, R, S, T, U.

Each letter of the teeth is a position in the departments of the cardiac organ:

• R- atrial depolarity of the myocardium;
• QRS- ventricular depolarity;
• T- ventricular repolarization;
• U wave, which is poorly expressed, indicates the process of repolarization of sections of the ventricular conduction system.

Leads are standard:

• 1 - the first assignment;
• 2 - second:
• 3 - third;
• AVL is analogous to lead #1;
• AVF is analogous to lead #3;
• AVR - display in mirror format of all three leads.

Leads of the chest type (these are the points that are located on the left side of the sternum in the region of the cardiac organ):

• V No. 1;
• V No. 2;
• V No. 3;
• V No. 4;
• V No. 5;
• V No. 6.

The value of each lead registers the course of an electrical impulse through a certain place in the cardiac organ.

Thanks to each lead, the following information can be recorded:

• The cardiac axis is indicated - this is when the electrical axis of the organ is combined with the anatomical cardiac axis (clear boundaries of the location in the sternum of the heart are indicated);
• The structure of the walls of the chambers of the atria and the chambers of the ventricles, as well as their thickness;
• The nature and strength of blood flow in the myocardium;
• The sinus rhythm is determined and whether there are interruptions in the sinus node;
• Is there any deviation in the parameters of the passage of impulses along the wire paths of the organ.

According to the results of the analysis, the cardiologist can see the strength of myocardial excitation and determine the time period during which the systole passes.

Photo Gallery: Segment and Scar Measurements

Norms of the heart organ

All the main values ​​​​are listed in this table and mean normal indicators of a healthy person. If minor deviations from the norm occur, then this does not indicate pathology. The causes of small changes in the heart do not always depend on the functionality of the organ.

How to decipher a cardiogram yourself

Everyone wants to decipher the cardiogram before reaching the doctor's office.

The main task of the organ is performed by the ventricles. The chambers of the heart have partitions between them that are relatively thin.

The left side of the body and its right side are also different from each other, and have their own functional responsibilities.

The right ventricle performs the function of providing biological fluid - the blood flow of the pulmonary circulation, and this is a less energy-consuming load than the function of the left ventricle to push the blood flow into the large blood circulation system.

The left ventricle is more developed than its right neighbor, but it also suffers much more often. But regardless of the degree of load, the left side of the organ and the right side should work smoothly and rhythmically.

The structure of the heart does not have a homogeneous structure. It has elements that can contract - this is the myocardium, and the elements are irreducible.

The irreducible elements of the heart include:

• Nerve fibers;
• arteries;
• valve;
• Fat fiber.

All these elements differ in the electrical conductivity of the impulse and the response to it.

Functionality of the heart organ

The cardiac organ has the following functional responsibilities:

• Automatism is an independent mechanism for the release of impulses, which subsequently cause cardiac excitation;
• Myocardial excitability is the process of activation of the heart muscle under the influence of sinus impulses on it;
• Conduction of impulses through the myocardium - the ability to conduct impulses from the sinus node to the department of the contractile function of the heart;
• Myocardial crush under the action of impulses - this function makes it possible for the organ chambers to relax;
• Myocardial tonicity is a condition during diastole, when the heart muscle does not lose its shape and provides a continuous cardiac cycle;
• in statistical polarization (diastolic state) - electrically neutral. Under the influence of impulses, biocurrents are formed in it.

ECG analysis

A more accurate interpretation of electrocardiography is performed by calculating the teeth by area, using special leads - this is called the vector theory. Quite often, in practice, only the indicator of the direction of the electric axis is used.

This indicator includes the QRS vector. When deciphering this analysis, the direction of the vector is indicated, both horizontal and vertical.

The results are analyzed in a strict sequence, which helps to determine the norm, as well as deviations in the work of the cardiac organ:

• The first is an assessment of the rhythm of the heart and the heart rate;
• There is a miscalculation of intervals (QT at a rate of 390.0 - 450.0 ms);
• The duration of systole qrst is calculated (according to the Bazett formula);

If the interval becomes longer, then the doctor may make a diagnosis:

• Pathology atherosclerosis;
• Ischemia of the cardiac organ;
• Inflammation of the myocardium - myocarditis;
• Cardiac rheumatism.

If the result shows a shortened time interval, then pathology - hypercalcemia can be suspected.

If the conductivity of the pulses is calculated by a special computer program, then the result is more reliable.

• EOS position. The calculation is carried out from the isoline based on the height of the cardiogram teeth, where the R wave is higher than the S wave. If, on the contrary, the axis is deviated to the right side, then there is a violation in the efficiency of the right ventricle. If the axis deviates to the left, and the height of the S wave is higher than the R wave in the second and third leads, then there is an increase in the electrical activity of the left ventricle, the diagnosis is left ventricular hypertrophy;
• Next is the study of the complex of cardiac impulses QRS, which develop during the passage of electrical waves to the ventricular myocardium, and determines their functionality - according to the norm, the width of this complex is not more than 120 ms and the complete absence of a pathological Q wave. If this interval is shifted, then there is a suspicion of blocking the legs of the His bundle, as well as for conduction disturbance. Cardiological data on the blockade of the right-sided leg of the bundle of His are data on hypertrophy of the right-sided ventricle, and the blockade of its left leg is on hypertrophy of the left-sided ventricle;
• After studying the legs of His, a description of the study of ST segments occurs.. This segment displays the recovery time of the state of the myocardium after its depolarization, which is normally present on the isoline. The T wave is an indicator of the process of repolarization of the left and right ventricles. The T wave is asymmetrical, has an upward direction. The change in the T wave is longer than the QRS complex.

This is how the heart of a healthy person looks in all respects. In pregnant women, the heart in the chest is located in a slightly different place, and therefore its electrical axis is also displaced.

Depending on the intrauterine development of the fetus, additional loads on the heart muscle occur, and the electrocardiogram during the period of intrauterine development of the child reveals these signs.

Cardiogram indicators in childhood change in accordance with the growing up of the child. ECGs in children also reveal abnormalities in the cardiac organ and are deciphered in accordance with the standard scheme. After the age of 12, the heart of a child corresponds to the organ of an adult.

Can an EKG be fooled?

Many people try to cheat electrocardiography. The most common place is the commission of the military registration and enlistment office.

In order for the cardiogram to be abnormal, many take drugs that increase blood pressure, or lower it, drink a lot of coffee, or take heart medications.

Many do not understand that by trying to deceive the ECG machine, you can earn complications in the heart organ and in the vascular system. The rhythm of the heart muscle may be disturbed and the syndrome of ventricular repolarization may develop, and this is fraught with acquired heart disease and heart failure.

Most often simulate the following pathologies in the body:

• Tachycardia- rapid contraction of the heart muscle. Occurs from strenuous exercise to ECG analysis, drinking large amounts of caffeinated drinks, taking medications to increase blood pressure;
• Early ventricular repolarization (ERVR)- this pathology provokes the intake of heart drugs, as well as the use of drinks that contain caffeine in their composition (energy);
• Arrhythmia- Incorrect rhythm of the heart. This pathology can be caused by taking beta-blockers. Also, the correct myocardial rhythm is knocked down by the unlimited use of a coffee drink and a large amount of nicotine;
• hypertension- also provoked by coffee in large volumes and overload of the body.

The danger in the desire to deceive the ECG lies in the fact that in such an easy way you can really get a heart pathology, because taking heart drugs by a healthy body causes an additional load on the heart organ and can lead to its failure.

Then it will be necessary to conduct a comprehensive instrumental examination to identify pathology in the cardiac organ and in the blood flow system, and to establish how complicated the pathology has become.

ECG diagnosis - heart attack

One of the most serious cardiac diagnoses, which is detected by the ECG technique, is a bad cardiogram - a heart attack. In myocardial infarction, the decoding indicates the zone of myocardial damage by necrosis.

ECG determines not only the location of myocardial damage by necrosis, but also the depth to which necrotic destruction has penetrated.

The ability of electrocardiography is that the device can distinguish between an acute form of a heart attack from an aneurysm pathology, as well as from old infarct scars.

In the cardiogram, an elevated ST segment is written in myocardial infarction, as well as an R wave reflects deformation, and provokes the appearance of an acute T wave. The characteristic of this segment is similar to a cat's back in a heart attack.

How to calculate heart rate at home

There are several methods for counting the number of heart impulses in one minute:

• A standard ECG records at a rate of 50.0 mm per second. In this situation, the frequency of contraction of the heart muscle is calculated by the formula - the heart rate is 60 divided by R-R (in millimeters) and multiplied by 0.02. There is a formula, with a cardiograph speed of 25 millimeters per second - the heart rate is 60 divided by R-R (in millimeters) and multiplied by 0.04;
• You can also calculate the frequency of heart impulses according to the cardiogram using the following formulas - with a device speed of 50 millimeters per second - the heart rate is 600, divided by the average coefficient of the population of cells (large) between the types of R waves on the graph. With a device speed of 25 millimeters per second, the heart rate equals an index of 300 divided by the average index of the number of cells (large) between the type of R wave on the graph.

ECG of a healthy cardiac organ and in cardiac pathology

Description and characteristics of electrocardiography, which are normal, or have a pathology, and are given in a simplified version of the decoded information.

A complete decoding, as well as a conclusion about the functionality of the cardiac organ, can only be given by a specialized doctor - a cardiologist who owns a complete and extended professional scheme for reading an electrocardiogram.

In case of violations in children, a professional conclusion and evaluation of the cardiogram is issued only by a pediatric cardiologist.

Video: Daily monitoring.

Conclusion

ECG readings - transcripts - are the basis for making an initial diagnosis during emergency hospitalization, as well as for establishing a final cardiodiagnosis, together with other instrumental diagnostic methods.

The importance of ECG diagnostics was appreciated in the 20th century, and to this day, electrocardiography remains the most common research technique in cardiology. Using the ECG method, diagnostics are made not only of the cardiac organ, but also of the vascular system of the human body.

The advantage of electrocardiography is its simplicity in execution, low price for diagnostics and accuracy in readings.

To use the results of the ECG to make an accurate diagnosis, it is only necessary to compare its results with the results of other diagnostic studies.

Probably every adult at least once in his life has come across such a method of examination as an ECG. Many people know that this abbreviation stands for “electrocardiogram” and with its help the heart rhythm is recorded. On this, perhaps, for most patients, all knowledge ends and on the resulting tape they see nothing but a broken line.

ATTENTION!

For especially curious people who want to find out about their state of health even before visiting a specialist, let's try to figure out how the ECG is decoded and what can be learned from it.

Moreover, on our website you can always get advice from a qualified cardiologist who can interpret the data on the cardiogram tape in detail and accurately.

ECG is not only a modern, but also the most accessible method for determining the characteristics of heart activity. Thanks to portable devices, the procedure can be carried out and read in almost extreme conditions: on the street, at home, in an ambulance or in other transport, and it takes only 5-7 minutes.

Indications for this procedure can be any unpleasant sensations that appear in the chest, with “echoes” of pain in the back, left arm, and abdominal cavity. In addition, a doctor of any specialization can refer a patient to an ECG as part of a routine examination or if he has:

• severe shortness of breath;
• hypertension;
• interruptions in the rhythm of the heart or noise in it;
• frequent fainting (or after a single case);
• causeless weakness;
• swelling of the extremities, etc.

Patients who have had a heart attack or stroke should be examined according to the prescription of the attending physician. In some cases, it is necessary to record the indicators of the daily work of the heart or with loads. And in order to prevent malfunctions in the work of the organ, even a healthy person should undergo an electrocardiography procedure at least 1 time in 1-2 years.

Can the heart be recorded?

To understand how to decipher a cardiogram, you should learn a little about the principle of the human heart and the method of taking an ECG.

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On the wall of the right atrium there is a sinus node, from which the propagation of impulses normally begins. Passing through the muscles of the atrium, the excitation reaches the antroventricular node, then into the bundle of His and along its legs, the impulse propagates through the tissues of the ventricles. All this causes 4 sections of the heart to contract. It is this pattern of excitations that is normal and gives rise to sinus rhythm.

As you know, the human body has electrical conductivity, so the biocurrents of the heart can be projected onto its surface and recorded using ECG devices.

From the point of view of physics, an electrocardiogram is nothing more than a registration of electrical signals, which is carried out from several sections of the heart muscle. To do this, plates are attached to certain points of the body that transmit signals to the ECG apparatus.

In practice, 3 standard bipolar leads (I, II, III), 3 reinforced unipolar leads (aVR, aVL, aVF), which are attached to the limbs, and 6 reinforced unipolar chest leads (V 1 -V 6) are used. But, despite the simplicity of their layout, only a trained physician can correctly fix the electrodes, otherwise the ECG results will be incorrect. Three more leads (V 7 -V 9) are less commonly used, which provide more accurate information about abnormalities in the myocardium of the posterior wall of the left ventricle.

From the video below, you can learn more about the propagation of impulses in the heart and the correct application of electrodes during an ECG.

Prongs and intervals

All received electrical signals are converted into graphic information and applied to a special tape, which is divided into squares of 1 mm 2 . Thus, we see the whole process of the work of our heart as a curve with pronounced teeth, for convenience they have their own “names”: P, Q, R, S, T.

Each tooth reflects certain actions of the heart muscle and their duration:

• P - excitation of the right and then the left atrium, united by one tooth (at least 0.12 s.);
• Q - excitation of the interventricular septum (0.03 s);
• R - excitation of the apex of the heart with the adjacent area (0.05 s.);
• S - excitation of the base of the organ (0.02 s.);

The Q, R, S waves are considered as a single ventricular complex (0.10 s).

• T - this wave displays repolarization, that is, the restoration of the initial state of all parts of the heart.

The teeth form corresponding segments and intervals between themselves.

When deciphering a cardiogram, specialists usually adhere to a certain sequence.

Heart rate and frequency

Normally, the rhythm should be sinus, that is, the impulse "originates" in the sinus node. This will be indicated by the P wave, which should precede the QRS complex and be positive in all leads except aVR. If this is not the case, then we can talk about the pathology of the heart. In case of weakness of the sinus node, the atrioventricular node, bundles of His, or Purkinje fibers can become the pacemaker. This information can be indicated by the functional diagnostician on the ECG tape. In addition, it indicates the heart rate (HR), which, however, can be calculated independently. To do this, it is enough to find out at what speed the ECG was recorded and find out the distance R-R (count the number of small squares between them).

If the writing speed is 25 mm / s, then it should be calculated according to the following formula:

HR= 60/R-R*0.04;

If - 50 mm / s, then heart rate \u003d 60 / R-R * 0.02;

For an adult, the normal heart rate is 60-90 beats per minute. For children, all indicators of the cardiogram change and "grow" with them. For example, the frequency varies from 110 in the first months of life to 90 strokes in adolescence.

If the rhythm is accelerated, then this indicates tachycardia, if slowed down, then bradycardia, and if the R-R distance is not the same, then this condition is called arrhythmia.

The figure shows examples of normal heart rhythm (a), tachycardia (b), bradycardia (c) and irregular rhythm (arrhythmia) of an adult (d).

Electrical axis of the heart

Next, the specialist draws attention to the location of the EOS. It can be not only normal, but also have a vertical, horizontal orientation, or be deviated to one of the sides. This indicator may depend on several factors at once - high growth, overweight, age, pregnancy, etc., therefore, it is not worth immediately and unequivocally making conclusions about deviations in the work of an adult organ. However, as well as ignore the changes, especially if the axis shift happened quite abruptly. This may indicate problems with the respiratory system, the development of heart disease, changes in the myocardium, atherosclerosis, etc. In this case, an additional examination of the patient will be scheduled.

When reading an ECG to determine the EOS, the following algorithm is used.

Wave and spacing analysis

ECG analysis is not complete without monitoring the waves and intervals. It all starts with the P wave, which, as mentioned above, should be sinus. If it has an increased amplitude or duration in the second lead, then this may indicate hypertrophy of the right or left atrium, respectively. Further, by evaluating the PQ interval, it is possible to identify the blockade of the antroventricular node, which is characterized by an increased duration of the PQ interval or its complete absence.

A separate point in the analysis of the ECG is the reading of the QRS complex. Normally, its duration is 60-100 ms. Its elongation is evidence of a conduction disturbance in the legs of the His bundle. Below are examples of areas of the ECG, where the blockade of the right and left legs is clearly visible.

Moreover, a Q wave deeper than 1/3 of the R wave may indicate myocardial infarction.

The QT interval displays the duration of ventricular contraction and is 390-450 ms. Its lengthening indicates the development of coronary heart disease, and its shortening indicates hypercalcemia. The ST segment normally should not rise above the isoline by more than 1 mm and decrease by more than 0.5 mm. Violation of the first condition indicates an acute infarction or pericarditis, and the second - about ischemia.

The video shows the sequence and more detailed decoding of all the teeth of the ECG intervals:

But no matter how detailed such information is presented, it should be understood that only a specialist can correctly interpret the cardiogram.

The ruler is an indispensable assistant

Sometimes it happens that a person's life depends on precious minutes, during which the doctor must understand what is the reason for the deterioration of the patient's condition and take appropriate measures. Ambulance paramedics sometimes have to make a diagnosis right at the patient's home, relying only on electrocardiography indicators. It goes without saying that the analysis in such a situation must be carried out extremely quickly and at the same time correctly. For such emergencies and to help medical students, a ruler was developed for interpreting the obtained ECG.

With its help, you can quickly read the ECG: determine the heart rate, measure and compare intervals with the norm, their duration, and also determine the EOS. Such an invention as a ruler can also become useful when trying to decipher the ECG on your own.

Other ways to look into the "motor" of the human body

In addition to the electrocardiogram, modern medicine has methods for examining the heart, such as echocardiography and the method of daily heart rate monitoring.

Holter method

This method allows you to obtain continuous data on the work of the heart for 24 hours (and sometimes even up to 7 days). Daily monitoring allows you to identify pathologies that are determined in special conditions. To do this, 2 or 3 electrodes (rarely more) are attached to the patient's body, a registrar is worn on the belt or over the shoulder on the belt, which keeps a continuous record. At the same time, the subject leads a normal life, with the usual physical activity, recording the time and circumstances in which unpleasant sensations appeared.

Recorders are divided into those that record on magnetic media and those that have digital memory. The analysis of the accumulated information is carried out on a computer with the software installed for this, but it is not complete without adjusting the results by a specialist. The conclusion on daily monitoring of the work of the heart contains the same mandatory items as in a conventional ECG. Only information about well-being is added, according to the diary, prescribed loads and related changes.

Echocardiogram

Like any organ, the heart is subject to ultrasound. The doctor performing the procedure sees a real-time video of the beating heart on the screen. Like conventional ultrasound, echocardiography is absolutely painless and has no contraindications. EchoCG may be prescribed if the patient:

• Murmurs in the heart;
• Signs of ventricular failure;
• IHD in chronic or acute form;
• chest trauma;
• Suspicion of aortic aneurysm or other vascular abnormalities, etc.

During echocardiography, a functional diagnostician can establish:

• Condition of all heart valves;
• The dimensions of all chambers of the heart and the thickness of their walls;
• Direction of blood flows and their speed;
• Pressure in the pulmonary artery.

To identify hidden pathologies or abnormalities that are not diagnosed at rest, certain loads can be assigned to the patient during echocardiography. This is called stress echo.

As practice shows, three factors can affect the results of echocardiography:

• Features of the patient, for example, obesity, specific location of the heart, chest deformity, emphysema.
• Experience and qualifications of a functional diagnostician.
• Ultrasound class.

Therefore, only one result of echocardiography does not make final conclusions about the health of the heart and does not make diagnoses. This procedure is usually prescribed in combination with electrocardiography.

conclusions

This article is more of a fact-finding character, because only a cardiologist who has been studying the heart for many years can read an electrocardiogram correctly. Thus, each person will be able to determine whether he has a sinus rhythm, heart rate, compare the duration of the intervals with the norm, and, guided by the proposed algorithm, set the EOS.

But it is worth reminding once again, if you find any abnormalities on your ECG, do not rush to diagnose yourself and take medication - wait for the doctors' opinion.

Be healthy!

And some secrets...

• Do you often experience discomfort in the area of ​​the heart (stabbing or squeezing pain, burning sensation)?
• You may suddenly feel weak and tired...
• The pressure keeps dropping...
• There is nothing to say about shortness of breath after the slightest physical exertion ...
• And you have been taking a bunch of medications for a long time, dieting and watching your weight...

But judging by the fact that you are reading these lines, victory is not on your side. That is why we recommend that you read new technique of Olga Markovich, which has found an effective remedy for the treatment of HEART diseases, atherosclerosis, hypertension and vascular cleansing.