Normal conduction pathway in the heart starts in the SA node, located in the wall of the right atrium, because this is where the normal rhythmical impulse is generated and is then conducted to the atrioventricular (AV) node by the internodal pathways. From here the AV bundle conducts the impulse from the atria into the ventricles where the left and right bundle branches of so called Purkinje fibers conduct the cardiac impulse to all parts of the ventricles. Impulses are also conducted by the atrial and ventricular muscle fibers, the only difference is in the speed of conduction which is much slower in this case than in the case of specialized conductive muscle fibers.
Arrhythmias (or dysrhythmias) are problems that affect the electrical system of the heart muscle, producing abnormal heart rhythms. They can cause the heart to pump less effectively. * when the heart&#x2019;s natural pacemaker develops an abnormal rate or rhythm. * when the normal conduction pathway is interrupted. * when another part of the heart takes over as pacemaker.
What causes arrhythmias?
Many arrhythmias have no known cause. However, a number of factors can contribute to arrhythmias. They include coronary artery disease, high blood pressure, diabetes, smoking, excessive use of alcohol or caffeine, drug abuse and stress. Certain substances, including some over-the-counter and prescription medications, dietary supplements and herbal remedies are known to cause arrhythmias in some peoplWhat
fatigue, dizziness, lightheadedness, fainting or near-fainting spells.
Blood clots can form during atrial fibrillation, a disorder found in 2.2 million Americans. In atrial fibrillation the atria quiver instead of beating effectively. Blood isn&#x2019;t pumped completely out of them when the heart beats, so the blood pools and clots.
If part of a blood clot in the atria leaves the heart and lodges in an artery in the brain (or leading to it), a stroke results. About 15 percent of strokes occur in people with atrial fibrillation.
What is atrial fibrillation (AF)?
Atrial fibrillation is a disorder found in about 2.2 million Americans. During atrial fibrillation, the heart&#x2019;s two small upper chambers (the atria) quiver instead of beating effectively. Blood isn&#x2019;t pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results. About 15 percent of strokes occur in people with atrial fibrillation.
The likelihood of developing atrial fibrillation increases with age. Three to five percent of people over 65 have atrial fibrillation
is death resulting from an abrupt loss of heart function (cardiac arrest). The victim may or may not have diagnosed heart disease. The time and mode of death are unexpected. It occurs within minutes after symptoms appear. The most common underlying reason for patients to die suddenly from cardiac arrest is coronary heart disease (fatty buildups in the arteries that supply blood to the heart muscle).
* Age: Men > 45; Women > 55
* Family History
* You can !!
* High Cholesterol
* High Blood Pressure
* Physical Inactivity
Interactions of Risk Factors
* Risk operates across a continuum - no clearcut line
* The risk is multiplicative when many risk factors co-
* exist; risk factors often cluster together
* Majority of events arise in individuals with modest
* elevations of many risk factors than from marked
* elevation of a single risk factor
"Doctor Secret Tip: Every pound of body weight lost drops your blood pressure by 1 point."
Misfortunes always come in by a door that has been left open for them. Czechoslovakian proverb
* otal cholesterol < 200;
* LDL < 100
* HDL > 40
* triglycerides < 200
Optimal levels : 120 /80 mm Hg
Fasting < 100; post meals <140
# Why Me ?
* Genetic predisposition
* Poor handling of fats and metabolic syndrome
o Diabetes, obesity, high BP, Coronary artery disease
* Environmental insults
* Sudden change in lifestyle
# For my car, I want the best mechanic. But for my own body, I follow hearsay and advice from friends, kitty party, local quacks&#x2026;. Just anyone And decide for the worst # Creative strategies do not work !
* Karva Chauth!
* Never had a test or retest
* Never been to Doctor ! I hate them
* Never take medicines!
* My BP is normal, so stopped meds!
* Miracle men and Miracle Medicines! So many of them
* I am my own doctor! No fees too
While a variety of technologically advanced diagnostic tests are available, the simple, well established 12 lead electrocardiogram (ECG) is cardiology's most widely used screening tool. Over 200 million ECGs are performed annually in developed nations. The electrocardiogram (ECG) is the most commonly conducted cardiovascular diagnostic procedure and a fundamental tool of clinical practice. It is indeed considered the "first choice" procedure in the evaluation of patients with chest pain, dizziness, or syncope.
the cardiac impulse passes through the heart, but while doing so electrical current also spreads from the heart into the adjacent tissues surrounding the heart. A small portion of the current spreads all the way to the surface of the body. If electrodes are placed on the skin on opposite sides of the heart, electrical potentials generated by the current can be recorded; the recording is known as an electrocardiogram.
Ten electrodes are used for a 12-lead ECG. They are labeled and placed on the patient's body as follows:
Electrode label (in the USA) Electrode placement
RA On the right arm, avoiding bony prominences.
LA In the same location that RA was placed, but on the left arm this time.
RL On the right leg, avoiding bony prominences.
LL In the same location that RL was placed, but on the left leg this time.
V1 In the fourth intercostal space (between ribs 4 & 5) just to the right of the sternum (breastbone).
V2 In the fourth intercostal space (between ribs 4 & 5) just to the left of the sternum.
V3 Between leads V2 and V4.
V4 In the fifth intercostal space (between ribs 5 & 6) in the mid-clavicular line (the imaginary line that extends down from the midpoint of the clavicle (collarbone).
V5 Horizontally even with V4, but in the anterior axillary line. (The anterior axillary line is the imaginary line that runs down from the point midway between the middle of the clavicle and the lateral end of the clavicle; the lateral end of the collarbone is the end closer to the arm.)
V6 Horizontally even with V4 and V5 in the midaxillary line. (The midaxillary line is the imaginary line that extends down from the middle of the patient's armpit.) a a
P wave: During normal atrial depolarization, the main electrical vector is directed from the SA node towards the AV node, and spreads from the right atrium to the left atrium. This turns into the P wave on the ECG. Duration :80ms
PR segment: The PR segment connects the P wave and the QRS complex.Duration:150 to 200ms
QRS complex :The QRS complex is a recording of a single heartbeat on the ECG that corresponds to the depolarization of the right and left ventricles.70 to 110ms
ST segment:The ST segment connects the QRS complex and the T wave.80 to 120ms
T wave: The T wave represents the repolarization (or recovery) of the ventricles. The interval from the beginning of the QRS complex to the apex of the T wave is referred to as the absolute refractory period. The last half of the T wave is referred to as the relative refractory period (or vulnerable period).160ms
PR interval :The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex.120 to 200ms
ST interval :The ST interval is measured from the J point to the end of the T wave.320ms
QT interval :The QT interval is measured from the beginning of the QRS complex to the end of the T wave. 300 to 440ms
U wave: The U wave is not always seen. It is typically small, and, by definition, follows the
One-lead ECG recorders may also be used for monitoring the heart in association with regular exercise, workouts, and sports activities
People with pacemakers. * Women in late stage pregnancy. * In addition, under no circumstances should the ONE ECG be used in conjunction with a defibrillator
Self-diagnosis and treatment based on measurement results is very dangerous.Please ask your doctor to analyze the measurement results
If you or someone in your family already diagnosed with heart disease
* Don&#x2019;t get disheartened &#x2013; science has made significant progress
* Just monitor risk factors much more aggressively
o Eat healthy
o Walk regularly
o Watch your weight
o Quit smoking immediately
o Keep your weight under control
o In addition to improving your heart &#x2013; health these measures are sure to enhance your appearance !!
Heart disease is often avoidable. Following a heart-healthy lifestyle doesn't have to be complicated, and it doesn't mean you need to live a life of self-deprivation. Instead, find ways to incorporate heart-healthy habits into your lifestyle &#x2014; and you may well enjoy a healthier life for years to come.
What is Normal Heart Rate?
The Heart is the first
organ formed at 22
Day after Conception.
In Adult the heart beats
at around 70 beats/
minute and 100,000
What is Normal Heart Rhythm?
•Normal Conduction pathway
starts in SA Node with the
generation of Normal
•From here it is conducted to AV
node by internodal pathways.
•Then impulse is transmitted
from the atria to ventricles.
•From here,to the right and left
bundle branches of purkinje
fibres,the cardiac impulses are
conducted to all parts of the
Normal ECG tracing
What is Abnormal Heart Rhythm
•Arrhythmias(or dysrhythmias) are
problems that effect the electrical
system of the heart muscles.
•They produce abnormal heart
•They can cause the heart to pump
Why does it occur?
•When the heart's natural pacemaker
•When normal conduction pathway is
•When another part of the heart acts
as a pacemaker.
What causes Abnormal Heart
•Coronary Artery Disease
•High Blood Pressure
•Abuse of Alcohol or
•Some Dietary Supplements
What are the Different Types of
Abnormal Heart Rhythms?
<60 beats per
>100 beats per
When the Atria is affected:it is
known as Atrial Fibrillation
When the Ventricle is affected:it
is known as Ventricular
What are the Symptoms of
Abnormal Heart Beats
Slow heart Beat Fast Heart Beat
•Fatigue •Chest Pain
What are the complications of
Abnormal Heart Rhythms
•When the blood is not
pumped effectively from
Heart,Blood pools and
clots like in Atrial
•If the clot leaves the heart
and gets stuck in the brain
it causes Stroke.
•Numbers:15 percent of
stroke occurs in people
with atrial fibrillation.
What is Atrial Fibrillation?
When the heart's two
upper chambers the atria
quiver instead of beating
3 to 5 percent of people
over 65 have atrial Purple arrow indicates P wave which is
lost as shown in red arrow
What is Sudden Cardiac Death?
•Death resulting from an
abrupt loss of heart
•The victim may or may
not have diagnosed heart
•Death occurs within
•Common causes are
Coronary artery disease-
when the arteries that
supply blood to the heart
muscle are blocked.
What does increase the risk for
Coronary Heart Disease?
You cannot Stop IT! You Can Stop IT!
•Age:Men>50 years Smoking
•Women >55 years High Blood Pressure
•Family History Alcohol
• Physical Inactivity
How does the risk factor increase
the risk of Heart Disease?
•Risk factors often have a multiplier effect.
•Risk factors often cluster together to increase the risk of
•Physical inactivity and poor eating habits and alcohol in
excess can lead to Obesity.
•Obesity can increase risk for Diabetes.
•Modest elevations of these risk factors over a period of
time and Increased age can predispose to heart disease.
•Smoking increases the risk of inhaling not only cancer
causing substances but they also damage the delicate
arteries supplying blood to the heart.
Tips to reduce your risk
Assess your Heart Health Risks
•For every pound of body
weight lost,your blood
pressure also drops.
•Develop healthy eating habits-
read food labels carefully for
•Brisk walking for 30 mins
reduces your risk for
developing diabetes by 30%
•Talk to your physician about
your risk for developing heart
Misfortunes always come in by a
door that has been left open for
Do not wait for Heart Disease
•Do not wait for Heart
disease to develop prior to
•Develop Healthy eating
•Quit Smoking and Drinking
•Talk to your physician about
What are your numbers!
They are not your bank account numbers!!
These are your health account numbers
Know them well before it is too late.
Optimal Lipid levels in Blood :
•Total Cholesterol <200
Optimal Blood pressure level:
Blood sugar level:
•Post meals <140
How do you prevent Abnormal
Better Management of Heart Disease Risk
•High Blood Pressure
•Changes in Food Habits
•Lack of Exercise
•Poor Eating habits.
Avoid these !!
•1.Self Medication-Never visited a
Physician to Save Time and Money.
•2 Never do a blood test or ECG.
•3.Never take medicines prescribed by
•4.Visit Miracle Men and take Miracle
•5.Follow hearsay advice from
Friends,Neighbours and then wait for
•6.Blood pressure or Blood sugar is
Normal,so full stop to Medicines,bye to
How can you diagnose Abnormal
The Simple testing
tool is a 12 lead
It is the first choice
procedure in the
patients with chest
What is an Electrocardiogram?
•When the cardiac impulse passes through the
•The electric current also spreads from the heart
into adjacent tissues around the heart.
•A small portion of the current spreads all the
way to the surface of the body.
•If electrodes are placed on the skin on opposite
side of the heart,electric potentials generated by
the current an be recorded by an
instrument :this recording is known as an
How do you record an ECG?
Ten electrodes are used for a 12 lead ECG
•RA:On the right arm.
•LA:On the left arm.
•RL:on the right leg
•LL:on the left leg
•V1: Fouth intercostal space between
the 4 &5 ribs right side of the sternum
•V2:Fourth intercostal space between
the 4 & % ribs on left of the sternum
•V3:Between the leads V2 and V4
•V4:In the fifth intercostal space
between the ribs 5& 6 in mid-clavicular
•V5:Horizontally even with V4 in
anterior axillary line.
•V6: Horizontally even with V4 and V5
in Mid axillary line.
It is recommended to avoid bony
prominences while placing the leads
What are the different components of ECG
•P wave:represents atrial
•PR interval:Time for the
impulse to travel from Atria
depolarization of right and
•QT interval:From the
beginning of QRS complex
to end of T wave
•T wave: Represents
normal ventricular re
What are the difficulties with 12
•What does it
•What does it
How can we deal with ?
Is this the option?
What are the other methods of
monitoring the heart activity?
•Although 12 lead ECG is the "Gold Standard"
for measuring Heart related electrical impulses,
•There are other methods to measure ECG at
Home,at work,during exercise and regular
•These can be shown to Physicians for further
Single Lead ECG
Single Lead ECG recorders may be
used for monitoring the heart In
•Checking out various arrhthymias.
What can single ECG do?
Screening for Heart Disease
only for Abnormal Rhythms.
•Cannot be used in
patients with pacemaker.
•Women in late stage of
•In Conjuction with a
Talk to your physician
Self-diagnosis and treatment based on
measurement results are very dangerous.Always
consult you physician to analyze your results.
What if I am already diagnosed
with heart disease
•Monitor your risk
•KEEP your weight
under optimum level
•TALK to your Physician.
Avoiding Heart Disease
*Following healthy lifestyle
strategies does not mean you have
to be self-deprived of all good
things in life.
*But,it is self-motivation for
incorporating healthy habits so that
you could live a healthy life longer
with your family.
*You should not have any worries
about medications and visiting
hospitals regularly for heart