The document provides an overview of ECG waveforms, specifically focusing on P waves in atrial enlargement conditions. It details how right and left atrial enlargements affect P wave characteristics, along with descriptions of other heart conditions like atrial fibrillation and ventricular fibrillation. Additionally, it outlines the procedure for conducting an ECG, including patient preparation, equipment setup, and post-procedure steps.

1. ECG

2. P wave
•It represents atrial
depolarisation
•Smooth contour

3. Right Atrial Enlargement – Lead II
• In right atrial enlargement,
right atrial depolarisation lasts
longer than normal and its
waveform extends to the end
of left atrial depolarisation.
• The combination of these two
waveforms produces a P
waves that is taller than
normal (> 2.5 mm), although
the width remains unchanged
(< 120 ms).

4. Left Atrial Enlargement – Lead II
• In left atrial enlargement, left
atrial depolarisation lasts longer
than normal but its amplitude
remains unchanged.
• Therefore, the height of the
resultant P wave remains within
normal limits but its duration is
longer than 120 ms.
• A notch (broken line) near its
peak may or may not be present
(“P mitrale”).

9. Acute STEMI may produce ST elevation with either
concave, convex or obliquely straight morphology.

10. Atrial Fibrillation
• Features:
1. Tachycardia
2. The rhythm is usually irregularly
irregular
3. No P waves
4. Shaky baseline

12. Ventricular fibrillation
•Completely disordered ventricular
depolarisation
• Not compatible with a cardiac output
• Results in a completely irregular trace
consisting of broad QRS complexes of
varying widths, heights and rates

17. PROCEDURE
•Explain the procedure to the patient
•Do hand wash
•Close the doors and the curtains
•Place ECG machine at the bedside and open
electrode package
•Ensure proper standardization of ECG machine
and enter all demographic data into the
machine

18. •Provide supine position to the patient with
exposed chest
•Remove moisture oil and excess hair from
the electrode site , apply electrode gel and
attach electrode to the chest
•Apply limb electrodes to the extremities of
the patient
•Instruct the patient to lie still while ECG is
being recorded

19. •After the procedure remove leads of
electrodes wipe the gel from the skin and
wash hands
•Interpret ECG and inform physician
•Replace the machine and document the
procedure

20. Thank you