Physiology Practical
Electrocardiogram
Instructor: Dr. Diederik Kuster
(Illustration: Vander’s Human Physiology, 11th edition)
Location
Medical Faculty of VU Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, Room B-039.
Preparation
Study the manual prior to the practical and take the manual with you.
1
,GENERAL RULES – PRACTICALS PHYSIOLOGY
It is assumed that every participating student is aware of these rules.
1. Preparation
You must thoroughly study the practical manual and theory; the relevant course material and
specified pages from the textbooks.
2. On time
The practicals start exactly on time; being late means not being able to follow the practical in
question at that time. You must then follow the practical at a different time (see 7).
3. Entry test
To test your preparation, the practical starts with 7 multiple choice questions; with less than 3
correct answers you cannot participate the practical. You must then follow the practical at a
different time (see 7). The questions can be asked both from the manual and from the other
compulsory subject matter.
NB: These entry tests are specifically intended to stimulate individual preparation for the
practicals. It is absolutely forbidden to copy, distribute and/or make public the questions or the
answers of these entry test(s), in any way. In the event of fraud, a note of unprofessional behavior
is passed on to the Examination Board.
4. Prohibited
Smoking, eating or drinking in the practicum room is prohibited; mobile phones must be switched
off. Mobile phones may therefore not be used to read the PDFs of the practical manuals. For this
purpose only tablets and laptops may be used or a "hard copy" of the text.
5. Afterwards
You must leave your unit in good condition. Clean your table and sign out by the practical student
assistant. Only then have you fulfilled all obligations.
6. Follow the practical at a different time than scheduled
Contact the course coordinator to get permission to switch places with another student. Without
prior permission the access to the practical course will be denied.
7. Did you miss the practical?
Contact the course coordinator to get information about the possibilities to catch up the practical
course that you missed.
For general questions about the Physiology practicals:
Dr. P. Koolwijk - Head of Physiology Practicals - O|2 building, by appointment only.
Tel. Secr. Physiology: 0627339910, or e-mail:
2
, Physiology Practical Electrocardiogram (ECG)
Aims of this practical:
Understanding of the shape of the ECG
Understanding the shape of the ECG when using different leads
Examination of the effect of exercise on the ECG
Understanding the relationship between phonocardiography and ECG
1. ELEKTROCARDIOGRAM (ECG)
Introduction
The conducting system
In contrast to skeletal muscle, cardiac muscle tissue has the property to contract autonomously (auto
rhythmicity). Every contraction of the heart is preceded by a depolarization wave which spreads from
the atria over the ventricles. The electrical impulses are generated in the sinoatrial (SA) node, and are
conducted to the ventricles via the atrioventricular (AV) node, the bundle of His, the right and left
bundle branches and Purkinje fibers. Depolarization of the muscle cell is accompanied by changes in
ion currents that lead to contraction.
The electrocardiogram - introduction
The electrocardiogram (ECG) reflects the sum of electrical impulses which occur in the heart, and
provides information about certain aspects of the condition of the heart. The fundamental function of
the ECG was developed by the Dutch scientist Wilhelm Einthoven at the beginning of the twentieth
century. He received the Nobel Prize for his work.
The electrical events of the heart are detected by electrodes on the surface of the body. The higher
the intensity of the electrical signal, the greater the amplitude of the ECG will be. A good interpretation
of an ECG recording requires knowledge of the heart and its function.
Depolarization and repolarization
Every contraction of the heart is preceded by a wave of depolarization spreading from the atria over
the muscle cells of the ventricles. During depolarization, cardiac muscle cells become relatively more
positive, and during the subsequent repolarization they become more negative. The waves of
depolarization and repolarization are registered by the electrodes, thus generating a picture of the
electrical activity of the heart (a ‘lead’). By looking at the depolarization and repolarization waves from
different points using different sets of ECG electrodes, one can obtain a complete picture of the
electrical activity of the heart.
3
Electrocardiogram
Instructor: Dr. Diederik Kuster
(Illustration: Vander’s Human Physiology, 11th edition)
Location
Medical Faculty of VU Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, Room B-039.
Preparation
Study the manual prior to the practical and take the manual with you.
1
,GENERAL RULES – PRACTICALS PHYSIOLOGY
It is assumed that every participating student is aware of these rules.
1. Preparation
You must thoroughly study the practical manual and theory; the relevant course material and
specified pages from the textbooks.
2. On time
The practicals start exactly on time; being late means not being able to follow the practical in
question at that time. You must then follow the practical at a different time (see 7).
3. Entry test
To test your preparation, the practical starts with 7 multiple choice questions; with less than 3
correct answers you cannot participate the practical. You must then follow the practical at a
different time (see 7). The questions can be asked both from the manual and from the other
compulsory subject matter.
NB: These entry tests are specifically intended to stimulate individual preparation for the
practicals. It is absolutely forbidden to copy, distribute and/or make public the questions or the
answers of these entry test(s), in any way. In the event of fraud, a note of unprofessional behavior
is passed on to the Examination Board.
4. Prohibited
Smoking, eating or drinking in the practicum room is prohibited; mobile phones must be switched
off. Mobile phones may therefore not be used to read the PDFs of the practical manuals. For this
purpose only tablets and laptops may be used or a "hard copy" of the text.
5. Afterwards
You must leave your unit in good condition. Clean your table and sign out by the practical student
assistant. Only then have you fulfilled all obligations.
6. Follow the practical at a different time than scheduled
Contact the course coordinator to get permission to switch places with another student. Without
prior permission the access to the practical course will be denied.
7. Did you miss the practical?
Contact the course coordinator to get information about the possibilities to catch up the practical
course that you missed.
For general questions about the Physiology practicals:
Dr. P. Koolwijk - Head of Physiology Practicals - O|2 building, by appointment only.
Tel. Secr. Physiology: 0627339910, or e-mail:
2
, Physiology Practical Electrocardiogram (ECG)
Aims of this practical:
Understanding of the shape of the ECG
Understanding the shape of the ECG when using different leads
Examination of the effect of exercise on the ECG
Understanding the relationship between phonocardiography and ECG
1. ELEKTROCARDIOGRAM (ECG)
Introduction
The conducting system
In contrast to skeletal muscle, cardiac muscle tissue has the property to contract autonomously (auto
rhythmicity). Every contraction of the heart is preceded by a depolarization wave which spreads from
the atria over the ventricles. The electrical impulses are generated in the sinoatrial (SA) node, and are
conducted to the ventricles via the atrioventricular (AV) node, the bundle of His, the right and left
bundle branches and Purkinje fibers. Depolarization of the muscle cell is accompanied by changes in
ion currents that lead to contraction.
The electrocardiogram - introduction
The electrocardiogram (ECG) reflects the sum of electrical impulses which occur in the heart, and
provides information about certain aspects of the condition of the heart. The fundamental function of
the ECG was developed by the Dutch scientist Wilhelm Einthoven at the beginning of the twentieth
century. He received the Nobel Prize for his work.
The electrical events of the heart are detected by electrodes on the surface of the body. The higher
the intensity of the electrical signal, the greater the amplitude of the ECG will be. A good interpretation
of an ECG recording requires knowledge of the heart and its function.
Depolarization and repolarization
Every contraction of the heart is preceded by a wave of depolarization spreading from the atria over
the muscle cells of the ventricles. During depolarization, cardiac muscle cells become relatively more
positive, and during the subsequent repolarization they become more negative. The waves of
depolarization and repolarization are registered by the electrodes, thus generating a picture of the
electrical activity of the heart (a ‘lead’). By looking at the depolarization and repolarization waves from
different points using different sets of ECG electrodes, one can obtain a complete picture of the
electrical activity of the heart.
3
