Electrocardiography

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Electrocardiography (ĭlĕk'trōkärdēŏg`rəfē), science of recording and interpreting the electrical activity that precedes and is a measure of the action of heart muscles. Since 1887, when Augustus Waller demonstrated the possibility of measuring such action, physicians and physiologists have recorded it in order to study the heart's normal behavior and to provide a method for diagnosing abnormalities. Electrical current associated with contraction of the heart muscles passes through the various tissues and reaches the surface of the body. What is actually recorded is the change in electrical potential on the body surface. The first practical device for recording the activity of the heart was the string galvanometer developed by William Einthoven in 1903. In this device a fine quartz string is suspended vertically between the poles of a magnet. The string is deflected in response to changes in electrical potential and its movement can be optically enlarged and photographed, or, if an immediately visible record is desired, the string's movement can be recorded on a sheet of paper. A more sophisticated form of the electrocardiograph employs a vacuum-tube amplifier. The greatly amplified current from the body deflects a mirror galvanometer that causes a beam of light to move across a light-sensitive film. When an electrocardiograph is taken, electrodes (leads) are attached to the extremities and to the left chest. The recordings obtained in this manner are called electrocardiograms, or more simply EKG's or ECG's. A normal EKG shows a sequence of three waves arbitrarily labeled P, QRS, and T. The P wave is a small, low-amplitude wave produced by the excitation of the atria of the heart. It is followed by a resting interval that marks the passage of electrical impulses into the ventricles. Following this interval comes the QRS wave, a rapid, high-amplitude wave marking ventricular excitation, and then a slow-building T wave denoting ventricular recovery. Abnormalities may be noted from deviation in wave form, height, direction, or duration. The type of abnormal wave may sometimes indicate the type of heart disorder. Usually the physician must associate the EKG with other clinical observations to determine the cause of the abnormality.

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