# 20.7 Nerve conduction–electrocardiograms  (Page 4/8)

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## Electrocardiograms

Just as nerve impulses are transmitted by depolarization and repolarization of adjacent membrane, the depolarization that causes muscle contraction can also stimulate adjacent muscle cells to depolarize (fire) and contract. Thus, a depolarization wave can be sent across the heart, coordinating its rhythmic contractions and enabling it to perform its vital function of propelling blood through the circulatory system. [link] is a simplified graphic of a depolarization wave spreading across the heart from the sinoarterial (SA) node , the heart’s natural pacemaker.

An electrocardiogram (ECG)    is a record of the voltages created by the wave of depolarization and subsequent repolarization in the heart. Voltages between pairs of electrodes placed on the chest are vector components of the voltage wave on the heart. Standard ECGs have 12 or more electrodes, but only three are shown in [link] for clarity. Decades ago, three-electrode ECGs were performed by placing electrodes on the left and right arms and the left leg. The voltage between the right arm and the left leg is called the lead II potential and is the most often graphed. We shall examine the lead II potential as an indicator of heart-muscle function and see that it is coordinated with arterial blood pressure as well.

Heart function and its four-chamber action are explored in Viscosity and Laminar Flow; Poiseuille’s Law . Basically, the right and left atria receive blood from the body and lungs, respectively, and pump the blood into the ventricles. The right and left ventricles, in turn, pump blood through the lungs and the rest of the body, respectively. Depolarization of the heart muscle causes it to contract. After contraction it is repolarized to ready it for the next beat. The ECG measures components of depolarization and repolarization of the heart muscle and can yield significant information on the functioning and malfunctioning of the heart.

[link] shows an ECG of the lead II potential and a graph of the corresponding arterial blood pressure. The major features are labeled P, Q, R, S, and T. The P wave is generated by the depolarization and contraction of the atria as they pump blood into the ventricles. The QRS complex is created by the depolarization of the ventricles as they pump blood to the lungs and body. Since the shape of the heart and the path of the depolarization wave are not simple, the QRS complex has this typical shape and time span. The lead II QRS signal also masks the repolarization of the atria, which occur at the same time. Finally, the T wave is generated by the repolarization of the ventricles and is followed by the next P wave in the next heartbeat. Arterial blood pressure varies with each part of the heartbeat, with systolic (maximum) pressure occurring closely after the QRS complex, which signals contraction of the ventricles.

Taken together, the 12 leads of a state-of-the-art ECG can yield a wealth of information about the heart. For example, regions of damaged heart tissue, called infarcts, reflect electrical waves and are apparent in one or more lead potentials. Subtle changes due to slight or gradual damage to the heart are most readily detected by comparing a recent ECG to an older one. This is particularly the case since individual heart shape, size, and orientation can cause variations in ECGs from one individual to another. ECG technology has advanced to the point where a portable ECG monitor with a liquid crystal instant display and a printer can be carried to patients' homes or used in emergency vehicles. See [link] .

## Phet explorations: neuron

Stimulate a neuron and monitor what happens. Pause, rewind, and move forward in time in order to observe the ions as they move across the neuron membrane.

## Section summary

• Electric potentials in neurons and other cells are created by ionic concentration differences across semipermeable membranes.
• Stimuli change the permeability and create action potentials that propagate along neurons.
• Myelin sheaths speed this process and reduce the needed energy input.
• This process in the heart can be measured with an electrocardiogram (ECG).

## Conceptual questions

Note that in [link] , both the concentration gradient and the Coulomb force tend to move ${\text{Na}}^{+}$ ions into the cell. What prevents this?

Define depolarization, repolarization, and the action potential.

Explain the properties of myelinated nerves in terms of the insulating properties of myelin.

## Problems&Exercises

Integrated Concepts

Use the ECG in [link] to determine the heart rate in beats per minute assuming a constant time between beats.

80 beats/minute

Integrated Concepts

(a) Referring to [link] , find the time systolic pressure lags behind the middle of the QRS complex. (b) Discuss the reasons for the time lag.

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