Ministry of Health of Ukraine

National Pirogov Memorial Medical University,

Vinnytsya Department of Internal Medicine №2

History of electrocardiography,
from the past to the present

Doctor of Medicine, Prof. Masik N.P.

 Electrocardiography (ECG)
- a method of graphical registration of electrical
potentials from the surface of the body that occur
in the heart muscle during its activity.
 Relevance of ECG diagnostics
• According to the WHO, every third patient with
cardiovascular disease suffers from various heart rhythm
disorders.
• Arrhythmias are found in various cardiovascular diseases
and in healthy individuals.
• There is a clear trend to increase the percentage of
arrhythmias in the population (1.6 times over the past 15
years).
• In the United States - extrasystole was observed in 6.5%
of healthy individuals, in Japan - in 1.4% of men and
1.1% of women.
• Over the last decade, there has been a fourfold increase in
arrhythmias in the pediatric population.
 ELECTROCARDIOGRAPHY
-With the help of an ECG device, the generated
electric fields are recorded, followed by the output
of the results in the form of a graphic image on
thermal paper (in most cases).
-One of the significant and obvious advantages of
this research method is its safety. This allows you to
repeat the study without restrictions, which is very
important not only for diagnosing the disease, but
also to monitor its course, monitor the effectiveness
of treatment and predict complications.
 Four periods in the 100-year history of ECG
development and cardiac monitoring
• The first period - from 1902 to 1930 - included the invention,
development and implementation of ECG in 3 leads.
• The second period - from 1930 to 1942 - includes the development
of thoracic leads and the introduction of 12-channel ECG.
• The third period concerns the development of cardiac monitoring in
the cardiac intensive care units.
• The fourth period includes the introduction of cardiac monitoring in
"non-intensive" departments and the development of modern
telemetric monitoring methods during the late twentieth and early
twenty-first century.
 The beginning of the history of electrocardiography
(ECG)
• It dates back to 1600, when William Gilbert, Queen Elizabeth's physician, coined
the term electrica (from the Greek electra - amber).
• Then (1660) Otto Von Guericke introduced the first static generator.
• Jan Swammerdam also entered history, writing to Prince Tuscany in 1668 about
the rhythm of frog muscles when silver and copper wires come into contact.
• In 1729, the study developed Stephen Gray with the concept of conducting
pulses with wet hemp wire at a distance of 150 m, later also replaced by copper.
• The city of Leiden (Holland) entered the history of the ECG thanks to Pieter van
Musschenbroek, who proposed the idea of ​a capacitor made of nails, cork and
jars.
• Later, Jean-Antoine Nollet (1746) sent electricity through Leiden's bank through
180 Imperial Guards to King Louis XV.
• John Walsh in 1773 describes an electric current from an eel.
• All this allowed Luigi Galvani in 1780, and then Hans Oerstad (1819) to propose
the idea of ​the interaction of nerve and scalpel, neuromuscular apparatus and
electric dynamo, and thus - formed the basis for the idea of ​the DVR - the idea of
​galvanometer.
 Detection of electrical phenomena
that occur in muscle tissue
• A Treatise on the Forces of
Electricity in Muscular Motion in
1791
• The study of the influence of
atmospheric electricity in stormy
weather on the muscles of frogs led to
Luigi Galvani the conclusion that the existence of
(1791) so-called "animal electricity"
Italian doctor and • This discovery formed the basis of
physiologist experimental electrophysiology.
• Alessandro Volta fights against Galvani - on
the principle of determining electricity only for
metallic origin and the impossibility of
electricity in a living organism, but Volta
created columns of zinc / copper, zinc / silver
with cardboard and salt gaskets.
• In 1820, Johann Schweigger proposed a
wrapped copper wire as an amplifier of
electricity, and therefore - this is the first
galvanometer, as evidenced by the outstanding
Michael Faraday.
Literary glorification of the idea of an electric
recorder cannot be overlooked

• Thus, the wife of Lord Byron Mary Shelly

(1818) created an essay "Frankenstein" with
the idea of the impact of electricity on the
restoration of the life of the executed man. The
creation of the electromagnetic concept is
underway.
 Physiologists are not left out:
1842 Carlo Matteuci describes electrical changes
depending on cardiac activity.
In 1845, Purkinje commissioned Palicke to study
unusual muscle cells in a sheep's heart and came
up with the idea of branching the conduction
system of the heart.
Emil Dubois-Reymond (1843) describes the
"action potential" - the electric current of muscle
contraction with the creation of the most
sensitive galvanometer of the time using a 5 km
long copper wire.
 In 1856, German scientists Robert
Kelliker and Johann Müller
discovered the presence of electrical
phenomena in the contraction of the
heart muscle.
Robert Kelliker
They conducted research on
various animals, working with an
open heart.

Johann Müller
 The real possibility of studying the electrical
impulses of the heart appeared when the first
capillary electrometer was designed - a device
that allows you to record electrical potentials
 The discovery of the Marey (1876) electrometer to
study the electrical activity of the frog's heart,
 1878 John Burden Sanderson and Frederick Page record
the electrical activity of the heart with a capillary
electrometer.
 In 1887, the British physiologist Augustus D. Waller of
St Mary's Medical School (London) published the first
recording of the electrical activity of the human heart,
recorded by the Thomas Goswell capillary electrometer.
 In 1887, A. Waller first received a record
of the electrical activity of the human
myocardium.
He first formulated the basic principles of
electrophysiological concepts of the
myocardium, assuming that the heart is a
dipole - a set of two electric charges,
equal in magnitude but opposite in sign,
located at some distance from each other.
Augustus D. Waller Waller also has such a concept as the
English physiologist "electric axis of the heart."
 He was the first to remove the
electrocardiogram from the
category of scientific experiments
and introduced it into wide medical
practice.
In 1913, Einthoven proposed a
method of placing electrodes on the
human body.

The scientist's merits were

appreciated, and in 1924 he was
Willem Einthoven awarded the Nobel Prize in
professor at Leiden University
Physiology or Medicine "for the
discovery of the ECG mechanism."
 William Einthoven - a man of interesting
destiny,
• was born in the city of Semarang on the island of Java (Dutch East
Indies, now Indonesia), the third of six children in the family of
doctors Jacob Einthoven and Louise de Vogel.
• After returning to Utrecht (Netherlands) in 1870 and graduating from
school, Einthoven entered the medical faculty of Utrecht University,
and in 1885 defended his dissertation on color differentiation
stereoscopy and received his doctorate.
• At the age of 25, Einthoven was appointed professor of physiology at
the University of Leiden.
• After attending Augustus D. Waller's experiments, Einthoven spent 6
years developing a string galvanometer consisting of a thin quartz
wire that is held in a magnetic field and records the oscillations of
electric potentials.
In 1893, at the congresses of the German Medical
Association, he proposed the term
"electrocardiography" for the new method, and two
years later the scientist divided the ECG curve into five
waves - P, Q, R, S, T. After seven years of hard work
in 1903 on Einthoven created his first
electrocardiograph on the basis of the string
galvanometer invented by
D. Schweigger.
The first electrocardiograph was a very bulky device, it was located
on several tables and weighed about 270 kg. It was serviced by five
qualified assistants.
Einthoven laid a
cable up to 2 km
long and in 1905
made the first
transmission of
ECG by telephone,
proposed the Latin
prefix "tele-" to
define remote
medical care.
The scientist introduced the
concept of "diversion",
He proposed three standard
leads from the extremities,
which allowed to register the
potential differences between
the left and right hand (lead I),
between the right hand and left
foot (lead II) and between the
left hand and left foot (lead III),
which together formed the so-
called triangle Einthoven.
Electrocardiogram recording (photo from the
first textbook on ECG, 1906)
 The ECG recording system is being created
• In 1909, D.F. Nicolai, A. Simons describe the signs of the
ECG in angina.
• In 1911, Thomas Lewis published the first classic
monograph, The mechanism of the heart beat.
• In 1932, the American physiologist Frank Wilson (N.F.
Wilson) described the amplified leads VR, VL and VF with
an indifferent electrode.
• In 1938, the American Heart Association and the Cardiac
Society of Great Britain described the standard ECG
position and the V1-6 chest lead system.
• In the future, Emanuel Goldberger increased the voltage of
Wilson's unipolar leads by 50% and created a system of
aVR, aVL in aVF, and thus - formed a system for recording
12 leads ECG.
The gold standard of ECG diagnostics is electrocardiography
with 12 leads: 3 standard, 3 amplified and 6 thoracic.
 Electrocardiographic leads
• Measurement of the potential difference on the body
surface that occurs during heart function is recorded
using different ECG leads. Each lead registers the
potential difference that exists between two specific
points of the heart's electric field where the electrodes
are installed.
• Electrodes installed at each of the selected points on the
body surface are connected to the electrocardiograph
galvanometer. One of the electrodes is connected to the
positive pole of the galvanometer (a positive or active
electrode), the other electrode - to its negative pole
(negative electrode).
 Installation of electrodes on the limbs
• To record standard and
amplified leads, the electrodes
are placed on the right arm (red
marking), on the left arm
(yellow marking), on the left leg
(green marking). The fourth
electrode is placed on the right
leg (black marking).
• Reinforced unipolar leads, as
well as standard, make it
possible to register changes in
the electromotive force of the
heart in the frontal plane.
 STANDARD ECG DRIVES (by Willem Einthoven)

I assignment
(+) left hand -
(-) right hand;
ІІ assignment
(+) left foot -
(-) right hand;
III assignment
(+) left foot -
(-) left hand.
ENHANCED ECG DRIVES
(by Emanuel Goldberger)

+
CHEST ECG DRIVE (by Wilson)
V1 - active electrode in the
fourth intercostal space on the
right edge of the sternum;
V2 - active electrode in the
fourth intercostal space from the
left edge of the sternum;
V3 - active electrode at the
level of the fourth rib (the middle
of the distance between V2 and V4;
V4 - active electrode in the
fifth intercostal space on the left
mid-clavicular line;
V5 - active electrode in the
fifth intercostal space on the left
along the anterior axillary line;
V6 is the active electrode in
the fifth intercostal space along the
left middle axillary line.
 ADDITIONAL
ELECTROCARDIOGRAPHIC LEADS

• Left chest : V7 -V9

• Right chest (V3R – V6R)
• Bipolar chest leads across the sky
• Chest assignments for Slopak
• Esophageal endocardiogram
• Intracardiac endocardiogram
 ADDITIONAL ECG DRIVES

Installation of the left Establishment of the

chest leads right chest leads
 Bipolar thoracic leads according to Nehb
• The red-marked electrode is placed in the
second intercostal space on the right edge
of the sternum;
• the electrode with green marking is set in
the lead position V4,
• the yellow-marked electrode is placed in
the V intercostal space along the posterior
axillary line.
• Register the assignment of "Dorsalis" (D).
"Anterior" (A) and "Inferior" (I).
• Nehb leads are used to diagnose focal
changes in the myocardium of the
posterior wall "Dorsalis", anterior-lateral
wall "Anterior" and the lower parts of the
anterior wall "Inferior".
 The ECG recording system is being created
• Since 1949, Norman Jeff Holter (Montana) has
been creating a 75-pound (30 kg) backpack with
ECG recording hardware - the era of Holter's
outpatient monitoring begins.
• Today, ECG recording is performed using a
special portable device that the patient carries
with him.
• The study is a continuous recording of the
electrocardiogram for 12 hours or more.
Recording is conducted on 2-12 channels. the
most common are 2- and 3-channel recorders.
 Holter ECG monitoring
- one of the popular methods of
diagnosing heart rhythm disorders.
- It is indicated for patients with
complaints of palpitations and heart
failure, with fainting
- to detect arrhythmias and conduction of
the heart,
-also for the registration of "silent"
(painless) myocardial ischemia,
-to evaluate some parameters of the
pacemaker.
Disposable adhesive electrodes are used to make contact with the patient's body.
An important condition for quality recording is the preparation of the skin
surface: it is degreased and slightly scarified. Then the skin is wiped with
alcohol, dried and glued electrodes.
 The principle of construction of the electrocardiograph

Electrocardiographs consist of an input device, a

biopotential amplifier and a recorder. The
potential difference that occurs on the surface of
the body during the work of the heart is
registered using a system of metal electrodes,
reinforced in different parts of the body with
rubber belts or pears. Through the input wires
marked in different colors, the electrical signal is
fed to the switch, and then to the input of the
amplifier, which consists of triodes of integrated
circuits.
perform thermal recording of the ECG with a
heated pen and as if "burns" the corresponding
curve on a special thermal paper. Finally, there
are capillary-type electrocardiographs
(mingographs) in which the ECG is recorded
using a thin stream of spray ink.
 Single-channel devices
They are used in almost all public and private treatment and prevention facilities,
ambulance services. This portable electrocardiograph weighs up to 1 kg. The
device has a built-in mini-printer that outputs ECG data on thermal paper. There is
a possibility of automatic diagnosis. This ECG device can be powered by mains or
built-in battery.
There are even smaller models (about 800 g), which are successful among
paramedics. It is possible to record a small amount of data in the memory of the
ECG device
 Three-channel devices
Such electrocardiographs are equipped with a thermal printer
and three-channel output of the study results. Have the
following features:
•calculations are performed automatically, control of the
device is not required;
•the thermal printer has a significant expansion, which allows,
in addition to graphical data of the electrocardiogram, to
indicate personal information about the patient, the
electrostatic precipitator used, the level of increase in the
amplitude of the study;
•the results can be transferred to a personal computer to
calculate additional indicators;
•there is a possibility of defibrillation.
 Six-channel device
This ECG device has a wider scope. It is used
by employees of rescue services, military
hospitals, ambulance services, private clinics.
ECG recording is possible on two types of six-
channel devices: portable (portable) and
computer.

Features:
•saving in memory about 1000 results of inspection (there is a hard disk
with 10 GB);
•the ability to examine 150 patients without recharging the device;
•high speed printing, which is carried out automatically;
•the ability to use multiple paper sizes to capture results.
 TWELVE CHANNEL electrocardiographs
The device allows you to record an hourly data for one patient, enter
data about the patient, as well as control the electrocardiograph from a
computer. An interesting point is that you can enter these rules, and in
the case of deviations in the examination of the device will give a
signal of violation. Make an ECG allows a set consisting of the
following elements:
•electrocardiograph;
•a computer that can communicate with the ECG device via wired or
wireless communication;
•a printer that allows you to print data of diagnostic results;
•ergometer - a device that can be used to assess the work of the heart
muscle with the load, connected to the electrocardiograph via
Bluetooth;
•Software.
Thank you!