Department of Cardiology
SBKS MI & RC
1. Suspected heart attack
2. Suspected pulmonary embolism
3. A third heart sound, fourth heart
sound, a cardiac murmur or other
findings to suggest structural heart
disease
4. Perceived cardiac dysrhythmias
5. Fainting or collapse
6. Seizures
7. Monitoring the effects of a heart
medication
8. Assessing severity of electrolyte
abnormalities, such as hyperkalemia
• the process of
recording the
electrical activity of
the heart over a
period of time using
electrodes placed
on a patient's body.
• These electrodes
detect the tiny
electrical changes
on the skin that
arise from the
heart muscle
depolarizing during
each heartbeat.
Preparation
1. Ensure that the client did not receive any
medication
2. Ask your pt to remove all jewelry and to wear a
hospital gown
3. Usually ECG is taken while the patient is resting so
ask your pt to lie down
4. Areas such as the chest where the adhesive
electrodes will be placed may need to be shaved
first, then skin is cleaned
Preparation
5. Avoid oily or greasy skin creams and
lotions the day of the test. They interfere
with the electrode-skin contact
6. Avoid full-length hosiery, as electrodes
need to be placed directly on the legs.
7. Wear a shirt that can be easily removed to
place the leads on the chest.
Placement of electrodes
Ten electrodes are used for a 12-lead ECG.
The electrodes usually consist of a conducting gel,
embedded in the middle of a self-adhesive pad onto
which cables clip. Sometimes the gel also forms the
adhesive. They are labeled and placed on the
patient's body
Proper placement of the limb electrodes, color-coded
The limb electrodes can be far down on the limbs or
close to the hips/shoulders, but they must be even
(left vs right)
Electrode
Electrode placement
label
RA On the right arm, avoiding thick muscle.
In the same location where RA was placed, but
LA
on the left arm.
RL On the right leg, lateral calf muscle.
In the same location where RL was placed, but
LL
Instruct patient to be calm and no movement, Then print
the result
The test is completely painless and takes less than a minute
to perform once the leads are in position.
After the test, the electrodes are removed & clean the skin
15
16
17
18
22
Anatomical
orientation:
Figure (Marquette
Electronics, 1996)
1: Yanowitz, FG. The Alan E Lindsay ECG Learning Centre in Cyberspace
(From:
[homepage on the Internet]. c2012. Available from:
[Link]
In a conventional 12 lead ECG, ten electrodes
are placed on the patient's limbs and on the
surface of the chest recorded over a period of
time (usually 10 seconds).
A typical ECG tracing is a repeating cycle of
three electrical entities:
a. a P wave (atrial depolarization)
b. a QRS complex (ventricular
depolarization)
c. a T wave (ventricular repolarization).
27
LATERAL
LATERAL
28
INFERIOR
INFERIOR INFERIOR
29
RIGHT SIDE
30
Antero-Septal
ANT & RV
Lateral
ANT & RV
Antero-Septal Lateral
31
32
33
34
35
Are the limb leads set up correctly?
Are the chest leads set up correctly?
Is the ECG free of artifact.
36
LIMB LEADS CHEST LEADS
AVR – always R wave progression
negative Small to Tall
Lead I – always
positive
37
Artifact
Electricalinterference
Muscle tremor
Wandering baseline
38
39
40
Heart Rate
Rhythm: regular? sinus?
Intervals: PR, QRS
ST segment
41
Voltage
0.04
(millivolts; seconds
mV)y
(1 1) 0.1 mV
mm2
x
’ x Time
(seconds; s)
Question: What would
the bigger square, i.e.
the (5 5) mm2,
represent?
y Answer: 0.2 seconds.
’
43
46
Heart Rate
Rhythm: regular? sinus?
Intervals: PR, QRS
ST segment
47
48
50
51
52
53
54
55
56
60
61
62
63
64
65
66
68
69
70
71
72
73
74
75
The Normal ECG
Sinus rhythm (P before QRS)
Rate 50 – 100 bpm
Axis +90o to –30o
Intervals: PR .12-.20 sec
QRS <.12 sec
Correct electrode placement
? Regular ? Sinus/ ’p’ wave
Rate
Recognize basic values
77