ELECTROCARDIOGRAPH

Y
(ECG)

ANATOMY OF THE HEART

ANATOMY OF THE HEART

3 Layers:
Inner layer / Endocardium - consists of
endothelial tissue and lines the inside of
the heart and valves
Middle layer / Myocardium - made up of
muscle fibers and responsible for the
pumping action
Exterior layer/ Epicardium
2 Layers of Pericardium
Visceral Pericardium - adheres to the
epicardium
Parietal Pericardium - a tough fibrous
tissue that attaches to the great vessels,
diaphragm, sternum and vertebral column.
Supports the heart in mediastenum.
*Pericardial Space the space between two
layers, filled with 30ml of fluid for
lubrication of the hearts surface and
reduction of friction during systole

ANATOMY OF THE HEART

Heart Chambers
Right Ventricle distributes
venous blood (deoxygenated
blood) to the lungs via
pulmonary artery for
oxygenation.
Left Ventricle distributes
oxygenated blood to the
remainder of the body
through the aorta
Right Atrium receives blood
returning from the superior
vena cava (head, neck, upper
extremities), inferior vena
cava (trunk and lower
extremities), and coronary
sinus (coronary circulation)
Left Atrium receives
oxygentaed blood from the
pulmonary circulation via the
pulmonary veins

ANATOMY OF THE HEART

Heart Valves

Permits blood to flow in only one direction

Composed of thin leaflets of fibrous tissue

Open and close in response to the

movement of blood

Pressure changes within the chambers

1.

2.

ATRIOVENTRICULAR VALVES

Separates the atria from the ventricle

1.
Tricuspid Valve separates the right
atrium from the right ventricle
2.
Mitral/Bicuspid Valve lies between
the left atrium and left venticle
SEMILUNAR VALVES
1.
Pulmonic Valve between the right
ventricle and pulmonary artery
2.
Aortic Valve between the left
ventricle and the aorta

CARDIAC
ELECTROPHYSIOLOGY
Cardiac Conduction System
- Generates and transmits electrical
impulses that stimulate contraction of
the myocardium
- Stimulates first the atria and then the
ventricles
Synchronization of the atrial and
ventricular events fill the ventricles
completely before ventricular ejection,
thus maximizing cardiac output
Synchronization is provided by the NODAL
CELLS and PURKINJE CELLS.
1. Automaticity: ability to initiate an
electrical impulse
2. Excitability: ability to respond to an
electrical impulse
3. Conductivity: ability to transmit an
electrical impulse from one cell to
another

CARDIAC
ELECTROPHYSIOLOGY

Sinoatrial Node
-primary pacemaker of the heart
-located at the junction of the
superior vena cava and the right
atrium
-has an inherent firing rate of 60
100 impulses per minute

Impulses cause electrical stimulation

and subsequent contraction of the
atria. Impulses are then
conducted to the atrioventricular
node.

Atrioventricular Node
-located in the rright atrial wall
near the tricuspid valve.
- coordinates the incoming
electrical impulses from the atria
and relays the impulse to the

Bundle of His specialized

conducting tissue where impulse
is conducted.
-Impulses travel through the bundle
branches until it reach the
terminal point, the PURKINJE
FIBERS.
PURKINJE FIBERS rapidly conducts
the impulses to stimulate the
myocardial cells to cause
ventricular contraction
HEART RATE is etermined by the
myocardial cells with the fastest
inherent firing.
SA node : 60 100 impulses
AV node : 40 60 impulses
*if both malfunctioned, a
pacemaker site in the
ventricle will fire at its
inherent bradycardic rate of
30 to 40 impulses per minute

CARDIAC CONDUCTION
SYSTEM

ELECTROCARDIOGRAPHY
A diagnostic tool used in
assessing the cardiovascular
system
A graphic recording of the
electrical activity of the heart
Graph is obtained by placing
disposable electrodes in
standard positions on the skin
of the chest wall and
extremities
Recorded on a special graph
paper with 12, 15, 18 leads
showing the activity from
those different reference point

ELECTROCARDIOGRAPHY
12 lead ECG

Used to diagnose dysrrhytmias, conduction

abnormalities, enlarged heart chambers, and
myocardial ischemia or infarction
Used to monitor high or low calcium and potassium
levels and the effects of some medications

15 lead ECG
Used for early diagnosis of right ventricular and
posterior left ventricular infarction

18 lead ECG
Useful for early detection of myocardial ischemia and
injury

12 LEAD ECG
Why there are only 10
electrodes?
Its important to fully
understand what the term
lead actually means. A lead
is a view of the electrical
activity of the heart from a
particular angle across the
body. Think of a lead as a
picture of the heart and the 10
electrodes give you 12
pictures. In other words, a lead
is a picture that is captured by
a group of electrodes.

LIMB LEADS
RL - Anywhere above
the ankle and below the
torso
RA - Anywhere between
the shoulder and the
elbow
LL - Anywhere above
the ankle and below the
torso
LA - Anywhere between
the shoulder and the
elbow

PRECORDIAL LEADS
V1 - 4th Intercostal space
to the right of the sternum
V2 - 4th Intercostal space
to the left of the sternum
V3 - Midway between V2
and V4
V4 - 5th Intercostal space
at themidclavicular line
V5 - Anterior axillary line at
the same level as V4
V6 - Midaxillary lineat the
same level as V4 and V5

NURSING CONSIDERATIONS

Patient Positioning
-Place the patient in a supine or semi-Fowlers position. If the patient
cannot tolerate being flat, you can do the ECG in a more upright position.
-Instruct the patient to place their arms down by their side and to relax
their shoulders.
-Make sure the patients legs are uncrossed.
-Move any electrical devices, such as cell phones, away from the patient as
they may interfere with the machine.
Skin Preparation
-Dry the skin if its moist or diaphoretic.
-Shave any hair that interferes with electrode placement. This will ensure a
better electrode contact with the skin.
-Rub an alcohol prep pad or benzoin tincture on the skin to remove any oils
and help with electrode adhesion.
Electrode Application
-Check the electrodes to make sure the gel is still moist.
-Do not place the electrodes over bones.
-Do not place the electrodes over areas where there is a lot of muscle
movement.