Electrocardiogram

(ECG)
Prepared by Joycelyn
Parazo-Reyes, RN MAN
 Electrocardiogram
An electrocardiogram (ECG or
EKG, abbreviated from the German
Elektrokardiogramm)
is a noninvasive transthoracic
graphic produced by an
electrocardiograph, which records
the electrical activity of the heart
over time
 is a test that checks for problems
with the electrical activity of your
heart.

graph produced by an
electrocardiograph

records the electrical activity of the

heart over time
 provides various waves and normal
vectors of repolarization and
repolarization of the myocardia
does not directly assess the
contractility of the heart, but gives a
rough indication of increased or
decreased contractility
 Its name is made of different parts:
electro, because it is related to
electrical activity
cardio, Greek for heart
gram, a Greek root meaning "to
write"
 Depolarization
It is the electrical activation of heart
muscle cells is cause by an electrical
process
Contraction of the atrial muscle cells
and pumping of blood from the atria
to the ventricles immediately follow
atrial activation or depolarization
 Repolarization
Electrical reverse process
Immediately after depolarization of
ventricular muscle cells,
repolarization occurs
 Anatomy and Physiology
The heart is a muscular pump made
up of four chambers . The two upper
chambers are called atria, and the
two lower chambers are called
ventricles. A natural electrical system
causes the heart muscle to contract
and pump blood through the heart to
the lungs and the rest of the body.
 Each beat of your heart is triggered
by an electrical impulse generated
from special cells in the upper right
chamber of your heart
The heart normally beats between 60
and 100 times per minute, with
many normal variations. This rate is
set by a small collection of
specialized heart cells called the
sinoatrial (SA) or sinus node
 Located in the right atrium, the sinus
node is the heart's "natural
pacemaker.

It has "automaticity," meaning it

discharges all by itself without
control from the brain.

 Two events occur with each

discharge: (1) both atria contract,
and (2) an electrical impulse travels
through the atria to reach another
area of the heart called the
atrioventricular (AV) node, which lies
in the wall between the 2 ventricles.
 The AV node serves as a relay point
to further propagate the electrical
impulse.

From the AV node, an electrical wave

travels to both ventricles, causing
them to contract and pump blood.
 The normal delay between the
contraction of the atria and of the
ventricles is 0.12 to 0.20 seconds.
This delay is perfectly timed to
account for the physical passage of
the blood from the atrium to the
ventricle. Intervals shorter or longer
than this range indicate possible
problems.
 The ECG records the electrical
activity that results when the heart
muscle cells in the atria and
ventricles contract.
Atrial contractions (both right and
left) show up as the P wave.
Ventricular contractions (both right
and left) show as a series of 3
waves, Q-R-S, known as the QRS
complex.
 The third and last common wave in
an ECG is the T wave. This reflects
the electrical activity produced when
the ventricles are recharging for the
next contraction (repolarizing).
 The electrical activity results in P,
QRS, and T waves that have a
myriad of sizes and shapes. When
viewed from multiple anatomic-
electric perspectives (that is, leads),
these waves can show a wide range
of abnormalities of both the electrical
conduction system and the muscle
tissue of the heart's 4 pumping
chambers.
 Indication of ECG
1. Check the heart's electrical activity.

2. Find the cause of unexplained chest

pain, which could be caused by a
heart attack, inflammation of the sac
surrounding the heart (pericarditis),
or angina.

3. Find the cause of symptoms of

heart disease, such as shortness of
breath, dizziness, fainting, or rapid,
irregular heartbeats (palpitations).

4. Find out if the walls of the heart

chambers are too thick
(hypertrophied).
5. Check how well medicines are
working and whether they are
causing side effects that affect the
heart.

6. Check how well mechanical devices

that are implanted in the heart, such
as pacemakers, are working to
control a normal heartbeat.
7. Check the health of the heart when
other diseases or conditions are
present, such as high blood pressure,
high cholesterol, cigarette smoking,
diabetes, or a family history of early
heart disease.
 How ECG works!
Sympathetic electrical impulses in
the heart originate in the Sinoatrial
node and travel through the heart
muscle where they impart electrical
initiation of systole or contraction of
the heart
 The electrical waves can be measured
at selectively placed electrodes
(electrical contacts) on the skin.

Electrodes are placed on different sides

of the heart measure the activity of
different parts of the heart muscle

Each heartbeat produces a set of P-

QRS-T waves
 An electrocardiogram also called
an ECG or EKG records these
electrical signals as they travel
through your heart.
 12 lead ECG
ECG leads : combination of
electrodes that form an imaginary
line in the body along which
electrical signals are measured

A typical ECG runs at a paper speed

of 25 millimeters per second.
Each small block of ECG paper is is
square millimeters, translating to
0.04 seconds or 40 milliseconds
 A large block has 5 small squares
across, hence there are 5 large
blocks per second
 12 lead ECG
Six of these points of view are the
locations of the 6 pads placed across
your chest. These are called V1, V2,
V3, V4, V5, and V6

The other points of view represent

combinations of the pads placed on
the arms and legs. These are called
I, II, III , aVR, aVL, and aVF.
 a) Limb Leads I, II, III
first three leads forming the
basis of Einthoven's triangle

b) Augmented Limb Leads aVR,

aVL, aVF
derived from limb leads but from
different vectors
negative electrodes are a
modification of Wilson's central
terminal
 c) Precordial Leads V1, V2, V3,
V4, V5, V6
no augmentation required due
to close proximity to the heart
 P wave : depolarization of the atrial
myocardia ; beginning precedes the
onset of atrial contraction

PR interval : atria contracts and

begins to relax, ventricles begin to
depolarize

QRS complex : depolarization of

ventricular myocardia ; beginning
precedes ventricular contraction
 QT interval : beginning of the QRS
complex to the end of T wave ;
length of time required for
ventricular depolarization and
repolarization

T wave : repolarization of the

ventricular myocardia ; beginning
precedes ventricular relaxation
 ECG is Interpreted by the
following:
Doctor such as an internist, family
medicine doctor, electrophysiologist,
cardiologist, anesthesiologist, or
surgeon
Trained nurses, paramedics
ECG Strips
 P wave
1. The first deflection of the cardiac
cycle
2. Represents depolarization of the
atria
3. Begins as the waveform begins to
leave the baseline, and ends when it
returns to baseline
 PR interval

1. Represents the time required for

the electrical impulse to leave the SA
node and travel through the atria, AV
node, bundle branches, and Purkinje
fibers
 QRS complex

1. Represents ventricular
depolarization

2. Measured from the beginning of

the QRS as the first wave leaves the
baseline to the J point
 J point

a) The junction between the QRS

and the ST segment
b) Where the last wave of the
complex begins to flatten out at,
above, or below the baseline
c) Elevation or depression of the ST
segment can make finding the J
point difficult
 ST segment
1. Represents the end of ventricular
conduction

T wave
1. Represents ventricular recovery or
repolarization

QT interval
1. Measures ventricular
depolarization and repolarizatio
 U wave

1. Represents the recovery period of

the Purkinje fibers
ECG Machine
 Procedure
1. Explain the procedure to the client
and attempt to allay anxiety
2. Position Client on Supine procedure
3. Inform the client that the procedure
is painless and non-invasive
4. Ask client to remove metal, coins,
keys etc
5. Instruct client to remain calm and
still during the procedure, avoid
unnecessary movement
6. Prepare the skin on the chest for
electrode attachment
Cleanse the skin with alcohol

Shave the area when necessary to

improve skin electrode connection
Place KY jelly for other electrode
connection
7. Place electrodes on the skin and
attach to the monitor cable (chest,
arms and lower extremities
8. Provide Privacy
9. Turn on the monitor and set the
machine
10. Observe the monitor for any
changes in rate and rhythm
11. Once finish, provide skin care
12. Document the results and evaluate
client response on the procedure
Documentation
Name, age, diagnosis, date and time