LEADS The term "lead" in electrocardiography causes much confusion because it is used to refer to two different things.

In accordance with common parlance, the word lead may be used to refer to the electrical cable attaching the electrodes to the ECG recorder. As such, it may be acceptable to refer to the "left arm lead" as the electrode (and its cable) that should be attached at or near the left arm. Usually, 10 of these electrodes are standard in a "12-lead" ECG. Limb Leads The limb leads are composed of standard leads I, II, and III and augmented leads aVL, aVR, and aVF. Place the electrodes as follows: LA: left arm - either on the shoulder, or the forearm RA: right arm - either on the shoulder, or the forearm LL: left leg - either just below the knee, or on the hip RL: right leg - either just below the knee, or on the hip Augmented leads are termed unipolar because they use one positive electrode as reference against a combination of the other limb electrodes. aVL uses the left arm as a positive electrode, aVR uses the right arm, and aVF the left leg. In both the 5- and 12-lead configurations, leads I, II and III are called limb leads. The electrodes that form these signals are located on the limbsone on each arm and one on the left leg. The limb leads form the points of what is known as Einthoven's triangle. Lead I is the volage between the (positive) left arm (LA) electrode and right arm (RA) electrode: Lead II is the voltage between the (positive) left leg (LL) electrode and the right arm (RA) electrode: Lead III is the voltage between the (positive) left leg (LL) electrode and the left arm (LA) electrode:

Patient Procedure -Place the patient supine, with the head slightly elevated. Ensure that the arms and legs are supported from underneath. -Expose the chest and limb areas. Where necessary, shave the skin to allow secure placement of the leads.

-Ask the patient to remain still, with their muscles relaxed, and to breathe normally. PRECORDIAL LEADS Unlike limb leads that measure electrical activity in the vertical plane, the precordial leads measure activity in the horizontal plane. Each of the 6 electrodes are set as positive, and a common negative point is calculated for comparison. The precordial leads are placed on the chest, just above the heart. Their positions are as follows: V1: fourth intercostal space, at right edge of sternum (red) V2: fourth intercostal space, at left edge of sternum (yellow) V3: midway between V2 and V4 (green) V4: fifth intercostal space, midclavicular line (blue) V5: same horizontal line as V4, Left anterior axillary line (brown) V6: same horizontal line as V4, left mid axillary line (purple) ECG Interpretation P wave PR segment PR interval QRS ST segment QT interval T wave Atrial depolarization Conduction delay through AV node; used as baseline to evaluate ST segment elevation or depression Atrial depolarization +conduction delay through AV node Ventricular depolarization Isoelectric; ventricles still depolarized Ventricular depolarization+ventricular repolarizatio; Mechanical contraction of ventricle Ventricular repolarization The paper which ECGs are recorded upon is standardized across all hospitals. Each large square on the paper represents 0.2 seconds Each small square represents 0.04 seconds 5 large squares therefore = 1 second 300 large squares = 1 minute To calculate heart rate count large squares within an R-R interval & divide 300 by this number Therefore if there are 4 large squares in an R-R interval 300/4 = 75bpm