Laguatan, Sherylle Joi M.

Electrocardiogram The electrocardiogram (ECG or EKG) is a diagnostic tool that is routinely used to assess the electrical activity of the heart.

An ECG is used to measure:

Any damage to the heart How fast the heart is beating and whether it is beating normally The effects of drugs or devices used to control the heart (such as a pacemaker) The size and position of the heart chambers

Preparations before the procedure Make sure that all the medications that can interfere test results are withhold. Exercising or drinking cold water immediately before an ECG may cause false results. How the test is performed The patient will be asked to lie down. The health care provider will clean several areas on the arms, legs, and chest, and then attach small patches called electrodes to the areas. It may be necessary to shave or clip some hair so the patches stick to the skin. The number of patches used may vary. The patches are connected by wires to a machine that turns the heart's electrical signals into wavy lines, which are often printed on paper. The test results are reviewed by the doctor.

The usually need to remain still during the procedure. The health care provider may also ask the patient to hold the breath for a few seconds as the test is being done. Any movement, including muscle tremors such as shivering, can alter the results. So it is important to be relaxed and relatively warm during an ECG recording. Sometimes this test is done while the patient are exercising or under minimal stress to monitor changes in the heart. This type of ECG is often called a stress test. An ECG is painless. No electricity is sent through the body. The electrodes may feel cold when first applied. In rare cases, some people may develop a rash or irritation where the patches were placed. Normal Results

Heart rate: 60 to 100 beats per minute Heart rhythm: consistent and even

Abnormal Results Abnormal ECG results may be a sign of Abnormal heart rhythms (arrhythmias) Cardiac muscle defect Congenital heart defect Coronary artery disease Ectopic heartbeat Enlargement of the heart Faster than normal heart rate (tachycardia) Heart valve disease Inflammation of the heart (myocarditis) Changes in the amount of electrolytes (chemicals in the blood) Past heart attack Present or impending heart attack Slower than normal heart rate (bradycardia) ECG Leads Bipolar Limb Leads The electrodes for the limb leads are placed on the right arm, the left arm and the left leg. Each limb lead consists of a pair of electrodes, one positive and one negative. Therefore, these leads are called "bipolar" limb leads. The placement and charges of these electrodes effectively create three leads named lead I, lead II and lead III. Lead I measures horizontally in the frontal plane. The positive electrode is placed on the left arm, and the negative electrode is placed on the right arm. Lead II provides superior and

inferior measurement in the frontal plane. The positive electrode is placed on the left leg, and the negative electrode is placed on the right arm. Lead III provides superior and inferior measurement in the frontal plane. The positive electrode is placed on the left leg, and the negative electrode is placed on the left arm. These three limb leads are often called "Einthoven's triangle." Each lead shows a different axis of the heart. The direction from the negative to the positive electrode is the lead's axis. Lead I has an axis of 0 degrees. Lead II forms the right side of the triangle and has an axis of 60 degrees, and lead III forms the left side of the triangle with an axis of 120 degrees. Augmented or Unipolar Leads These leads provide additional views of the heart, utilizing the same electrodes as the bipolar limb leads. The EKG electronically combines the negative electrodes of two of the bipolar leads in order to obtain a different axis. This is effectively a combination, or a cross of two of the bipolar leads. The unipolar leads are as follows: AVF, AVR and AVL. The letter "A" indicates that the lead is augmented. The R, L and F identify the extremity on which the lead is placed (R=right arm, L=left arm and F=left foot). Chest Leads The six chest leads are unipolar leads that measure cardiac electrical activity in the horizontal plane. These leads are recorded using a positive electrode, which is placed at six anatomical positions on the chest, encircling the heart in the horizontal plane. They are arranged in progressive order from V1 through V6, and are positioned in successive steps from the patient's right to the left side of the chest. The chest leads cover the heart in its normal anatomic position. V1: right 4th intercostal space V2: left 4th intercostal space These two chest leads are oriented over the right side of the heart. V3: halfway between V2 and V4 V4: left 5th intercostal space, mid-clavicular line V3 and V4 are the middle leads located in the midline of the heart. V5: horizontal to V4, anterior axillary line V6: horizontal to V5, mid-axillary line Leads V5 and V6 are oriented over the left side of the heart (Rapid Interpretation EKGs).

Normal Sinus Rhythm

Sinus Tachycardia

Sinus Bradycardia

Premature atrial contraction

Atrial Flutter

Ventricular Tachycardia

Atrial fibrillation

Premature ventricular contraction