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Electrocardiogram (EKG or ECG)

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Electrocardiogram

(EKG or ECG)
Definition
ECG is defined as a graphical representation of
electrical activity of heart.
OR
recording of electrical activity of the heart on the graph
paper.
 Electrocardiograph- the machine which is used to
measure the electrical activity of the heart.
 Electrocardiogram- the graph in which the electrical
activity is recorded.
ECG machine
Purpose of ECG
To assist in the diagnosis of heart disease.eg. Unstable
angina, HTN, chest pain, congenital heart disease and
arrhythmias.
To evaluate the effectiveness of patient’s treatment.
To detect electrolyte disturbances( hyper and
hypokalemia)
Standard 12 lead ECG
The ECG tracing represents the net electrical activity
of the atria and ventricles as it depolarizes and
repolarizes. The electrical currents passing through the
heart are subsequently conducted to the body surface.
This current can be detected by electrodes and the
measured when they reach the surface.
In a conventional 12 lead ECG, 10 electrodes are placed
on the patient’s limbs and on the surface of the chest.
The overall magnitude of the heart’s electrical potential
is then measured from 12 different angle.
Cont’d
There are 3 main components to an ECG; the P wave,
which represents the depolarization of the atria, the QRS
complex; which represents the depolarization of the
ventricles; and the T wave, which represents the
repolarization of the ventricles.
During each heartbeat, a healthy heart has an orderly
progression of depolarization that starts with pacemaker
cells in the SA node, spreads throughout the atrium , and
passes through the AV node down into the bundle of his
and into the purkinjee fibres, spreading down and to the
left throughout the ventricles. This orderly pattern of
depolarization gives rise to the characteristic ECG tracing.
Placement of electrodes
Cont’d
 RA- on the right arm, avoiding thick muscle.
 LA- In the same location where RA was placed, but on the left arm.
 RL- On the right leg, lower end of inner aspect of calf muscle. (Avoid
bony prominences)
 LL- In the same location where RL was placed, but on the left leg.
 V1- In the fourth intercostal space (between ribs 4 and 5) just to the
right of the sternum(breastbone)
 V2-- In the fourth intercostal space (between ribs 4 and 5) just to the left
of the sternum.
 V3---Between leads V2 and V4.
 V4---In the fifth intercostal space (between ribs 5 and 6) in the mid-
clavicular line.
 V5---Horizontally even with V4, in the left anterior axillary line.
 V6--Horizontally even with V4 and V5 in the mid-axillary line.
Nursing interventions
Explain the procedure to the patient.
Maintain appropriate environment and maintain privacy.
Remove all jewelry and metal object from the patient.
Expose patient’s necessary part only.
Instruct patient to lie still during the procedure.
Clean the electrodes placing area with spirit/NS and apply the
jelly to proper site.
Make sure ECG machine is plugged and operate according to
directions.
Place the electrodes on the patient and attach the leads to
proper electrodes.
Cont’d
After taking the EGC , disconnect the electrodes and
the leads.
Wipe the conductive jelly off the patient.
Record the patient’s name, date , time and label the
leads on the ECG strip.
Clean the electrodes with the spirit and return
equipments to its proper place.

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