ELECTROCARDIOGRAM

(EKG/ECG) records the electrical activity of the

heart, providing a record of cardiac electrical activity,
as well as valuable information about the heart’s
function and structure.

The electrocardiogram records the electrical

impulses that stimulate the heart muscle
“myocardium” to contract.
 ELECTROCARDIOGRAM
 When at rest, the muscle cells of the heart have
negatively charged (“polarized”) interiors, but when
they are “depolarized” by an electrical stimulus, they
contract.

 A progressive wave of stimulation (depolarization)

passes through the heart, causing contraction of the
myocardium.
You will obtain the highest quality
ECGs when your patient is relaxed.
Assure your patient that there is no
danger or pain involved.
Make the patient comfortable on a
cot or padded table which is large
enough to support arms and legs.
The patients arms should rest at his
sides and the legs should lie flat, not
touching one another.
 Preparing Patients for ECGs
 Use a pillow to support the patient’s head.
 Try to avoid the factors like cold drafts which could
cause disconfort.
 Leave the chest and sensor sites exposed.
 Cover your patient with blanket to prevent shivering.
 Preparing the Skin
 You are more likely to get a stable baseline and clean
trace if you prepare patient’s skin properly and
sensor sites.
 For the best contact:
1. Clean the skin with alcohol or acetone and let dry
completely.
2. Abrade the skin slightly with the dry, heavy gauze or
similar alternative.
 Applying ECG Sensors

 Apply sensors and connect the patient cable to

them.

 Make sure the leads cables follow the contours of

the patient’s body and lie flat.

 If any lead wire is too long, as with a short patient or

child, take up the length by making a small “stress
loop”.
 Applying ECG Sensors
 When applying sensors to sites with a lot of hair, the
following techniques may improve contact:
1. Use the thumb and forefinger to spread the hair before
applying the sensor to the skin.
2. Abrade the skin slightly with a dry, heavy gauze of similar
alternative.
3. If the sensor does not adhere well, it may be necessary to
shave the site.
Using Disposable ECG Sensors
 Save time and are an affordable alternative to
bulbs, plates, straps, creams and gels.
 Utilize a highly conductive, natural adhesive for
good results.
 Should be stored according to the guidelines on
the packaging and should not be used after the
expiration date.
 Never mix sensor types or brands.
 Incompatibilities can cause baseline drift and
increase trace recovery time after defibrillation, or
cause unstable baseline.
 Applying Chest Sensors
 Expose the chest.
 Locate the electrode position on the patient’s chest.
 Apply the sensors.
 Ensure that the leads conform to the body contours
and that no strain is placed on the sensors.
LOCATION OF CHEST ELECTRODES IN 4TH AND 5TH
INTERCOSTAL SPACES:

V1: right 4th intercostal space

V2: left 4th intercostal space
V3: halfway between V2 and V4
V4: left 5th intercostal space, mid-clavicular line
V5: horizontal to V4, anterior axillary line
V6: horizontal to V5, mid-axillary line
Waves and intervals
Schematic representation of normal ECG

Detail of the QRS complex, showing ventricular activation time (VAT) and
amplitude.
A typical ECG tracing of the cardiac cycle (heartbeat) consists of a P wave, a QRS
complex, a T wave, and a U wave which is normally visible in 50 to 75% of ECGs.[23]
The baseline voltage of the electrocardiogram is known as the isoelectric line.
Typically the isoelectric line is measured as the portion of the tracing following the
T wave and preceding the next P wave.
Feature Description Duration

The interval between an R wave and the next R wave .

RR interval Normal resting heart rate is between 60 and 100 bpm 0.6 to 1.2s

During normal atrial depolarization, the main electrical

vector is directed from the SA node towards the AV node,
and spreads from the right atrium to the left atrium. This
P wave turns into the P wave on the ECG. 80ms
PR interval The PR interval is measured from the beginning of the P
wave to the beginning of the QRS complex. The PR interval
reflects the time the electrical impulse takes to travel from
the sinus node through the AV node and entering the
ventricles. The PR interval is therefore a good estimate of 120 to
AV node function. 200ms

The PR segment connects the P wave and the QRS

PR segment complex. The impulse vector is from the AV node to the
bundle of His to the bundle branches and then to the
Purkinje Fibers. This electrical activity does not produce a
contraction directly and is merely traveling down towards
the ventricles and this shows up flat on the ECG. The PR 50 to
interval is more clinically relevant. 120ms
QRS complex
The QRS complex reflects the rapid depolarization of the
right and left ventricles. They have a large muscle mass
compared to the atria and so the QRS complex usually has a
much larger amplitude than the P-wave. 80 to 120ms

J-point
The point at which the QRS complex finishes and the ST
segment begins. Used to measure the degree of ST elevation
or depression present. N/A

ST segment
The ST segment connects the QRS complex and the T wave.
The ST segment represents the period when the ventricles
are depolarized. It is isoelectric. 80 to 120ms
 The T wave represents the repolarization (or recovery) of
T wave the ventricles. The interval from the beginning of the QRS
complex to the apex of the T wave is referred to as the
absolute refractory period. The last half of the T wave is
referred to as the relative refractory period (or vulnerable
period). 160ms
ST interval The ST interval is measured from the J point to the end of
the T wave. 320ms

The QT interval is measured from the beginning of the

QT interval QRS complex to the end of the T wave. A prolonged QT 300 to
interval is a risk factor for ventricular tachyarrhythmias 430ms[citat
and sudden death. It varies with heart rate and for clinical ion
relevance requires a correction for this, giving the QTc. needed]
 The U wave is hypothesized to be caused by the
U wave repolarization of the interventricular septum. They
normally have a low amplitude, and even more often
completely absent. They always follow the T wave and
also follow the same direction in amplitude. If they are
too prominent we suspect hypokalemia, hypercalcemia
or hyperthyroidism usually.[24]

The J wave, elevated J-Point or Osborn Wave appears

J wave as a late delta wave following the QRS or as a small
secondary R wave . It is considered pathognomonic of
hypothermia or hypocalcemia.[25]
MYOCARDIAL ISCHEMIA, INJURY, INFARTION
ANTEROLATERAL WALL MI
INFERIOR WALL MI
ECG
PLACEMENT
CARDIAC ARREST TRACING
THANK YOU!
Maria Cristina S. Alteran, RN MN