Presented by

Varun Bajaj

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Electrocardiography

• Electrocardiography (ECG) is the process of recording the electrical

activity of the heart over a period of time using electrodes placed on the
skin
• These electrodes detect the tiny electrical changes on the skin that arise
from the heart muscle's electrophysiological pattern of depolarizing and
repolarizing during each heartbeat [1]

Fig Connection of electrodes and ECG machine 2

QUICK REVIEW OF HEART

 The heart is a muscular pump made up of four

chambers .
 The two upper chambers are called atria. The
two lower chambers are called ventricles.
 A natural electrical system causes the heart
muscle to contract.
 This pumps blood through the heart to the lungs
and the rest of the body

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QUICK REVIEW OF
HEART
Purpose
• Pumps blood

Basic Anatomy
• 4 chambers
• 2 sides
• 4 valves
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THE CONDUCTINGY
SYSTEM
• SA Node
• Inter-nodal
pathway
• AV Node
• Bundle of HIS
• Bundle Branches
• Purkinje Fibers

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CARDIAC CYCLES

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12 LEAD ECG

Learning objectives:

Describe the correct

placement of all electrodes
Proper Skin preparation
Care of the ECG machine, wires
and electrodes
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Principles of
Electrocardiograph

• Electrocardiograph – is the
instrument that records the
electrical activity of the heart
• Electrocardiogram (ECG) is the
record of that activity

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HOOKING UP THE
12-LEAD ECG

• Proper skin prep

• Placement of the limb
electrodes
• Placement of the chest
electrodes

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SKIN PREPARATION

• REASON FOR SKIN

PREPARATION

• 5 STEP METHOD
• 2 STEP METHOD

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ELECTRODE
PLACEMENT

• LIMB LEADS

• CHEST LEAD

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LIMB LEADS

• Bipolar leads
I II III

• Augment leads
Avr Avl Avf

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CHEST LEADS
• 6 UNIPOLAR
LEADS
• V1
• V2
• V3
• V4
• V5
• V6
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RELATIONSHIP

Fig 4. ECG Relation with heart

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ELECTRODE PLACEMENT

LIMB LEADS
Bipolar leads
I II III
Augment leads
aVR aVL aVF
CHEST LEAD
6 Unipolar leads
V1
V2
V3
V4
Fig. 5 Electrodes
V5
V6
Placement [3]
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LETS REVIEW

• What is an ECG
• What are the limb leads?
• What are the chest leads?
• Why do skin prep?

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12-LEAD ECG LAYOUT

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INFORMATION ON THE
ECG

• Patients demographics
• Heart rate and measurements
• Speed ECG is recorded at
• Voltage ECG is recorded at
• What the filter is set on

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INFORMATION ON THE
12-LEAD ECG

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WHAT YOU NEED TO
LOOK FOR

• Are the limb leads hooked up

correctly?
• Are the chest leads hooked up
correctly?
• Is the ECG free of artifact.
• Is this ECG a Critical Value
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IS the ECG HOOKED UP
CORRECTLY?
LIMB LEADS CHEST LEADS
Normal 12-lead COLUMN III
• AVR – always • R wave progression
negative • Small to Tall
• Lead I – always
positive COLUMN IV
• Lead II, III – • R wave progression
positive or • Tall to Small
biphasic

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RULING OUT LIMB LEAD
REVERSAL

• Avr is always negative

• Lead I is always positive

• Lead II and III positive for the P

wave and usually the QRS
complex
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CHEST LEADS
CHEST LEADS
COLUMN III
• R wave progression
• Small to Tall

COLUMN IV
• R wave progression
• Tall to Small

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LIMB LEADS

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CHEST LEADS

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OTHER PROBLEMS
WITH THE ECG

• Artifact
• Electrical interference
• Somatic tremor
• Wandering baseline

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EINTHOVENS TRIANGLE

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ARTIFACT ON THE ECG

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FIND THE ARTEFACT

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WANDERIN BASELINE

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SOMATIC TREMOR

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ELECTRICAL
INTERFERANCE

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BASIC CRITICAL
VALUES

• Bradycardia – HR < 40bpm

• Tachycardia HR > 120bpm
• PVC’s - 4 or more in a row
• ST Elevation

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LOOKING AT THE
RHYTHM
• Evaluate the • Is the rhythm
rhythm strip at regular or
the bottom of irregular?
the 12-lead for • Is there a P
the following wave before
every QRS
complex
• Are they any
abnormal beats.
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FINDING THE HEART
RATE
• 3 METHODS

• RATE RULER
• COUNTING
• BOX METHOD

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BOX METHOD

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ECTOPIC BEATS

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ECTOPIC BEATS

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LETS SUMMARIZE
How do we produce an excellent
12-lead ECG?
Proper skin prep
Correct electrode placement
Recognize and know how to
correct problems
Recognize basic critical values
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