Scribd
Upload
29 views8 pages

ECG-12 Lead System Practical Guide

A detailed guide on ECG

Uploaded by

Dinesh Veera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
29 views8 pages

ECG-12 Lead System Practical Guide

A detailed guide on ECG

Uploaded by

Dinesh Veera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 8

Recording and interpretation of Electrocardiogram

Aim:
To record and interpret ECG of a normal subject.

Objectives:
At the end of the demonstration the student should be able to:
 State the placement & connections of different bipolar
and unipolar leads
 Identify different ECG waves in all the leads
 Determine heart rate
 Find out whether the rhythm is regular or irregular
 Determine PR and QT interval
 Determine presence of ischemia or infarct

Principle:

During the generation and transmission of cardiac impulse electrical


currents also spread to the adjacent tissues surrounding the heart and small
fluctuations of this current spread all the way to body surface because body
fluids are good volume conductors. The electrical potentials generated by
these currents can be recorded from the surface of the body if appropriate
electrodes and recorders are used. The record of these potential fluctuations
during the cardiac cycle is the electrocardiogram abbreviated as ECG or
EKG and the electronic machine that is used to obtain this record is called
electrocardiograph.

Requirements:
Electrocardiograph / ECG machine with accessories like electrodes,
connecting cables, ECG paper.
ECG Lead system:
ECG lead is an arrangement of the electrodes system on the body
surface by which electrical activity of the heart is recorded e. g. lead I
consists of circuit between two electrodes one fixed on the left arm and the
other on the right arm. Classically following lead systems are used
internationally.

A. Standard Bipolar limb leads- Lead I, Lead II and Lead III.


B. Augmented unipolar limb leads- aVR, aVL, aVF.
C. Unipolar Chest leads- V1- V6

A. Standard Bipolar limb leads: ( Fig.1 ):

Lead I: Between left and right arms, with left arm connected to
positive and right arm to negative terminal.

Lead II: Between right arm and left leg, with left leg connected to
positive and right arm to negative terminal.

Lead III: Between left leg and left arm, with left leg connected to
positive and left arm to negative terminal.
Figure 1: Standard Bipolar limb leads connections

B. Augmented Unipolar Limb Leads :


The augmented limb leads record between one limb as active
electrode and the other two made zero by connecting to the recorder through
a high resistance (5000 ohms). This increases the size of the potential by
50% without affecting the configuration of different waves. The augmented
limb leads are designated according to the position of active electrode as:
aVR active electrode on the right arm
aVL active electrode on the left arm
aVF active electrode on the left leg.
C. Unipolar chest leads :
In this lead system all the three limb leads are connected to a high
resistance (5000 ohms) to create a zero potential. An exploring electrode is
placed at different standard positions in precordial region as:
V1 4th intercostals space just right to the sternum
V2 4th intercostals space just left to the sternum
V3 Midway between V2 & V4
V4 5th intercostals space at mid clavicular line
V5 5th intercostals space at anterior axillary line
V6 5th intercostals space at mid axillaary line.

Procedure:

 Make the subject lie supine in the bed/ couch comfortably.


 Explain the procedure to the subject assuring that it is
noninvasive
 Check the ECG machine
 Fix various limb and chest electrodes according to the standard
lead system
 Enter subject’s particulars
 Record ECG according to the standard sequence (I, II, III, aVR,
aVL, aVF, V1-V6 ).
Figure 2: Placement of chest electrodes

Observations:

 Examine the record carefully


 Identify different waves (P, QRS complex, T) and rhythm.
 Calculate Heart Rate
 Calculate duration of P wave, QRS complex and following
intervals and segments:
PR & QT intervals
PR & ST segment

Identify three main waves (P, QRS, T) in the ECG record. Also identify flat
lines (base lines) before P, between the P and QRS and after the T waves.
The line connecting end of QRS to beginning of T wave is the iso-electric
line called the ST segment is quite close to the base line and is considered
electrically silent.
Important lead sets: Different lead sets provide an insight into
different parts of the heart and so ought to be examined as given below:
Leads II, III & aVF-- reflect activity of the inferior wall of the heart
Leads I, aVL, V5 & V6- reflect activity of the left most (lateral) wall
of the heart.
Leads V1, V2, V3 & V4- reflect activity of the front (anterior) wall of
the heart
ST segment- needs to be examined carefully as depression of this segment
below the base line along with T wave inversion can be due to myocardial
ischemia. Elevation of the ST segment can be earliest sign of myocardial
infarction.

1. Tabulate the observations and interpret by comparing with the


expected normal values:
(Use Lead II record for calculations)

S.N. Phase of Complex Duration in Secs Normal Value


(sec)
1. P wave 0.08-0.1
2. QRS 0.08-0.12
3 T wave 0.16-0.27
4 PR interval 0.12-0.20
5. QT interval 0.40-0.43
Normal ECG Record

31
Interpret the results of the ECG recorded

Answer the questions:


1. Define Electrocardiogram (ECG), Electrocardiography and
Electrocardiograph.
2. State the uses of ECG.
3. Describe the various ECG waves, intervals and segments.
4. State the significance of PR interval.
5. Using ECG strip, how heart rate can be calculated.
6. Explain the different types of arrhythmias.
7. Describe ECG changes in different degrees of heart block.
8. Describe main ECG changes seen in a case of myocardial ischemia and
myocardial infarction.
9. Describe the ECG changes in electrolyte imbalance.

You might also like