INTRODUCTION

An Electrocardiogram also termed an ECG or EKG (K means kardia for heart in Greek). It is a simple non
invasive test that records the heart's electrical activity.

* The ECG machine is designed to recognize and record any electrical activity within the heart.

* It provides information about the function of the intracardiac conducting tissue of the heart and
reflects the presence of cardiac disease through its electrical properties.

* Understanding ECG helps to understand how the heart works with each heartbeat, an electrical
impulse starts from the superior part of the heart to the bottom. The impulse prompts the heart to
contract and pump blood.

*It is done by an Electrocardiogram technician. Thay are trained to use EKG machines and certified to do
this type of testing.

BRIEF HISTORY

ECG was invented by a dutch physician "William Einthoven" in 1902. In 1924 he was named the "father
of electrocardiography" and was awarded a Nobel prize in medicine.

PURPOSE OF ECG TEST

1. To determine if symptoms such as chest pain, shortness of breath, or palpitations are due to a heart
problem.

2. Use to know a steady or irregular heart rhythm and electrolyte imbalance.

3. To know the strength and timing of electrical signals as they pass through each part of your heart.

4. To detect disorders that affect heart functions.

5. To study and detect many heart problems such as heart attack, heart failure, congenital heart disease
etc.

6. To monitor deeply sedated patients and for consciously sedated patients with compromised
cardiovascular function.

7. To monitor some medications and treatment for the heart (such as pacemakers).

ELECTRODE & LEAD

 An ELECTRODE is a sensor (conductive pad) attached to the skin and enables recording of electrical
currents. ECG lead is a graphical description of the electrical activity of the heart created by reading
several electrodes, ( this means that each ECG lead is gotten by analysing the electrical currents
detected by several electrodes). A 12 lead ECG is obtained using 10 electrodes. These leads consists of
limbs leads and chest leads.

ECG PAPER

The ECG paper is a strip of graph paper with large and small grods with horizontal axis ( time in seconds)
and vertical axis ( amplitude in volts). Each 1mm square ( d smallest square) represents 0.04second and
each large (5mm) represents 0.2second. On the vertical axis, each large square represents 0.5mV and
each small block equals to 0.1mV.

ELECTRODE PLACEMENT

* LIMB SENSOR APPLICATION

Place the 4 limb sensors on a smooth fleshy area of the lower inner forearm and lower inner thighs,or
upper inner arms and lower abdomen. Attach the limb leads.

* CHEST SENSOR APPLICATION

Place the 6 chest sensor on the patient chest as follows :

• V1 fourth intercostal space at right border of the sternum.

• V2 fourth intercostal space at left border of the sternum.

• V3 midway between position V2 and V4.

• V4 at the mid clavicular line in the fifth intercostal space.

• V5 at the anterior axillary line on the same horizontal level as V4

• V6 at the mid axillary line on the same horizontal level as V4 and V5.

Types OF ECG TESTS

Your doctor may do different types of ECG to get the information they need about your heart and these
include:

1 RESTING EKG: this is the standard type. It's done while you are lying down and resting.

2 STRESS TEST: it is done while your exercise on a stationary bike or treadmill. This requires you
gradually increasing the intensity of the exercise so your doctor can see how your heart reacts.

3 SIGNAL AVERAGE EKG: this more detailed test helps your doctor see whether you are at high rish of
developing a potentially fatal heart arrhythmia. It captures the electrical signals from your heart for
about 20minutes.

4. AMBULATORY EKG: you get this done while you go about your usual daily activities. You will wear a
portable device that records your heart activity.

EKG DEVICES

1.HOLTER MONITOR: this portable EKG checks the electrical activity of your heart for 1 - 2 days, 24hours
a day.your doctor may suggest it if they suspect you have abnormal heart rhythm, palpitations, or too
little blood flow to ur heart muscle. The electrodes from the monitor are taped to your skin. Once In
place, you go home and continue with your normal activities, except taking a shower. You will be ask to
record all your activities and any symptoms noticed.

2. EVENT MONITOR: Your doctor may suggest one of these devices if you only get symptoms sometimes.
With some models, you push a button and it records and stores ur heart's electrical activity for a few
minutes. Others turn on automatically when they detect an irregular heartbeat. You may need to wear
one for weeks or sometimes months. Some of these monitors may transmit information to your doctor
wirelessly. E.g
- Implantable Loop Monitor: this is a type of event monitor that a doctor implants just under the skin of
your chest. It records your heart's electrical activity continuously for up to 3yrs. You might get one if
your doctor thinks you have problems with your heart rhythm, or if you repeatedly faint for no apparent
reason. You can do all your normal activities with the implant including swimming and showering.

WHAT INFORMATION DOES AN EKG DETECT

Your heart's electrical activity controls your heartbeat. EKG let your doctor see how much of this activity
there is, how strong it is, and how much time passes between electrical impulses. In a healthy human,
the heartbeat will he regular and consistent.

HOW TO PREPARE FOR AN EKG

Things that you can do to get yourself ready for an EKG include:

* Don't use skin creams, lotions or powder on the day of the test. This can keep the electrodes from
making contact with your skin.

* Avoid full length hosiery, since the electrodes need to be placed directly on your legs.

* Wear a shirt you can easily remove so the lead can be placed on your chest.

* If you are having a stress test, avoid having heavy meals and caffeine before hand.

EKG RESULTS

Abnormal EKG results could be a sign of several conditions:

* Heart attack ( current or past )

* Heart failure

* Genetic heart defect

* Abnormal heart rhythm (arrhythmia)

* Poor blood supply to the heart

* Heart enlargement

* Swelling or extra fluid in the daf around the heart.

* Heart inflammation ( myocarditis )

 ECG RISKS

It has few risks

It doesn't transmit electricity so your body, so it can't give you a shock. You might have a rash or skin
irritation where the electrodes were removed.

THINGS THAT CAN INTERFERE WITH THE TEST RESULTS

* Moving or talking during the test.

* Smoking or exercising before the test.

* Pregnancy

* Obesity

* Certain drugs

* Electrolyte imbalance, such as too much or too little calcium, potassium, or magnesium in the blood.

Before getting an EKG, make sure your doctor knows about any health conditions you may have
including pregnancy and all medicines and supplement you take.

KEY COMPONENTS

• P Wave: represents atrial depolarization (contraction of the atria).

• QRS Complex : Represents ventricular depolarization (contraction of the ventricles)..

• T Wave: represents ventricular repolarization (the recovery phase of the ventricles).

ECG SEGMENTS

•PR segment: time between the P wave and the QRS complex

• ST segment: time between the QRS complex and the T wave

 INTERPRETATION

1. Heart Rate : when the cardiac rhythm is regular, the heartbeat can be determined be the interval
between two successive QRS complexes. The heart rate is calculated be dividing the number of large
boxes (5mm or 0.2sec) between two successive QRS complexes into 300. For example, if the interval
between two QRS complexes is 2 large boxes, them the rate is 150 beat per minute (bpm) (300 ÷ 2 =
150bpm).

. if the
heart rate is irregular, count the number of QRS complexes on the ECG and multiply by 6 to obtain the
average heart rate in bpm ( the ECG displays a period of 10seconds, thus 6 × 10seconds = 60seconds
(1minute).

2. P Wave : the P wave represents atrial depolarization. The P wave is typically biphasic in lead V1
(positive - negative), but when the negative terminal component of the P wave exceeds 0.04seconds in
duration (equivalent to one small box) it is abnormal.

Left atrial enlargement should be suspected when the P wave duration is increased, it is associated
with being more than one small box deep (1mm) in lead V1 and a bifid P wave in lead ii with a duration
that is longer than 110milliseconds. Right atrial enlargement us associated with a leaked P wave taller
than 2.5mm in the inferior leads and more than 1.5mm tall in leads V1 and V2.
3. The PR interval : it incorporate the time from the depolarization of the sinus node to the onset of
ventricular depolarization. The measurement starts from the beginning of the P wave to the first part of
the QRS complex, with a normal duration between 0.12 to 0.20seconds.

4. The QRS complex: the duration is normally 0.06 to 0.10seconds.

Reference:

• Edhouse J, Thakur RK, Khalil JM. ABC of clinical electrocardiography. Conditions affecting the left side
of the heart. BMJ. 2002 may 25.

• Harrigab RA, Jones K. ABC of clinical electrocardiography. Conditions affecting the right side of the
heart. BMJ. 2002 May 18.

• "Definition of EKG". Lexico Dictionaries. Archived from the original on 15 February 2020. Retrieved 20
January 2020.