What is an ECG?

ECG (electrocardiogram) is a test that measures the electrical activity of the heart. The heart is a muscular organ that beats in rhythm to pump the blood through the body. The signals that make the heart's muscle fibres contract come from the sinoatrial node, which is the natural pacemaker of the heart. In an ECG test, the electrical impulses made while the heart is beating are recorded and usually shown on a piece of paper. This is known as an electrocardiogram, and records any problems with the heart's rhythm, and the conduction of the heart beat through the heart which may be affected by underlying heart disease.

What is the resting ECG used for?

The information obtained from an electrocardiogram can be used to discover different types of heart disease. It may be useful for seeing how well the patient is responding to treatment. It is a good idea to have an ECG in the case of symptoms such as dyspnoea (difficulty in breathing), chest pain (angina), fainting, palpitations or when someone can feel that their own heart beat is abnormal. The test can show evidence of disease in the coronary arteries. Unfortunately, in many people who have significant narrowing of the arteries supplying the heart muscle, the ECG recording made at rest is often normal. Therefore, if a significant narrowing is suspected, an ECG recording is often made when the patient is exercising (an exercise stress test) because this is more likely to reveal the problem. An ECG can be used to assess if the patient has had a heart attack or evidence of a previous heart attack. An ECG can be used to monitor the effect of medicines used for coronary artery disease. An ECG reveals rhythm problems such as the cause of a slow or fast heart beat. To demonstrate thickening of a heart muscle (left ventricular hypertrophy), for example due to longstanding high blood pressure. To see if there are too few minerals in the blood. An ECG may appear normal even in the presence of significant heart disease. Thus, for a full assessment of the heart, other tests may be needed.

How is an ECG performed?

It depends on what is being measured. Usually, an ECG is taken while the patient is resting. But if there's concern that a patient's symptoms may be caused by coronary artery disease, the test is done while the patient is on an exercise bike or treadmill. It may also be used to assess the success of drug treatment or coronary revascularisation, such as coronary intervention or bypass surgery. It may be necessary to supplement an ECG with additional tests, such as a radioisotope perfusion scan, which uses low-dosage radioactive dye to show which areas of the heart muscle receive the best and worst blood supply or angiography(X-ray examination of arteries), to determine the extent of the illness and the cause of symptoms.

How is an ECG performed?

Up to 12 self-adhesive electrodes will be attached to select locations of the skin on the arms, legs and chest. Areas such as the chest where the electrodes will be placed may need to be shaved. First, the skin is cleaned. The test is completely painless and takes less than a minute to perform once the leads are in position. After the test, the electrodes are removed. The doctor will review the paper print-out of the ECG.

Is an ECG dangerous?

When the patient is at rest it is completely harmless. If an exercise test is performed, the patient may get chest pains that will resolve after the exercise is stopped. This examination must be supervised by a medical doctor in addition to the ECG technicians. If necessary, the test will be discontinued at an appropriate time such as in the case of significant chest pain, changes on the ECG, a drop in blood pressure or simply when the patient achieves their target heart rate.

http://www.netdoctor.co.uk/health_advice/examinations/ecg.htm

Electrocardiography is the most commonly used test for evaluating cardiac status, graphically records the electrical current (electrical potential) generated by the heart. This current radiates from the heart in all directions and, on reaching the skin, is measured by electrodes connected to an amplier and strip chart recorder. The standard resting ECG uses five electrodes to measure the electrical potential from 12 different leads; the standard limb leads (I,II,III), the augmented limb leads (aVf, aVL, and aVr), and the precordial, or chest, leads (V1 through V6). ECG tracings normally consist of three identifiable waveforms: the P wave, the QRS complex, and the T wave. The P wave depicts atrial depolarization; the QRS complex, ventricular depolarization; and the T wave, ventricular repolarization. Computerized ECG machines use small electrode tabs that peel off a sheet and adhere to the patients skin. The entire ECG tracing is displayed on a screen so abnormalities can be corrected before printing; then its printed on one sheet of paper. Electrode tabs can remain on the patients chest, arms, and legs to provide continuous lead placement for serial ECG studies. Purpose of Electrocardiography (ECG) To help identify primary conduction abnormalities, cardiac arrhythmias, cardiac hypertrophy,pericarditis, electrolyte imbalances, myocardial ischemia, and the site and extent ofmyocardial infarction. To monitor recovery from an MI. To evaluate the effectiveness of cardiac medication. To assess pacemaker performance To determine effectiveness of thrombolytic therapy and the resolution of ST-segment depression or elevation and T-wave changes. Electrocardiography (ECG) Procedure Patient Preparation for Electrocardiography (ECG) 1. Explain to the patient the need to lie still, relax, and breathe normally during the procedure. 2. Note current cardiac drug therapy on the test request form as well as any other pertinent clinical information, such as chest pain or pacemaker. 3. Explain that the test is painless and takes 5 to 10 minutes. Implementation 1. Place the patient in a supine or semi-Fowlers position. 2. Expose the chest, ankles, and wrists. 3. Place electrodes on the inner aspect of the wrists, on the medical aspect of the lower legs, and on the chest. 4. After all electrodes are in place, connect the lead wires. 5. Press the START button and input any required information. 6. Make sure that all leads are represented in the tracing. If not, determine which electrode has come loose, reattach it, and restart the tracing. 7. All recording and other nearby electrical equipment should be properly grounded. 8. Make sure that the electrodes are firmly attached. Nursing Interventions 1. Disconnect the equipment, remove the electrodes, and remove the gel with a moist cloth towel. 2. If the patient is having recurrent chest pain or if serial ECGs are ordered, leave the electrode patches in place. Interpretations Normal Results 1. P wave that doesnt exceed 2.5 mm (0.25 mV) in height or last longer than 0.12 second. 2. PR interval (includes the P wave plus the PR segment) persisting for 0.12 to 0.2 second for heart rates above 60 beats/min. 3. QT interval that varies with the heart rate and lasts 0.4 to 0.52 second for heart rates above 60 beats/min. 4. Voltage of the R wave leads V1 through V6 that doesnt exceed 27 mm. 5. Total QRS complex lasting 0.06 to 0.1 second.

Abnormal Results 1. Myocardial infarction (MI), right or left ventricular hypertrophy, arrhythmias, right or left bundle-branch block, ischemia, conduction defects or pericarditis, and electrolyte abnormalities. 2. Abnormal wave forms during angina episodes or during exercise. Precautions The recording equipment and other nearby electrical equipment should be properly grounded to prevent electrical interference. Double-check color codes and lead markings to be sure connectors march. Make sure that the electrodes are firmly attached, and reattached them if loose skin contact is suspended. Dont use cables that are broken, frayed, or bare. Interfering Factors Improper lead placement. Complications Skin sensitivity to the electrodes.

http://nursingcrib.com/medical-laboratory-diagnostic-test/electrocardiography-ecg/