ECG Booklet PDF

Basic Principles of ECG Booklet
Basic Principles of
Electrocardiography
Nursing Program, Medicine Faculty Brawijaya University 2004
References
Atwood,Stanton, Storey (1996). Pengenalan Dasar Disritmia Jantung. Yogyakarta : Gajah Mada University Press. Emergency Nurses Chapter (2001). Basic ECG Course. 3rd edition. Singapore : Singapore Nurses Association Ginger & Melvin Ochs (1997). Recognition & Interpretation : ECG RHYTHMS. 3rd edition. USA: Appleton & Lange. Thaler (2000). Satu-satunya BUKU EKG yang Anda Perlukan. Edisi 2. Jakarta : Hipokrates.
Alfrina Hany,S.Kp/Brawijaya University
Learning Objectives
General Objectives
After studying this subject in about 2 x 3 x 50 menit, the students expected to be able to use ECG machine and interpret the ECG result. Composition : 15 Pre test 90 Presentation & Discussion 15 Post test
Specific Objectives
1. Fundamentals of EKG (20)
a. Introduction b. Hearts conducting system c. EKG Machine d. EKG Waveform Analysis
2. Obtaining 12 leads EKG (20)

a. About 12-Lead EKG b. Recording 12-Lead EKG c. Troubleshooting (problems&solutions) d. Care & Cleaning
3. Interpreting Basic EKG (50)

a. 5 Steps of Arrhythmia Interpretation b. Classification of Arrythmias c. Recognition & Treatment
Fundamentals of EKG

Introduction Hearts conducting system EKG Machine EKG Waveform Analysis
During the late 1800's and early 1900's, Dutch physiologist Willem Einthoven developed the early electrocardiogram. He won the Nobel prize for its invention in 1924. Hubert Mann first uses the electrocardiogram to describe electrocardiographic changes associated with a heart attack in 1920. Electrocardiography - graphic recording of the electrical activity (potentials) produced by the conduction system and the myocardium of the heart during it depolarization / repolarization cycle.
Fundamentals of ECG
Hearts Conducting System

(Ginger & Melvin Och, 1997)
Normally electrical impulses that causes rythmic contraction of heart muscles arises in the SA Node as the intrinsic pacemaker of the heart. From the SA Node, impulse spreads over the atrial muscles causing atrial contraction. The impulse is also conducted to the AV Node & it takes 0.03 sec to travel from SA to AV Node. From AV Node the electrical impulse is conducted to ventricular muscles via the bundle of his, the bundle branches & the purkinje fibres. The bundle branches & the purkinje fibres are collectively called the ventricular conduction system
Fundamentals of ECG
A heart controlled by the SA Node is said to be in normal sinus rhythm. The SA Node under influence of the autonomic nervous system (Sympathetic which increases the heart rate via B1 adrenergic receptors; Parasympathetic which slows the heart rate via vagus nerve) The rhythm originates from SA Node because the SA Node depolarizes more frequently (60100 beats/min) than AV Node (40-60 b/m) & ventricular conducting system (30-40 b/m), so the AV Node & ventricular conducting system are captured by the sinus impulse and driven at 60-100 b/m
Fundamentals of ECG
The electrical impulse from the SA node is conducted through the AV node because the atria & ventricles are separated by a fibrous connective tissue ring that has poor conductivity. The AV node provides a path for the impulse to proceed from the atria to ventricles. The AV node together with bundle of His make up the AV junctional tissue. The AV Junc Tissue has its own intrinsic pacemaker activity at 40-60 b/m. if SA node are injured,
the AV Junc Tissue can take over control of the heart rate & rhythm
Fundamentals of ECG
EKG Machine
(Ginger & Melvin Och, 1997)
An EKG machine is a highly sensitive voltmeter that measures voltage difference between two points on the body surface The voltage difference comes from depolarization and repolarization of cardiac muscle cells An EKG machine has a positive and a negative terminal Single, Multi Channel
Fundamentals of ECG
Electrophysiology
(Ginger & Melvin Och, 1997) Normal electrical activity of the heart Polarization the phase of readiness. The muscles is relaxed and the cardiac cells are ready to receive an electrical impulse Depolarization the phase of contraction. The cardiac cells have transmitted an electrical impulse, causing the cardiac muscle to contract. Repolarization the recovery phase. The muscles are returning to a relaxed state. ** The cardiac muscle cells have K inside and Na outside the cells. When polarized cell is stimulated by an electrical impulse, K moves outside the cell and Na moves inside.
Fundamentals of ECG
.1 mv
paper
Voltage
.5 mv .04 seconds
Time
.20 seconds
Paper speed = 25mm / second
1 small box = 0.040 sec 5 small boxes = 0.20 sec 15 small boxes = 3 sec 30 small boxes = 6 sec 300 small boxes = 1 min
1 mm = 1mV
Fundamentals of ECG
ECG Waveform Analysis

Consist of : 1. Isoelectric Line 2. ECG Waves * P * QRS *T *U 3. ECG Intervals * P-R * QRS 4. ST Segment 5. J Point Picture 1 Picture 1 & 2
Picture 1 & 2 Picture 2 Picture 2
Fundamentals of ECG
Picture1
Picture 2
Fundamentals of ECG
EKG Intervals
QRS Complex
P-R Interval = A-V Conduction Time Q-T Interval = Ventricular Contraction Time R-R Interval = Cardiac Cycle Time Heart Rate = 1/R-R Interval
One Cardiac Cycle

P wave T wave Q-T Interval P wave
P-R Interval
Fundamentals of ECG
P Wave represents the electrical activity of the original impulse from the SA node and its subsequent spread to the atria. If the P wave is absent or abnormal in shape, it means the impulse originates from outside of the SA node. Normal duration is 0.04 to 0.11 second (maximum about 3 small squares) PR Intervals is measured from the beginning of the P wave to the beginning of the QRS complex. It represents the time taken for the impulse to travel from the SA node to the AV node and the ventricles. Normal duration is 0.12 to 0.20 second (3 to 5 small squares)
Emergency Nursing Chapter, 2001
Fundamentals of ECG
QRS Complex represents the time taken for the impulse to travel from the Bundle of His to the Purkinje fibres, wich results in the contraction of the ventricles. Duration is less than 0.12 second (3 small squares). The complex consists of an initial downward deflection Q wave, an upward deflection R wave and second downward deflection S wave. The configuration of the QRS complex varies from lead to lead and there are several patterns. ST Segment begins at the end of the S wave and terminates at the upstroke of the T wave. The J point (junction point) marks where the S wave ends the ST segment begins. The segment is elevated in acute injury of AMI and depressed in ischemic states Emergency Nursing Chapter, 2001
Fundamentals of ECG
T Wave represents the recovery phase after ventricular contraction. Tall, peaked or tented T waves indicate myocardial injury or hyperkalemia. Inverted T waves may mean myocardial ischemia.
QT Interval represents the depolarization& repolarization of the ventricles. Abnormal duration indicates myocardial problems
U Wave represents the recovery period of the Purkinje fibres. It is not present on all ECG waveforms. A prominent u wave may indicated hypercalemia, hypokalemia or digoxin overdose. Emergency Nurses Chapter, 2001
Fundamentals of ECG
Characteristics of a Normal Sinus Rhythm

Regular rhythm Heart rate 60 to 100 per minute P wave precedes every QRS complex. All P waves are similar in shape and size All QRS complexes are similar in shape and size Normal PR interval T waves are after the QRS complexes All waves and interval are normal in duration and position
An Arrhytmia is an abnormal rhythm I.e. either the rate or the contour/position of any individual wave is abnormal
10
Obtaining 12 Lead EKG
About 12-Lead EKG Recording 12-Lead EKG Troubleshooting (Problems & Solution) Care & Cleaning
Obtaining 12-lead ECG
12-Lead ECG
The 12 EKG leads measure the electrical activity of the heart from 12 different directions Bipolar Leads (augmented vector): Lead I, Lead II, Lead III Unipolar Leads: aVR, aVL, aVF Precordial Leads: V1, V2, V3, V4, V5, V6
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12
13
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Recording the 12-Leads ECG

(Emergency Nurses Chapter, 2001)
Explanation

Tell the patient that the doctor has ordered an ECG and explain the procedure Emphasize that the test takes about a few minutes and that its a safe and painless way to evaluate cardiac function Answer the patients question, and offer reassurance. Preparing him well helps alleviate and promote co-operation
Prepping the Patient

Ask the patient to lie supine in the center of the bed with his arms at his sides If he cant tolerate lying flat, raise the head of the bed to semi-Fowlers position Ensure privacy, and expose the patients arms, legs, and chest
Selection of the Electrode Sites

Choose spots that are flat and fleshy, not muscular or bony Clean excess oil or ather substances from the skin to enhance electrode contact. Remember the better
the electrode contact, the better the recording
15
Steps in recording the ECG

Know your machine Set the ECG paper speed selector to 25mm/second. If necessary, enter the patients identification data. Then calibrate or standardize the machine according to the manufacturers instructions. Plug the cord of the ECG machine into a grounded outlet. If the machine operates on a charged battery, it may not need to be plugged in. Place one or all of the electrodes on the patients chest, based on the type of machine youre using. Make sure all the leads are securely attached, and then turn on the machine.
Obtaining 12-lead ECG Instruct
the patient to relax, lie still, and breathe normally. Ask him not to talk during the recording to prevent distortion of the ECG tracing.
Press
the AUTO button and record the ECG. If youre performing a right chest lead ECG, select the approriate button for recording.
Observe Remove
the quality of the tracing. When the machine finishes the recording, turn it off. the electrodes and clean the patients skin.
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Documentation

Date Time Doctors name Nurses name Special circumstances : vital sign, clients condition
Troubleshooting
Problem Power line AC interference Cause Poor electrode contact. Dry or dirty electrodes Solution Abrade skin. Use new electrodes. Reapply electrodes.
Power line AC interference
Lead wires may be picking Route lead wires along limbs and away up interference from from other equipment. Fix or move poorly poorly grounded grounded equipment equipment near the patient Patient cable is too Move cardiograph away from the close to the cardiograph patient. Unplug the cardiograph and or other power cords operate on battery only. Move other equipment away from the patient
Power line AC interference
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Problem
Wandering baseline
Cause
Electrode movement. Poor electrode contact and skin preparation Patient movement Respiratory interference
Solution
Be sure that the lead wires are not pulling on the electrodes. Reapply electrodes. Press the filterkey Reassure and relax the patient Move lead wires away from areas with the greatest respiratory motion
Problem
Tremor or muscle artifact
Cause
Poor electrode placement. Poor electrode contact. Patient is cold
Solution
Clean the electrode site. Be sure the limb electrodes are placed on flat, nonmuscular areas. Warm the patient Reassure and relax the patient. Press the filterkey Attach the limb electrodes near the trunk. Pressthe filterkey
Tense, uncomfortable patient Tremors
18
Problem
Intermittent or jittery waveform
Cause
Poor electrode contact. Dry electrodes
Solution
Clean the electrode site. Reapply electrodes
Faulty lead wires

Poor print quality Dirty printhead or ink has finished
Replace faulty patient cable

Clean printhead or change the ECG stylus
Emergency Nurses Chapter, 2001
Interpreting Basic ECG

5 Steps of Arrhythmia Interpretation Classification of Arrythmias Recognition & Treatment Acute Myocard Infarct
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5 Steps of Arrhythmia Interpretation

Step 1 : Calculate the Heart Rate
Using the two simplest methods :
10-times / 20-times method

= Number of R-waves in a 6 second strip multiply by 10 = Number of R waves in 3 second strip multiply by 20 = 1500 divided by the number of small boxes between consecutive R-waves
Dividing Methods
Use only if the rhythm is regular. Divide 300 with the big boxes between 2 R waves. If there are also small boxes, add the small boxes to the big boxes. Divide 300 with the combination
Step 2 : Measure the regularity of the R waves

Using methods :

Pen/pencil and paper method Caliper method
Step 3 : Examine the P waves
Present before all QRS Normal configuration Similar size & shape
20
Step 4 : Measure the PR interval
Number of small squares between the start of P wave and the beginning of QRS complex not more than 5.
Step 5 : Evaluate the QRS complex

Number of small squares from the beginning to the end of the complex not more than 3. Conclusion
Classification of Arrhythmia
Emergency Nursing Chapter, 2001
According to :

Site of arrhythmia Mechanism of disorder Seriousness of the arrhythmia
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Major Sites

Sinus arrhythmia Atrial arrhythmia AV node arrhythmia Ventricular arrhythmia Tachycardia (HR > 100 beats per minute) Bradycardia (HR < 60 beats per minute) Premature beats Flutter Fibrilation Defects in conduction e.g. heart block
Major Mechanisms

Recognition & Treatment

Ginger & Melvin Och, 1997 Thaler, 2000

Normal Sinus Rhythm Sinus Arrhythmias Atrial Arrhythmias Heart Blocks Ventricular Arrhythmias
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Normal Sinus Rhythm (NSR)
Description This is the normal heart rhythm. It originates in the SA node and follows the appropriate conduction pathways. The rate is normal, and the rhythm is regular. Every beat has a P wave, and every P wave is followed by a ventricular response. EKG Criteria Rate: 60-100 bpm. Rhythm: Regular. A normal variant called Sinus Arrythmia changes rhythm in response to respiration. This is seen most often in young healthy people. Pacemaker: Each beat originates in the SA node. P wave: look the same, all originate from the same locus (SA node) PRI: 120-200 msec QRS: 80-120 msec, narrow unless effected by underlying anomoly
SINUS BRADYCARDIA
Description Sinus bradycardia originates in the SA node. It has reduced rate generally from a reduction in sympathetic input, or excessive vagal (parasympathetic) tone. This rhythm may accompany inferior MI's, hypoxia, hypothermia, or drug reactions. At moderately slow rates, the patient may be asymptomatic. At slower rates, they may become hypotensive and present with symptoms consistant with decreased perfusion: dizziness, syncope, shock like signs and symptoms. Treatment is aimed at increasing the heart rate. Therapies include atropine, transcutaneous and transvenous pacing, epinephrine, dopamine, isoproterenol. EKG Criteria Rate: <60 bpm. Rhythm: Regular generally. Pacemaker: SA node P wave: Present, all originating from SA node, all look the same. PRI: <200 msec, and constant. QRS: Normal, 80-120 msec.
23
SINUS TACHYCARDIA
Description This arrythmia originates from the SA node. It is defined as a sinus rhythm exceeding 100 bpm. Sinus tach is a normal rhythm which occurs in response to increased oxygen demand. This occurs with exercise, infection, hypovolemia, hypoxia, myocardial infarct, and in response to stimulant drugs, The rate usually has a gradual onset and elimination. Treatment is not usually needed, but is aimed at treating the underlying condition. EKG Criteria Rate: >100 bpm. Rhythm: Regular, generally. Pacemaker: SA node. P wave: Present and normal, may be buried in T waves in rapid tracings. PRI: 120-200 msec., generally closer to 120 msec. QRS: Normal.
PREMATURE ATRIAL COMPLEXES(PAC)
Description These complexes originate in the atria. They often originate from ectopic pacemaker sites within the atria which results in an abnormal P wave. The complex occurs before the normal beat is expected, hence the prematurity. It is followed by a pause. There are many causes including: increased sympathetic input, exogenous stimulants, drug interactions, AMI, cardiac ischemia, idiopathic. These complexes can indicate increased automaticity. They may lead to re-entry rhythms. EKG Criteria Rate: Underlying rhythm. Rhythm: Irregular with PACs. Pacemaker: Ectopic atrial pacemaker outside SA node. P wave: Ectopic P wave present, generally different than normal SA P wave. PRI: Generall normal range 120-200 msec, but differ from underlying rhythm. QRS: Same as underlying rhythm.
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SUPRAVENTRICULAR TACHYCARDIA (SVT)
Description There are several different types of SVT depending on the site of reentry (accessory pathway, atrioventricular node or atrium). This rapid rhythm starts and stops suddenly. Treatment includes vagal maneuvers, antiarrhythmia medication, radio-frequency ablation or surgical modification of site of reentry. EKG Criteria Rate: 140 - 220 bpm Rhythm: Regular Pacemaker: Reentry circuit Accessory pathway: Normal or short (if down accessory pathway) A-V nodal reentry: Hidden in or at end of QRS PRI: Depends on location of circuit QRS: Normal if accessory pathway used - prolonged (>120 msec) with delta wave
ATRIAL FLUTTER
Description Atrial flutter is characterized by "sawtooth" atrial activity and a conduction ratio to the ventricles of 2:1 to 8:1. It is caused by a reentrant circuit located in the right atrium. It may occur when the atria are enlar ged in chronic obstructive lung disease, mitral or tricuspid disease, pericarditis or post-operatively. Definitive treatment is direct-current cardioversion, surgical or catheter ablation. EKG Criteria Rate: 250 - 350 bpm (atrium) Rhythm: Atrial rate regular, ventricular conduction 2:1 to 8:1 Pacemaker: Reentrant circuit rhythm located in the right atrium P wave: Saw-tooth or picket fence PRI: Constant onset
25
ATRIAL FIBRILLATION
Description This is the most common sustained cardiac arrhythmia. It is characterized by an undulating baseline replacing P waves and an irregularly irregular ventricular response. This arrhythmia occurs with hypertension, ischemic, mitral, myocardial and pericardi al disease, thyrotoxicosis, aging and sometimes occurs in normals. Treatment includes anticoagulation, drugs to slow ventricular conduction and/or cardioversion EKG Criteria Undulating baseline replaces P waves Rhythm: Irregularly irregular
FIRST DEGREE AV BLOCK
Description Conduction disturbances are characterized as first degree, second degree Mobitz 1, second degree Mobitz II and complete heart block. The normal P-R interval is 120 - 200 msec. First degree AV block is a constant and prolonged PR interval. Possible etiologies include insult to AV node, hypoxemia, myocardial infarction, digitalis toxicity, ischemia of the conduction system and increased vagal tone but is also seen in normals.
EKG Criteria Rhythm: Regular PRI: >200 msec
26
SECOND DEGREE AV BLOCK MOBITZ I (WENKEBACH)
Description Wenkebach is characterized by progressive delay at the AV node until the impulse is completely blocked. Etiologies are the same as cause first degree AV block and is also seen in normals. This conduction abnormality does usually not progress to higher degree heart blocks. EKG Criteria Rhythm: Irregular PRI: Progressive lengthening of PRI until dropped beat. A clue to Wenckebach is that the QRS's appear to occur in groups.
SECOND DEGREE AV BLOCK MOBITZ II
Description This is a higher degree of conduction block then Mobitz I and may progress to complete AV block. AV conduction appears normal until suddenly there is no AV conduction following one P wave. This may occur in a pattern (every 2nd, 3rd or 4th complex) or may occur randomly. This is intermittent block at the AV node and may progress to complete heart block.
EKG Criteria PRI: Constant on conducted complexes until a sudden block of AV conduction. That is, a P wave is abruptly not followed by a QRS
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PREMATURE VENTRICULAR CONTRACTIONS (PVC)
Description A PVC is a depolarization that arises in either ventricle before the next expected sinus beat. The normal sequence of depolarization is altered because the impulse originates in the ventricle. The two ventricules depolarize sequentially insteat of simultaneously. Conduction moves more slowely than through the specialized conduction pathways, this results in a widened QRS complex (greater than 0.12 sec). PVCs may occur as isolated complexes or may occur in pairs, triplets, or in a repeating sequence with normal QRS complexes. Three or more PVCs in a row is considered a run of Ventricular Tachycardia. If it lasts for more than 30 seconds it is designated sustained VT. Treatment: Rarely treated unless symptomatic. PVCs may indicate acute mycardial ischemia requiring rapid intervention including oxygen, NTG, morphine, thrombolytic. Treating with lidocaine will cease the PVC, but won't address the ischemic cause. EKG Criteria Rhythm: Irregular QRS: Is not normal looking. Broadened, greater than 0.12 seconds. P waves are usually obscured by the QRS, ST segment, or T wave of the OVC. The P wave may sometimes be seen as notching during the ST segment or T wave.
BIGEMINY PVCs
Description PVC's may occur in patterns. When each normal complex is followed by a PVC forming groups of 2, the term "ventricular bigeminy" is used.
EKG Criteria QRS: Normal QRS complex followed by premature wide bizarre complex (PVC) in patterns of 2
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VENTRICULAR TACHYCARDIA
Description Ventricular Tachycardia (VT) is defined as three or more beats of ventricular origin in succession at a rate greater than 100 beats per minute. There are no normal (narrow) looking QRS complexes. Consequences of VT depend on accompanying myocardial dysfunction. It may be well tolerated or associated with life-threatening hemodynamic compromise. Treatment: If patient is stable, they are initially treated with lidocaine, procainamide, or bretylium tosylate. Hemodynamically unstable VT (with a pulse) is cardioverted at 200J, 300J, 360J as needed. VT without a pulse is treated like VF and defibrillated. EKG Criteria No normal looking QRS complexes, often bizzare with notching. Width of QRS>0.12 sec. ST segment and T wave are opposite polarity to the QRS. Sinus node may be depolarizing normally. There is usually complete AV dissociation. P waves are sometimes seen between QRS complexes. They have no impact on the QRS complexes. Rate: Generally 100 to 220 bpm Rhythm: Generally regular, on occassion can be modestly irregular.
VENTRICULAR FIBRILLATION
Description
Ventricular Fibrillation is a rhythm in which multiple areas within the ventricles display marked variation in depolarization and repolarization. There is no organized depolarization, therefore the ventricles do not contract as a unit. The myocardium is quivering when visualized grossly. There is no cardiac output. This is the most common arrythmia seen in cardiac arrest from ischemia or infarction. The rhythm is described as coarse or fine VF. Coarse VF indicates recent onset of VF. Prolonged delay without defibrillation results in fine VF and eventually asysyole. Resuscitation becomes more difficult as VF becomes finer. Treatment is always immediate unsynchronized defibrillation at 200J, 300J, 360J for adult patients.
EKG Criteria
Rate: Very rapid, too disorganized to count. Rhythm: Irregular, waveform varies in size and shape No normal QRS complexes. Absent ST segments, P waves, T waves.
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ASYSTOLE
Description Asystole represents the total absence of ventricular electrical activity. Since depolarization does not occur, there is no ventricular contraction. This may occur as a primary event in cardiac arrest, or it may follow VF or pulseless electrical activity (PEA). Ventricular asystole can occur also in patients with complete heart block in whom there is no excape pacemaker. VF may masquerade as asystole; it is best always to check two leads perpendicular to each other to make sure that asystole is not VF. Treatment for each arrythmia is very different. Fine VF which may mimic asystole should be treated with defibrillation. But defibrillating asystole is potentially harmful. Treatment: Epinephrine and Atropine are administered. Consider causes: pulmonary embolism, acidosis, tension pneumothorax, cardiac tamponade, hyperkalemia, hypokalemia, hypoxia, hypothermia, overdose, myocardial infarction. EKG Criteria Complete absence of ventricular electrical activity. Occasional P waves or erratic ventricular beats may be seen. These patients will be pulseless. Treatment must be immediate if the patient is to have any chance at resusctiation. Rate: None Rhythm: None
Myocardial Infarction
ECG will reflect the three pathologic changes of a MI : Ischaemia Injury Infarction/Necrotic
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Zone of Infarction / Necrotic

Area of myocardial necrosis may develop within an hour of an infarct / a few days later. Irreversibel & permanent Pathologic Q wave (1/3 R wave)
Zone of Injury Marked by an elevated ST-segment Result from prolonged lack of blood supply
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Zone of ischaemia Results from an interrupted blood supply Represented by T-wave inversion or J-point depression
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EVOLUTION OF AMI
Assessing AMI
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Conclusion
It is important for nurses not only to record the patients ECG but also interpret it to give the best treatment for their patient based on his/her problem
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Basic Principles of ECG Booklet

Nursing Program, Medicine Faculty Brawijaya University 2004

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

2. Obtaining 12 leads EKG (20)

3. Interpreting Basic EKG (50)

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Introduction Hearts conducting system EKG Machine EKG Waveform Analysis

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Hearts Conducting System

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Paper speed = 25mm / second

ECG Waveform Analysis

Picture 1 & 2 Picture 2 Picture 2

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

One Cardiac Cycle

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Characteristics of a Normal Sinus Rhythm

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Obtaining 12 Lead EKG

Obtaining 12-lead ECG

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Obtaining 12-lead ECG

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Obtaining 12-lead ECG

Recording the 12-Leads ECG

Obtaining 12-lead ECG

Prepping the Patient

Selection of the Electrode Sites

the electrode contact, the better the recording

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Obtaining 12-lead ECG

Steps in recording the ECG

Obtaining 12-lead ECG Instruct

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Obtaining 12-lead ECG

Obtaining 12-lead ECG

Power line AC interference

Power line AC interference

Alfrina Hany,S.Kp/Brawijaya University

Basic Principles of ECG Booklet

Obtaining 12-lead ECG