Objectives:

1. To record the ECG

2. To interpret ECG tracing

Basis of ECG recording

The human body consists of mainly fluid with electrolytes that acts as a good electrical
conductor. ECG is a record of electrical activity in the heart alternating between
depolarization and repolarisation in all parts of the heart following transmission of cardiac
impulses. The electrocardiogram (ECG) is an invaluable tool to study heart electrical activity.
It works by picking up and amplifying very small electrical potential changes between
different points on the surface of the body caused by cyclical depolarization and
repolarisation of the heart cells. Electrical potentials are picked up by electrodes that are
placed on the body surface. The location of the electrodes and the conventional ways in
which they are connected enable the ECG to ‘look at the heart’ from a series of different
designated directions. The cycle of electrical changes during a single heart beat is termed
an ECG complex. Different components of the ECG complex reflect the activation of different
parts of the heart. In a normal ECG tracing there are the P wave, QRS complex and T wave.
The waves indicate activity of the heart as follows:

1. P wave indicates atrial depolarization.

2. QRS complex indicates ventricular depolarization.

3. T wave indicates vertricular repolarisation.

Question 1: What is recorded by the ECG machine?

Question 2: Draw and label a normal ECG tracing.

Understanding ECG recording

ECG can be recorded by using

1) Bipolar leads (2 opposite points) consisting of lead 1, 2, 3.

2) Unipolar leads consisting of aVR, aVL, aVF, and chest leads (V1, V2, V3, V4, V5,
and V6).

Bipolar leads

All the bipolar leads measure the potential difference between 2 points namely:

1. Lead 1 between right arm (RA) and left arm (LA).

2. Lead 2 between RA and left leg (LL).

3. Lead 3 between LA and LL.

Unipolar leads

1. Augmented leads: aVR, aVL, aVF

The unipolar lead measures the voltage at a point on the surface of the body which is
connected to the positive terminal with respect to the other 2 electrodes connected through
electrical resistance of 5000 Ohms (Wilson). The depolarization wave from the 2 electrodes
will neutralize one another or give zero potential called indifferent electrodes. However the
electrical resistance decreases the sensitivity of the recording machine and thus reduces the
size of the recorded tracing. The circuit was rearranged by removing the parallel resistance
and this is called augmented unipolar leads which are aVR, aVL and aVF (Goldberg). The
recorded tracing is 11/2 times larger. So when the positive terminal is on the right arm, the
lead is known as a aVR lead; when on the left arm, the aVL lead and when on the left leg,
the aVF lead depending on lead location/placement.

Chest leads

Chest leads are used to study the activity of the heart in a horizontal plane. These leads
record the voltage of the anterior surface of the chest directly over the heart at one of the six
separate points. This electrode is connected to the positive terminal of the ECG and the
negative (indifferent) electrode is connected through equal electrical resistances to the right
arm, left arm and left leg. The different unipolar recording are known as V1, V2, V3, V4, V5
and V6 leads depending on lead location/placement on the chest/precordium.

Apparatus

1. Portable ECG machine – this is an automatically-run machine which only requires

single button operation and equipped fully with its own electrodes and cables.

Procedure

1. Several students are chosen as subjects for ECG recording.

2. The subject is asked to lie on the couch/table.

3. The skin of the arms and legs are cleaned with alcohol provided.

4. Electrolyte is applied cream/jelly on the electrode for optimum conduction of

electricity on the skin.

5. The electrodes are secured to the arms or legs using rubber straps.

A. Recording standard lead i, ii,iii

1. The electrodes are set up on the subject’s arms and legs as follows:
 a) RA electrode on the right arm

b) LA electrode on the left arm

c) LF/LL electrode on the left leg

d) Earth/ground electrode on right leg

2. Heart beat is recorded 5 times from each bipolar lead (i, ii, iii) and unipolar lead
(aVR, aVL and aVF).

3. Recording the chest lead, the subject is asked to undress the upper body to
expose the chest.

4. The anatomical parts of the subject’s chest are located and the cup is placed at a
time as follows:

a) V1 – right margin of the sternum at the 4th intercoastal space

b) V2 – left margin of the sternum at the 4th intercoastal space

c) V3 – midway between V2 and V3

d) V4 – 5th intercoastal space at left midclavicular line

e) V5 – 5th intercoastal space at left anterior axillary line

f) V6 – 5th intercoastal space at left midaxillary line

5. 5 heart beats are recorded from each lead.

Question 3: is there any differencein the ECG tracing from standard leads?

Question 4: is there any difference in the ECG tracing obtained from chest leads and
standard leads?

B. Sinus arrthymia

1. Using lead ii as the standard lead, the subject is asked to inhale and exhale deeply.

2. The ECG tracing is recorded.

Question 5: explain the changes that occur to the ECG tracing during deep inspiration and
expiration.

C. How to interpret ECG tracing

 1. Cardiac rhythm

a) It is; sinus rhythm or arrhythmia?

Sinus rhythm means the heart beat starts from sinoatrial node. The tracing shows the
P, QRS and T sequence.

b) Is the rhythm regular or irregular?

This can be determined by comparing the distance between the R-R peak of the
QRS complex.

2. Heart rate

Count the heart rate by dividing 300 with the number of big squares between 2 R-R
peaks (each square is 0.2 second)

Question 6: what is your heart rate?

Question 7: why do we use 300 in the calculation for heart rate?

3. Duration of PR interval, QRS complex and QT interval

By counting the number of small squares, (each is 0.04 sec), determine the following:

a. PR interval:

b. QRS complex:

Is the shape and the duration of QRS complex normal? :

c. QT interval:

Is the value of QT interval normal? :

4. The ST segment:

5. The T wave:

6. Size of the myocardium of the left and right ventricle:

7. Electrical axis of the heart:

Cardiac axis

Question 8: Is there any difference between cardiac anatomical axis and cardiac electrical
axis/cardiac axis)? Explain.
Question 9: What does PR interval of 0.25 sec indicate?

Question 10: What will happen in a prolonged cardiac arrhythmia?

Question 11: What is the function of ECG in the clinic? Is there is any limitation in the use of
ECG?

Conclusion
Diagnoses of heart conducted through the ECG machine and study of the ECG tracing
showed that it is healthy and normal.