The ECG Leads

The electrocardiogram (ECG) traces the variation in voltage produced by the heart muscle during depolarization and repolarization. The standard ECG records depolarization and repolarization along designated paths called lead systems. A lead or lead system is an electrical picture of a hearts surface. Each lead traces the electrical activity between two points. Each lead traces the electrical activity between two points. Each lead traces the electrical activity between two points called electrodes. Electrodes of opposite polarity make up a bipolar lead. One positive electrode and a reference point make up a unipolar lead. Six limb leads (three bipolar and three unipolar) and six precordial leads make up the standard 12-lead ECG. The limb leads I, II, III, aVR, aVL, and aVF provide information about the superior, inferior, rightward, and leftward forces.

The six precordial leads are also called the chest leads. The electrodes for the these leads are placed directly over the heart itself. These leads encircle the precordium and provide information about the anterior, posterior, right and left forces.

Objectives Explain purpose of ECG. Locate limb and chest leads placement. Explain procedure. Practice taking 12 lead ECG.

Electrocardiogram (ECG) Electrocardiogram (ECG) is a graphic record of the voltage produced by the myocardium during the cardiac cycle. Continuous monitoring of the heart action by ECG: This has become an extremely important medical tool in the diagnosis of many heart disorders and provides vital information about - The clients condition and progress - Heart action - Response to therapy Cardiac disorders detected by ECG - Arrhythmias - Myocardial infarction - Atrial and ventricular hypertrophy - Drug effects such as digitalis and quinidine - Pericarditis - Congenital heart disease. Principle An electric current is generated in the cardiac tissues by two processes depolarization and repolarization. - Depolarization: The excited state of the tissue. Positive sodium ions move across the cell membrane causing the inside of the cell to become positive and the outside negative. The cardiac muscle contracts in the process and is repolarized. - Repolarization: Slow movement of ions across the cell membrane to restore the polarized state. - Heart muscle polarize (charged) when it is at rest. When ventricles and atria contract they depolarize. - Electrical activity generated in the heart muscle is transmitted to all parts of the body. This can be detected by electrodes placed on the skin and connected to the wire leads of the oscilloscope. - Graph recorded is called an electrocardiogram. Procedure is called electrocardiography. - Typical sites for placement of the electrodes are the extremities (arms and legs) and the chest. 12 Lead ECG The ECG consists of the following main leads:

- Three bipolar standard leads labeled as lead I, II, & III. - Three augmented, unipolar leads: aVR, aVL & aVF. - Six unipolar chest leads: V1-V6. Procedure - Explain the procedure to the client. Explain that the procedure is painless and takes about 10-15 min. Client may be anxious about the result. - Provide privacy. - Sometimes mens chest hair may need to be shaved. For women, make sure skin is dry especially under breasts before putting electrodes on. - Patient lie flat. Remove necklace, watches. - Put jelly on skin sites according to policy. Place electrodes on chest. Post procedure: Remove jelly from skin. - Switch off machine. - Document.

Wave forms in an ECG - Cardiac stimulus originates in a point, called sinoatrial (SA) node or sinus node, located in the posterior wall of the right atrium at a rate of 60-80 beats per minute. - Specialized conductive fibers inside the myocardium transmit the cardiac stimulus to all the myocardial cells. - Atria contract first, and then the ventricles. - Depolarization wave produces a current wave of atrial contraction, which is called the P wave. - After about 1/10 of a second, the atrial depolarization wave reaches the atrioventricular (AV) node, which is situated between the two sets of chambers. - Electrical stimulus passes then from the atrioventricular node through the bundle of His to the atrioventricular bundle branches, and the Purkinje fibers, which initiate the ventricular depolarization. - Ventricular depolarization is represented graphically on the electrocardiogram by a waveform called QRS complex. - During the ventricular depolarization, the right and left ventricles contract. After the QRS complex, there is a pause, called ST segment. - During the ventricular repolarization, the heart cells regain the negative charge which is represented by the T wave.

Normal ECG - Normal sinus rhythm - P wave rate 60-100 bpm

Each P wave is followed by a QRS - Normal shape - Duration 0.11 s. - Normal PR interval: 0.12 to 0.2 s. - Normal QRS complex: less than 0.12 s (3 small squares) - Normal QT interval: 0.42 s - Normal ST segment: No elevation or depression - Normal T wave - Normal U wave