ELECTROCARDIOGRAM

BY: KEVERNE JHAY P. COLAS, RN

Electrocardiogram (ECG)
• a diagnostic tool that measures and records
the electrical activity of the heart in exquisite
detail. Interpretation of these details allows
diagnosis of a wide range of heart
conditions. These conditions can vary from
minor to life threatening.
• The term electrocardiogram was introduced
by Willem Einthoven in 1893 at a meeting of
the Dutch Medical Society. In 1924,
Einthoven received the Nobel Prize for his
life's work in developing the ECG.
• The 12- lead ECG that is used throughout
the world was introduced in 1942.
 Reasons to Have an
Heart problemsECG
can produce a wide
array of symptoms.
Without the benefit of an ECG, it
may be impossible to tell whether
these symptoms are being caused
by a heart problem or just
mimicking one.

Common symptoms that frequently

require an ECG include the
following:
Chest pain or discomfort
Shortness of breath
 The Heart
• The heart itself is made up of 4
chambers, 2 atria and 2 ventricles.
De-oxygenated blood returns to the
right side of the heart via the venous
circulation. It is pumped into the
right ventricle and then to the lungs
where carbon dioxide is released and
oxygen is absorbed. The oxygenated
blood then travels back to the left
side of the heart into the left atria,
then into the left ventricle from
 The Heart
• Systolic blood pressure:
v Is the pressure created in the arteries when
the ventricles contract

• Diastolic blood pressure:

v When the ventricles starts to refill, the
pressure from the arteries falls simultaneously
the atriums contract creating pressure known
as the diastolic pressure.
 The Heart
Image: The passage of blood through the
heart
 The Heart
Image: The cardiac conduction system
 Role of the ECG
The ECG machine is designed to recognise and
Machine
record any electrical activity within the heart. It
prints out this information on ECG paper made up of
small squares 1mm squared.
 Role of the ECG
Machine
Each electrical stimulus takes the
form of a wave and so patterns
emerge made up of a number of
connected waves. A standard ECG is
printed at 25mm per second or 25
small squares per second (see
above). In this way it is possible to
calculate the duration of individual
waves.
10 small squares vertically is equal to
Role of the ECG
Machine
 Sinus Rhythm
Sinus rhythm is the name given to the
normal rhythm of the heart where
electrical stimuli are initiated in the SA
node, and are then conducted through
the AV node and bundle of His, bundle
branches and Purkinje fibres.
Depolarisation and repolarisation of
the atria and ventricles show up as 3
distinct waves on ECG. A unique
labelling system is used to identify
Sinus Rhythm
 The P Wave
The first wave (p wave) represents
atrial depolarisation
 The QRS Complex
After the first wave there follows a
short period where the line is flat. This
is the point at which the stimulus is
delayed in the bundle of His to allow
the atria enough time to pump all the
blood into the ventricles.
As the ventricles fill, the growing
pressure causes the valves between
the atria and ventricles to close. At this
point the electrical stimulus passes
from the bundle of His into the bundle
The Q Wave
Q wave and represents depolarisation
in the septum.
 The R Wave
R wave represents the ventricular
depolarisation
 The S Wave
S wave represents depolarisation of
the Purkinje fibres.
The T Wave
T wave represents ventricular
repolarisation.
 The ST Segment
There is a brief period between the end of the QRS
complex and the beginning of the T wave where
there is no conduction and the line is flat. This is
known as the ST segment and it is a key indicator
for both myocardial ischemia and necrosis if it goes
up or down.
V1: 4th intercostal space right
sternal border
V2: 4th intercostal space left sternal
border
V3: halfway between V2 and V4
V4: left 5th intercostal space,mid-
clavicular line
V5: horizontal to V4, anterior axillary
line
V6: horizontal to V5, mid-axillary line
 Points To Remember:

Ask the patient to remove all metalic objects

including watches, rings, neclaces, pocketed
coins and phones etc…
Let the patient relax before the procedure
starts and ask them to lay still for a minute
during the procedure.
Explain the procedure and reassure them
that no pain will be felt during the procedure.
~END~
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