Ashley Hawthorne

Electrocardiograms (ECG)
WHY 3, 5, 12?
• 3 Lead
o White/Black/Red Leads
o Monitor Rhythm, but not sufficient for ST Elevation
• 5 Lead
o 4 Limb, 1 Chest Leads
o Improved ST Elevation Reading
• 12 Lead
o 10 Electrodes Providing 12 Perspectives of Heart Activity
Figure 1 12 Lead ECG Perspectives

PATIENT PREPARATION

Figure 2 Patient Positioning Figure 3 Skin Should be Dry, Hairless, and Oil Free

EINTHOVEN’S TRIANGLE
• This Explains why there are 6 Frontal Leads
and just 4 Limb Electrodes
• Electrodes RA, LA, and LL record Electrical Activity
and Correspond with each other to form Leads 1, 2, 3
o Lead 1 RA-LA
o Lead 2 RA-LL
o Lead 3 LL-LA
• RL is Neutral / Point Zero where the electrical
current is measured
o RL does NOT come up in ECG readings
o Considered as a grounding to minimize Artifact

TRANSVERSE LEADS Figure 4 Einthoven's Triangle

• 6 Transverse Leads are the 6 Chest Electrodes

o V1, V2, V3, V4, V5, V6
• They Provide information about the Heart’s Horizontal Plane
• Transverse Leads are Unipolar (Do not require a positive electrode)
• The Negative Pole of all 6 leads is found at the center of the heart
o Calculated with the ECG
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ECG LEAD CODING FOR 12 LEAD

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LEAD PLACEMENT

HOW TO READ AN ECG

Figure 5 The Meaning of the Pieces

Figure 6 The Meaning of the Boxe s

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Figure 7 Sometime s It's All Upside Down

The Five Step Approach

Determine the Heart Rate Determine the Heart Rhythm

a.Tachy- Fast a.Regular
b.Brady- Slow b.Irregular
c.Varies i.Chaotic
ii.– when PAC/PVC occurs
iii.Irregular Atrial Contraction
iv.During PJC
v.Whenever an escape beat occurs

Evaluate the P Wave

a.Normal
b.Present
c.Hidden in Preceding T Wave
Determine the QRS Duration d.Buried in QRS
a.Normal 0.06-0.10 e.NO True P Waves
f.Chaotic Atrial Activity
g.Inverted
h.None / Absent

Measure the PR Interval

a.Normal 0.12-0.20
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THE NORMAL
• Because each lead takes a different view of heart activity, it generates a characteristic tracing on an
electrocardiogram (ECG). The traces shown here are representative of each of the 12 leads.
• Leads aVR, V1, V2, V3, and V4 normally show strong negative deflections.
• Negative deflections indicate that the current is moving away from the positive electrode
• Positive deflections, that the current is moving toward the positive electrode
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THE ABNORMAL ECG

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ECG Changes in Electrolyte Imbalance