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Electrocardiogram Test (ECG).

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Introduction

An electrocardiogram (ECG) test is a test performed to diagnose heart conditions by

measuring the heart’s electrical activity. The ECG is an electrical heart tracing recorded non-

invasively from the body’s surface (Bulková, 2021). The term ECG was derived from the

German language “elektro-kardiographie”. ECG was invented in 1902 by Einthovan, a Dutch

physician (Krikler, 1987) in his ten years of clinical studies which contributed to the recognition

of the technique’s potential.

ECG is regarded as a non-invasive diagnostic modality that has improved the clinical process

of investigating cardiovascular disease severity (Rundo et al., 2018). The test is being applied in

patients monitoring antiarrhythmics and other drugs as a preoperative assessment part of patients

placed under non-cardiac surgery. ECG test is an integral part of screening individuals involved

in occupations termed as highly risky and those in various sports activities. The test is also used

as a surveillance and experimental trial tool for drugs with known cardiac effects. The type of

ECG tests depends on the symptoms and suspected heart problems in an individual, the

following are the main three types of ECG tests:

 Resting ECG: this is carried out while the patient is lying down in a comfortable

position

 A stress or exercise ECG: this is carried out while the patient is using an exercise

bike or treadmill
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 An ambulatory ECG (a Holter monitor): this is where the electrodes are connected

to a small portable machine worn at the patient’s waist for heart monitoring at home

for 1 or more days

Indications of the Screening Test

The ECG test is recommended to be performed on an individual by doctors because of several

reasons including the following:

 Presence of signs and symptoms linked to heart illness including bradycardia,

tachycardia, and other clinical conditions such as hypertension, murmur, shock, and

hypotension.

 Individuals experiencing symptoms such as palpitations, dizziness, chest pains,

seizures, poisoning, and cyanosis.

 To detect the malfunction of the pacemaker and defibrillator, an ECG test is

performed to evaluate the performance of these programs through verifying the

arrhythmias analysis and monitoring of the delivery of required electrical pacing in

patients with pacemakers and defibrillators (Locati et al., 2018). Surface ECG is

important in detecting malfunction and evaluating the function of the electric therapy,

therefore, enhancing the prevention of inappropriate measures.

 Detecting cardiomyopathy in individuals participating in sports

An athlete is an individual engaged in regular exercises during training for sports and to be

physically fit for optimum performance. ECG test is applied as a screening tool in sports during
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physical examinations of athletes to detect cardiomyopathy based on the International consensus

standards for ECG interpretation in athletes (Drezner et al., 2017).

Figure 1: International consensus standards for ECG interpretation in athletes

 Diagnosis of various arrhythmias in children with congenital heart diseases

ECG test is important in the diagnosis of congenital heart diseases in children. The test helps

in the evaluation of P-wave dispersion (PWD) and QT dispersion (QTd) in children diagnosed

with congenital heart disease and pulmonary arterial hypertension (PAH-CHD) (Saleh et al.,
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2019). Through PWD and QTd, the predictors of arrhythmias in children with congenital heart

diseases are easily determined.

Equipment for ECG test

The equipment for performing ECG test include:

 Electrodes /sensors

 Gauze and skin preparation solution (alcohol rub)

 Razors, clippers, and a roll of tape for removing hair

 Skin adhesive and antiperspirant

 ECG paper

 Cardiac monitor or electrocardiography machine

Figure 2: ECG Machine and Electrocardiogram Test

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The ECG machine is equipment consisting of 12 leads divided into two groups including the

limb leads and precordial leads. The limb leads are categorized as standard bipolar limb leads I,

II, and III, and as augmented Unipolar Leads aVL, aVF, and aVR. The precordial Leads consist

of V1-V6. The limb leads are used in viewing the heat in a vertical plane, and the precordial

leads are for the recording of the electrical activity of the heart in the horizontal plane.

ECG test Phases

1) Pre-test phase

The Electrocardiogram test needs adequate preparation. Before the test is performed, the

history of the patient’s drugs and allergies to adhesive should be done. The room temperature

should be maintained at an optimal state to avoid the patient shivering. The nurses identify the

electrode sites and if the patient has a hairy chest, shaving should be done, and application of

electrocardiographic adhesive gel to the electrodes. A clean chest ensures there is good contact
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between the body and the electrodes. The medical professional explains the procedure to the

patient and provides an opportunity for questions to be asked. If the patients have jewelry and

other objects they should be removed. The patient should lie down and relax before the recording

of the standard 10-second strip.

2) Intra-test phase

During the test the "angle of Louis" method is used to provide the correct and exact placement

of the electrodes as follows:

a) V1 should be placed to the right of the sternal border and V2 placed to the left of the

sternal edge.

b) V4 should be placed at the fifth intercostal space in the mid-clavicular line. V4 is

placed before V3 and V3 should be placed between V2 and V4.

c) V5 should be placed directly between V4 and V6.

d) V6 should be placed at the level of the fifth intercostal space in the mid-axillary line.

e) V4 through V6 should

line up horizontally along

with the fifth intercostal

space.
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Electrocardiogram machines record changes in electrical activity by drawing a trace on a

moving electrocardiograph paper. The electrocardiograph moves at a speed of 25 mm/sec. The

X-axis is for plotting time and the y-axis is for voltage. 1 second is divided into five large

squares representing 0.2 seconds on the x-axis. The large squares are divided further into small

five squares representing 0.04 seconds. The machine is calibrated in a manner that increases the

voltage by 1 mVolt making the stylus move by 1 cm (Sattar & Chhabra, 2022).

3) Post-test phase

After the ECG test, there is no special care to be administered and the patient should be able

to resume his or her normal activities and diet unless there are further instructions provided by

the doctor on what should be done or not. The doctor interprets the results of the test based on

the medical history, the signs and symptoms of the patients, and clinical examination. If the

patient develops the symptoms and signs they had before the test including breath shortness,

dizziness, fainting, and chest pains, they should notify the doctor and further tests may be

recommended to be performed by the doctor. Before the patient is discharged the doctor

determines the exercise prescription by subjecting the patient to an exercise test of a lower level.

Health Teaching for The Test

According to (Sattar & Chhabra, 2022), the use of ECG tests has improved from the

interpretations of simple heart rates to the monitoring of heart rhythms and interpretations of

complex abnormalities including arrhythmias and myocardial infarction. Therefore, the medical

professional should have the necessary skills and knowledge for effective ECG readings and

make appropriate health recommendations for various medications.

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To achieve better ECG outcomes and effective patient care in the nursing departments and

among the medical team, there should exist a better interaction among the healthcare team,

nurses, patients, care assistants, and ECG technicians. Collaboration and teamwork in clinical

settings are imperative in reducing errors especially in the cardia department through the use of

multiple checkpoints and ensuring timely care (Adams et al., 2014). Therefore, the health care

team should work by work ethics, ensure high levels of patient satisfaction and employ

proficiency during ECG tests. Role of good communication should be enhanced among medical

professionals to provide clear instructions on their roles and how to solve issues related to the use

of ECG equipment and machines, to ensure there are maximum and intended patient results.
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References

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collaborative team: from creation to operation. J Interprof Care, 28(4), 339-344.

https://doi.org/10.3109/13561820.2014.891571

Bulková, V. (2021). Long-term ECG monitoring. Vnitr Lek, 67(1), 16-21. (Dlouhodobá EKG

monitorace.)

Drezner, J. A., Sharma, S., Baggish, A., Papadakis, M., Wilson, M. G., Prutkin, J. M., Gerche,

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Locati, E. T., Bagliani, G., Testoni, A., Lunati, M., & Padeletti, L. (2018). Role of Surface

Electrocardiograms in Patients with Cardiac Implantable Electronic Devices. Card

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Rundo, F., Conoci, S., Ortis, A., & Battiato, S. (2018). An Advanced Bio-Inspired

PhotoPlethysmoGraphy (PPG) and ECG Pattern Recognition System for Medical

Assessment. Sensors (Basel), 18(2). https://doi.org/10.3390/s18020405

Saleh, A., Shabana, A., El Amrousy, D., & Zoair, A. (2019). Predictive value of P-wave and QT

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https://doi.org/10.1016/j.jsha.2018.11.006

Sattar, Y., & Chhabra, L. (2022). Electrocardiogram. In StatPearls [Internet]. StatPearls

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