Chapter 1

ELECTROCARDIOGRAPHY

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 Learning Outcomes
1.1 Describe the history and the importance of the ECG.
1.2 Identify the uses of an ECG and opportunities for an
electrocardiographer.
1.3 Troubleshoot legal, ethical, patient education, and
communication issues related to the ECG.
1.4 Perform infection control measures required for the ECG.
1.5 Compare basic vital sign measurements related to the ECG.

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 Learning Outcome 1.1 The Electrocardiogram
Key Terms
Cardiovascular disease (CVD)
Coronary artery disease (CAD)
Electrocardiogram (ECG)
Electrocardiograph
Myocardial infarction (MI; heart attack)

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 The ECG and Its History 1
Cardiovascular disease (CVD) ‒ #1 cause of death in United
States

Coronary artery disease (CAD)

• Narrowing of heart arteries
• Affects 1 in 3 American adults

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 The ECG and Its History 2
Electrocardiograph
• Records heart’s electrical activity
• Produces electrocardiogram (ECG)

History
• Dr. Augustus D. Waller (1856-1922)
• Willem Einthoven (1860-1927)

Today’s machines
• Fast
• Digital communication

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 Learning Outcome 1.1
Apply Your Knowledge #1

What is the name of the instrument that allows the electrical

activity of the heart to be studied?

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 Learning Outcome 1.1
Apply Your Knowledge #1
Answer
What is the name of the instrument that allows the electrical
activity of the heart to be studied?

The electrocardiograph

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 Learning Outcome 1.1
Apply Your Knowledge #2

Who was credited with the development of the first

electrocardiograph?

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 Learning Outcome 1.1
Apply Your Knowledge #2
Answer
Who was credited with the development of the first
electrocardiograph?

Wilhelm Einthoven

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 Learning Outcome 1.2
Uses of an ECG
Key Terms 1
Automatic external defibrillator (AED)
Cardiopulmonary resuscitation (CPR)
Cardiovascular technologist
Code Blue
Defibrillator
Dysrhythmia
ECG monitor technician

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 Learning Outcome 1.2
Uses of an ECG
Key Terms 2
Electrocardiograph (ECG) technician
Healthcare providers
Stat
Telemedicine

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 Uses of an ECG
Healthcare providers
• Study ECG to learn about
patient’s
heart.
• Baseline tracing helps
diagnose
future abnormalities.

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 Uses of an ECG—Hospital
12-lead ECG
• Routine—before surgery
• Code Blue—emergency ECG required stat

Continuous monitoring
• Patients in CCU, SICU, or ED
• During surgery
• Telemetry monitoring

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 Uses of an ECG—Doctors’ Offices
and Ambulatory Care Clinics
12-lead ECG
• Routine—part of wellness exam
• Baseline recordings

Treadmill stress testing

Holter monitoring

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 Uses of an ECG—Outside of a
Healthcare Facility: Portable ECG
During cardiac emergencies
• Portable ECG machines used at site of emergency
• Tracing transmitted to physician or assessed by emergency
personnel

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 Uses of an ECG—Outside of a
Healthcare Facility: Defibrillator
Defibrillator

Automatic external defibrillator

• Sudden cardiac arrest
• Serious dysrhythmias
• May suggest shock or cardiopulmonary resuscitation (CPR)

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 Uses of an ECG—Outside of a Healthcare
Facility: Telemedicine
Telemedicine
• Transtelephonic monitoring
• Digital monitoring

Types of telemedicine monitors

• Continuous
• Symptom-based

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 Opportunities in Electrocardiography
Exclusively in ECG
• Electrocardiograph (ECG) technician
• ECG monitor technician
• Cardiovascular technologist

As part of another profession

• Medical assistant
• Nurse
• Emergency medical technicians
• Paramedics

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 Learning Outcome 1.2
Apply Your Knowledge #1

What device allows laypeople to provide emergency

defibrillation to someone in cardiac arrest?

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 Learning Outcome 1.2
Apply Your Knowledge #1
Answer
What device allows laypeople to provide emergency
defibrillation to someone in cardiac arrest?

An automatic external defibrillator (AED)

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 Learning Outcome 1.2
Apply Your Knowledge #2

Which healthcare professional views ECG tracings in real time

and notifies a healthcare practitioner of any abnormalities?

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 Learning Outcome 1.2
Apply Your Knowledge #2
Answer
Which healthcare professional views ECG tracings in real time
and notifies a healthcare practitioner of any abnormalities?

ECG monitor technician

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 Learning Outcome 1.3
Preparing for an ECG
Key Terms
Ethics
Law
Libel
Medical professional liability
Slander

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 Legal and Ethical Issues
Laws
• Rules of conduct
• Enforced by controlling authority

Ethics
• Standards of behavior
• Concepts of right and wrong
• Based on moral values

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 HIPAA
Health Insurance Portability and Accountability Act
• National standards for electronic healthcare transactions
• Limits and secures use of electronic patient data
• Helps ensure patient privacy

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 Ethics
Code of ethics
• Confidentiality
• Respect
• Dignity

Acting professionally
• Cooperate with co-workers, supervisors, and other healthcare
professionals
• Continue education and training

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 Medical Professional Liability
Healthcare professionals are held accountable for:
• Performing unlawful acts
• Performing legal acts improperly
• Failing to perform an act when necessary

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 Slander and Libel
Slander
• Making derogatory remarks about someone

Libel
• Writing defamatory words about someone

Both slander and libel are illegal and unethical.

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 Documentation
All medical care and treatment must be documented

Part of the medical record

• Medical record can be used in court
• Complete documentation provides legal protection

Provides for continuity of care

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 Consent
Patient must provide consent before the procedure is performed
• Written consent
• Implied consent

If patient cannot read:

• Explain to patient with witness present
• Patient signs with X
• Witness signs as well

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 Patient Education and Communication
Develop a positive relationship and atmosphere

Reduce patient fears

• Explain the procedure clearly
• Answer questions
• Use simple terms
• Speak slowly and distinctly

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 Learning Outcome 1.3
Apply Your Knowledge #1

True or False: The practice of confidentiality is essential to the

practice of ethics in medicine.

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 Learning Outcome 1.3
Apply Your Knowledge #1
Answer
True or False: The practice of confidentiality is essential to the
practice of ethics in medicine.

True; confidentiality is an essential part of caring for the patient

and is required by HIPAA.

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 Learning Outcome 1.3
Apply Your Knowledge #2

Who should sign a consent form if a patient cannot read or

write?

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 Learning Outcome 1.3
Apply Your Knowledge #2
Answer
Who should sign a consent form if a patient cannot read or
write?

Explain the procedure to the patient with a witness present.

Then have the patient place an “X” on the form and have the
witness sign the form as well.

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 Learning Outcome 1.4
Infection Control
Key Terms
Isolation precautions

Personal protective equipment (PPE)

Standard precautions

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 Standard Precautions 1
Perform hand hygiene

Wear gloves when possibility

of exposure to:
• Blood
• Body fluids, secretions, and
excretions (except sweat)
• Nonintact skin
• Mucous membranes

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 Standard Precautions 2
Standard precautions also
include:
• Wearing personal protective
equipment (PPE) when
required
• Avoiding artificial nails
• Keeping natural nails no
more than ¼-inch long

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 Isolation Precautions
Based on how the infectious agent is transmitted
• Airborne precautions
• Droplet precautions
• Contact precautions

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 Learning Outcome 1.4
Apply Your Knowledge #1

You have been asked to perform an ECG on a patient who is in a

wheelchair and cannot move to the procedure table by herself.
The patient weighs 245 lb. What should you do?

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 Learning Outcome 1.4
Apply Your Knowledge #1
Answer
You have been asked to perform an ECG on a patient who is in a
wheelchair and cannot move to the procedure table by herself.
The patient weighs 245 lb. What should you do?

If the patient cannot help, find a co-worker to help you move

the patient.

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 Learning Outcome 1.4
Apply Your Knowledge #2

You are about to run an ECG on a patient known to have

tuberculosis, which can be spread through the air to infect
people close to the patient. What type of precautions should
you use?

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 Learning Outcome 1.4
Apply Your Knowledge #2
Answer
You are about to run an ECG on a patient known to have
tuberculosis, which can be spread through the air to infect
people close to the patient. What type of precautions should
you use?
Airborne precautions, including a respirator, gloves, gown, and
goggles or face shield.

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 Learning Outcome 1.5
Vital Signs
Key Terms
Auscultated blood pressure Hypotension

Cardiac output Tilt table test

Diastolic blood pressure Systolic blood pressure

Hypertension Vital signs

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 Vital Signs
• Pulse
• Respiration
• Blood pressure
• Temperature
• Pulse oximetry
• Weight
• Pain assessment

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 Pulse
Indirect measurement of cardiac output

Usually measured at the radial or carotid artery

Count for 1 minute

• Rate
• Rhythm
• Volume

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 Respiration
Rate indicates oxygen supply to tissues

Watch, listen, or feel for patient respirations

• Do not tell patient you are counting respirations

Count for 1 minute

• Rate
• Rhythm
• Effort
• Irregularities

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 Blood Pressure
Force with which blood is
pumped against the arterial
walls
• Systolic blood pressure
• Diastolic blood pressure

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 Factors Affecting Blood Pressure
Hypertension

Hypotension

Internal factors
• Cardiac output
• Blood volume
• Vasoconstriction
• Blood viscosity

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 Measuring Blood Pressure
• Place sphygmomanometer 1 to 2 inches above antecubital
space
• Determine palpatory pressure, if necessary
• Release cuff for 30 to 60 seconds
• Determine auscultated blood pressure

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 Learning Outcome 1.5
Apply Your Knowledge #1

How can you count respirations without letting the patient know
you are counting them?

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 Learning Outcome 1.5
Apply Your Knowledge #1
Answer
How can you count respirations without letting the patient know
you are counting them?

Tell the patient you want to listen to his or her lungs, or count
the respirations while you have your fingers on the patient’s
pulse.

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 Learning Outcome 1.5
Apply Your Knowledge #2

What is the difference between palpatory and auscultated blood

pressure?

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 Learning Outcome 1.5
Apply Your Knowledge #2
Answer
What is the difference between palpatory and auscultated blood
pressure?

The palpatory blood pressure is an estimate of the patient’s

systolic pressure and is used to find the target peak cuff
inflation. Auscultated blood pressure is a measurement of the
systolic and diastolic blood pressure and is performed with a
stethoscope.

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 Chapter 1 Summary 1
An ECG is
• A tracing of the heart’s electrical activity
• Used in the diagnosis of cardiovascular disease

Uses of an ECG:
• In the hospital as a part of a routine exam or during
emergencies
• In doctors’ offices and clinics as part of a routine exam, stress
test, or Holter monitoring
• Outside of healthcare facilities in emergencies or via
telemedicine

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 Chapter Summary 21
Legal and ethical issues in preparing for an ECG include:
• Protecting patient information (HIPAA)
• Practicing ethically and legally
• Understanding medical professional liability
• Avoiding slander and libel
• Documenting all care and treatment
• Obtaining informed consent when necessary
• Educating and communicating with the patient

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 Chapter Summary 322
• Infection control procedures include use of standard
precautions, personal protective equipment (PPE), and
isolation precautions.
• Vital signs include pulse, respiration, blood pressure,
temperature, and pain assessment.
• Vital signs provide information about the patient’s state of
health.

©McGraw-Hill Education.