ECG – Skill Lab

Post Graduate Trainees

Physiology Department
Islamic International Medical College
Electrocardiogram (ECG):

It is the graphical record of electrical activities of the heart,

which occur prior to the onset of mechanical activities
Electrocardiograph:
ELECTROCARDIOGRAM ELECTROCARDIOGRAPH
ECG
• Electrocardiography (ECG or EKG) is the process of recording the
electrical activity of the heart over a period of time using
electrodes placed on the skin
Electro cardio gram
• A record or display of a person's heartbeat
produced by electrocardiography
Electrocardiograph
• An instrument used in the detection and diagnosis of heart
abnormalities that measures electrical potentials on the body
surface and generates a record of the electrical currents
associated with heart muscle activity
Uses of ECG:
Electrocardiogram is useful in determining and diagnosing the:

1. Heart rate

2. Heart rhythm

3. Abnormal electrical conduction

4. Poor blood flow to heart muscle (Ischemia)

5. Heart Attack (Myocardial Infarction)

ECG LEADS:
• ECG is recorded by placing series of electrodes on the
surface of the body

• These electrodes are called ECG leads and are connected to

the ECG machine

• A lead records potential difference between two electrodes

Types of ECG leads:

There are total 12 ECG leads:

• Bipolar limb leads – 3

• Augmented unipolar limb leads – 3

• Chest leads – 6
Limb
leads
Chest
leads
The 12-Lead ECG

A 12-lead ECG paints a complete picture of the heart’s

electrical activity by recording information through 12
different perspective Think of it as 12 different points of
view of an object woven together to create a cohesive story
— the ECG interpretation

These 12 views are collected by placing electrodes or small,

sticky patches on the chest (precordial), wrists, and ankles

These electrodes are connected to a machine that registers

the heart’s electrical activity
Placement of
limb & chest
leads
15
Bipolar limb leads:

• +ve electrode is placed on one limb and –ve electrode on

the other limb

• These leads measure the electrical potential difference

between +ve and –ve electrodes
 LIMB LEAD I:

Lead I
• -ve electrode is on right arm
• +ve electrode is on left arm
Limb lead II:

Lead II
• -ve electrode is on right arm
• +ve electrode is on left foot
Limb lead III:

Lead III
• -ve electrode is on left arm
• +ve electrode is on left foot
Augmented unipolar limb leads:

• Unipolar limb leads are also called augmented limb leads.

• Here, one electrode is active electrode and the other one is

an indifferent electrode

• Active electrode is positive and the indifferent electrode is

serving as a composite negative electrode
Types of unipolar limb leads:

Unipolar limb leads are of three types:

1. aVR lead

2. aVL lead

3. aVF lead
aVR lead:
• Active electrode is
connected to right arm
• Indifferent electrode is
connected to left arm and
left leg
aVL lead:
• Active electrode is
connected to left arm
• Indifferent electrode is
connected to right arm and
left leg
aVF lead:
• Active electrode is
connected left leg (foot)
• Indifferent electrode is
connected to the two
upper limbs
26
Chest leads:

• Chest leads are also called ‘V’ leads or precordial chest leads

• Indifferent electrode (negative electrode) is connected to three

limbs, viz. left arm, left leg and right arm

• Active electrode (positive electrode) is placed on six points over

the chest
Position of chest leads:
V1: Over 4th intercostal space near
right sternal margin

V2: Over 4th intercostal space near

left sternal margin

V3: In between V2 and V4

V4: Over left 5th intercostal space on

the mid clavicular line

V5: Over left 5th intercostal space on

the anterior axillary line

V6: Over left 5th intercostal space on

the mid axillary line
• Pre-requisites
• ECG machine with ECG Roll
• Gel
• Couch
• Gown
• Screen
• Cotton
Procedure
• Remove your patient's shirt to bare the chest. Ethically a patient
should wear a gown with the opening in the front for modesty
as well as accessibility to the chest.
• Prepare the patient's skin by using alcohol pads to remove any
oils, lotions or powders. Male patients who have copious
amounts of chest hair may need to be shaved over the sternum
and chest to ensure the ECG pads adhere properly.
Procedure (contd.)
• Select the appropriate leads and number of electrode pads.
• Place electrodes, adhesive side down, onto the patient. Press
each electrode firmly and make sure each is adhering well,
without any gaps or lifting up from the skin.
• Secure the ECG leads to the electrodes. Clip one lead to each
electrode. Once all leads have been placed, the ECG machine
will be able to read cardiac activity.
• Connection for Limbs: • Connections for Chest:
• Red Right Arm • Red V1
• Yellow Left Arm • Yellow V2
• Green Left Leg • Green V3
• Black Right Leg • Brown V4
• Black V5
• Violet V6
• The Electrodes for the Chest Leads MUST go in the Standard
Positions:
• V1 - Fourth intercostal space, right sternal border.
• V2 - Fourth intercostal space, left sternal border.
• V3 - Midway between V2 and V4.
• V4 - Fifth intercostal space, left midclavicular line.
• V5 - Level with V4, left anterior axillary line.
• V6 - Level with V4, left mid axillary line.