Electrocardiography (ECG)

Electrocardiography (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. These electrodes detect the tiny electrical changes on the skin that arise from the heart muscle’s electrophysiologic pattern of depolarizing and repolarizing during each heartbeat. It is a very commonly performed cardiology test.

In a conventional 12-lead ECG, 10 electrodes are placed on the patient’s limbs and on the surface of the chest. The overall magnitude of the heart’s electrical potential is then measured from 12 different angles (“leads”) and is recorded over a period of time (usually 10 seconds). In this way, the overall magnitude and direction of the heart’s electrical depolarization is captured at each moment throughout the cardiac cycle.The graph of voltage versus time produced by this noninvasive medical procedure is referred to as an electrocardiogram.

During each heartbeat, a healthy heart has an orderly progression of depolarization that starts with pacemaker cells in the sinoatrial node, spreads out through the atrium, passes through the atrioventricular node down into the bundle of His and into the Purkinje fibers, spreading down and to the left throughout the ventricles. This orderly pattern of depolarization gives rise to the characteristic ECG tracing. To the trained clinician, an ECG conveys a large amount of information about the structure of the heart and the function of its electrical conduction system. Among other things, an ECG can be used to measure the rate and rhythm of heartbeats, the size and position of the heart chambers, the presence of any damage to the heart’s muscle cells or conduction system, the effects of cardiac drugs, and the function of implanted pacemakers.

Electrode name	Electrode placement
RA	On the right arm, avoiding thick muscle.
LA	In the same location where RA was placed, but on the left arm.
RL	On the right leg, lower end of medial aspect of calf muscle. (Avoid bony prominences)
LL	In the same location where RL was placed, but on the left leg.
V1	In the fourth intercostal space (between ribs 4 and 5) just to the right of the sternum (breastbone).
V2	In the fourth intercostal space (between ribs 4 and 5) just to the left of the sternum.
V3	Between leads V2 and V4.
V4	In the fifth intercostal space (between ribs 5 and 6) in the mid-clavicular line.
V5	Horizontally even with V4, in the left anterior axillary line.
V6	Horizontally even with V4 and V5 in the midaxillary line.