ECG Workshop Dr Jeremy Wright Cardiologist Hearts1st, Greenslopes Private Hospital

Topics To Cover  Skin preparation  Electrode Placement  Troubleshooting – Minimise Noise / Artifact  Limb Lead Reversal  ECG Examples

Skin Preparation  Important to have good contact between the skin and electrodes  Minimises artifact and electrode movement  Things to use: -Razors / part hair to expose skin -Preparation tape -Alcohol wipes

Electrode Placement LA = Left Arm RA = Right Arm LL = Left Leg RL = Right Leg (ground)

Electrode Placement V1: 4 th intercostal space, R sternal border V2: 4 th intercostal space, L sternal border V3: between V3 and V4 V4: 5 th intercostal space, Mid Clavicular line V5: horizontally in line with V4, Anterior Auxillary line V6: horizontally in line with V4, Mid Auxillary line

Noise / Artifact

Bed Artifact

Limb Lead Reversal Most common mistake made when acquiring ECG’s. Be sure to check all leads (especially limb leads) before acquiring the ECG.

Limb Lead Reversal

Alternate Limb Lead Placement How do you perform an ECG in the following situations? -Amputee -Theatre Stockings -Patient with Parkinson's -Disease / Tremors

Normal ECG Waveforms

A: Ventricular Ectopy

A: 2 nd Degree AV Block; Type II

A: Complete Heart Block

A: Sinus Rhythm with frequent atrial ectopy

A: Atrial Fibrillation

A: Idioventricular Rhythm

A: Acute Anterior MI

A: Junctional Rhythm

A: Supraventricular Tachycardia

A: Ventricular Tachycardia (VT)

A: Ventricular Fibrillation (VF)