QUICK REFERENCE GUIDE 4
Critical care nurses regard the ECG recording as an essential diagnostic tool for theimmediate assessment of patients suffering from chest pain and for the routinescreening of cardiac pathologies. In the same way, general nurses should perceive the ECG as another means of expanding their scope of professional practice whichbenefits the patients in their care
A monthly series of quick reference guides to some of thebasic tools of nursing. Whether you are a student nurse,need to update your skills or are teaching others, theguides will be a useful aid to your practice
NORMAL ELECTROPHYSIOLOGYOF THE HEART
A specialised electrical conducting system in theheart ensures an orderly contraction so that theheart can act as an efficient pump. Below the rightatrium is the sinoatrial (SA) node, an area ofspecialised muscle fibres that propagates the heart’scontraction stimulus. It has the ability, in the absenceof external stimuli, to initiate electrical impulses at arate of approximately 100 per minute. Other areasof the heart also possess this ability, calledautomacity (Nash and Nahas 1996), but because theSA node produces the fastest rate, it assumes therole of pacemaker.
RECORDING THE ECG
When taking an ECG recording, either via a monitoror ECG machine, electrodes are applied to thepatient at strategic points. These allow severaldifferent recordings to be taken, as seen in the 12lead ECG, giving the operator different views of theheart.
Conducting system of the heart
SA nodeAV nodeFibrous atrioventricular septumRight bundlebranchLeft bundlebranchBundle of His
V14thintercostalspace onthe rightsternalborderClavicleV24th intercostalspace on the leftsternal borderV3Between V2and V4V45th intercostal spaceon the mid clavicular lineV5Between V4and V6on the same horizontalplaneV6Mid axilliary on the samehorizontal plane as V4and V5Right arm lead (RA)Left arm lead (LA)Right leg lead (RL)Left leg lead (LL)