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Electrocardiography, Stress Test, Holter Test

Electrocardiography, Stress Test, Holter Test

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Published by: anreilegarde on Aug 17, 2010
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12/31/2012

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ECG, HOLTER, and STRESS Treadmill TESTS
Electrocardiography(ECG) provides a graphic recording of the heart’s electrical activity.electrodes placed on the skin transmit the electrical impulses to an oscillope or graphic recorder. With the waveforms recorded, the ECG can then be examined to detect dysrythmias and alterations in conductionindicative of myocardial damage, enlargement of the heart or drug effects. (
 Kozier’s Fundamentals of  Nursing, 2007)
It a diagnostic tool that measures and records the electrical activity of theheartin exquisite detail.Interpretation of these details allowsdiagnosis of a wide range of heart conditions. These conditions can vary from minor to life threatening.The term electrocardiogram was introduced by Willem Einthoven in 1893 at a meeting of the DutchMedical Society. In 1924, Einthoven received the Nobel Prize for his life's work in developing theECG.The ECG has evolved over the years.
The standard 12-lead ECG that is used throughout the world was introduced in 1942.
LE’ANREI CONRADO P. LEGARDE, BSN IV A SJDEFI GROUP 2 A 
 
It is called a 12-lead ECG because it examines the electrical activity of the heart from 12 pointsof view.
This is necessary because no single point (or even 2 or 3 points of view) provides a complete picture of what is going on.
To fully understand how an ECG reveals useful information about the condition of your heartrequires a basic understanding of theanatomy(that is, the structure) and  physiology (that is, the function) of the heart.As the heart undergoesdepolarization and repolarization,the electrical currents that are generated spreadnot only within the heart, but also throughout the body. This electrical activity generated by the heart can be measured by an array of electrodes placed on the body surface. The recorded tracing is called anelectrocardiogram (ECG, or EKG). A "typical" ECG tracing is shown to the right. The different wavesthat comprise the ECG represent the sequence of depolarization and repolarization of the atria andventricles. The ECG is recorded at a speed of 25 mm/sec, and the voltages are calibrated so that 1 mV =10 mm in the vertical direction. Therefore, each small 1-mm square represents 0.04 sec (40 msec) in timeand 0.1 mV in voltage. Because the recording speed is standardized, one cancalculate the heart ratefromthe intervals between different waves.
Heart Function and the ECG
The heart normally beats between 60 and 100 times per minute, with many normal variations. For example, athletes at rest have slower heart rates than most people. This rate is set by a small collection of specialized heart cells called the sinoatrial (SA) or sinus node.Located in the right atrium, thesinus node is the heart's "natural pacemaker ."
It has "automaticity," meaning it discharges all by itself without control from the brain.
Two events occur with eachdischarge:(1) both atria contract, and (2) an electrical impulse travels through the atria to reach another area of the heart called theatrioventricular  (AV) node, which lies in the wall between the 2 ventricles. 
LE’ANREI CONRADO P. LEGARDE, BSN IV A SJDEFI GROUP 2 A 
 
TheAV nodeserves as a relay point to further propagate the electrical impulse.
From the AV node, an electrical wave travels to both ventricles, causing them to contract and pump blood.
The normal delay between thecontraction of the atria and of the ventricles is 0.12 to 0.20 seconds. This delay is perfectly timed to account for the physical passage of the blood from theatrium to the ventricle. Intervals shorter or longer than this rangeindicatepossible problems.The ECG records the electrical activity that results when the heart muscle cells in the atria and ventriclescontract.
Atrialcontractions (both right and left) show up as the P wave.
Ventricular contractions (both right and left) show as a series of 3 waves, Q-R-S, known astheQRS complex.
The third and last common wave in an ECG is the T wave. This reflects the electrical activity produced when the ventricles are recharging for the next contraction (repolarizing).
Interestingly, the letters P, Q, R, S, and T are not abbreviations for any actual words but werechosen many years ago for their position in the middle of the alphabet.
The electrical activity results in P, QRS, and T waves that have amyriadof sizes and shapes.When viewed from multiple anatomic-electric perspectives (that is, leads), these waves can show awide range of abnormalities of both the electrical conduction system and the muscle tissue of theheart's 4 pumping chambers.Some of the ECG leads are
bipolar leads
(e.g., standard limb leads) that utilize a single positive and asingle negative electrode between which electrical potentials are measured.
Unipolar leads
(augmentedleads and chest leads) have a single positive recording electrode and utilize a combination of the other electrodes to serve as a composite negative electrode. Normally, when an ECG is recorded, all leads are
BIPOLAR LEADS
recorded simultaneously, giving rise to what is called a 12-lead ECG.
LE’ANREI CONRADO P. LEGARDE, BSN IV A SJDEFI GROUP 2 A 

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