THE 12-LEAD

ELECTROCARDIOGRAM
12 lead ECG

The routine testing used in ECG, that

consist of:

3 Standard leads
3 Augmented leads
6 precordial leads or chest leads
Indications
To measure and diagnose abnormal rhythms
& rate of the heart
To detect arrhythmia and conduction defects
Identify ischemia or infarction
Electrolyte abnormalities – Hypo/HyperK
Drug effects – digitalis, cardiac glycosides
Anatomic orientation of the heart
ECG MACHINE AND EQUIPMENT

ECG Paper

ECG CABLE

Electrodes
ECG Leads
An imaginary line that serves as a reference
point from which the electrical activity is
viewed.
An ECG lead is a record of the electrical activity
generated by the heart that is sensed by
either one of two ways:
1. Two electrodes of opposite polarity
(Bipolar)
2. One positive electrode and an indifferent
zero point (Unipolar)
ECG Leads
Unipolar lead –
Bipolar lead –
composed of one
composed of two
positive electrode
electrodes of
and a zero reference
opposite polarity.
point.
Standard Leads
Are called bipolar leads because they are
composed of two electrodes, one that is (+)
and one that is (-).
LEAD I – composed of the
right arm which is
designated (-), and the left
arm which is considered
(+).
LEAD II – composed of the
right arm which is made
(-) and the left leg which
is considered (+).
LEAD III – is made up of the
left arm which is (-) and
the left leg considered (+).Einthoven's triangle
- the diagramatic representation of the
3 leads
Augmented Leads
 Is considered unipolar leads because they comprise one
(+) electrode either at the left arm, right arm or left leg
recording the electric potential at the point with
reference to the other two
remaining leads

aVR – augmented voltage of

right arm.
aVL – augmented voltage of
left arm
aVF – augmented voltage of
the left leg.
Precordial Leads
 These six unipolar leads, each in a different
position on the chest, record the electric
potential changes in the heart in a cross
sectional plane.

• V1 – 4th ICS right parasternal border

• V2 – 4th ICS left parasternal border
• V3 – midway between V2 and V4
• V4 – 5th ICS left midclavicular line
• V5 – 5th ICS left anterior axillary line
• V6 – 5th ICS left midaxillary line
Lead Placement
 Electrodes are placed
on both wrists and on
left ankle
 A right leg electrode is
used as the ground.
 6 Electrodes are
placed on chest
 ELECTROCARDIOGRAM

 After the electric

current generated by
depolarization and
repolarization of the
atria and ventricles is
detected by
electrodes, it is
amplified and
displayed on an
oscilloscope, and
recorded on ECG
paper as waves and
complexes.
A normal 12 lead ECG
Important Leads to Remember
in relation to the Anatomy of
the Heart

V1, AVR right side of the heart

V3, V6, L1, AVL left side of the heart
L11, L111, AVF Inferior heart
Nursing Considerations in ECG
 Explain properly
 The electrodes need to be in proper
contact with the skin at all times to
maintain a good reading
 Clean the skin with alcohol and shave/clip
hair if needed.
 Apply the electrodes to areas that are not
bony and no significant movement.
 Instruct patient not to move unnecessarily
throughout the procedure.