T he electrocardiogram (ECG) is a graphic recording of the

electrical activity of the heart. The standard ECG is

obtained by applying electrodes over the chest and limbs to
record the electrical activity of the cardiac cycle. Developed
100 years ago, the ECG remains the most important initial
diagnostic tool for the assessment of myocardial disease, ischemia,
and cardiac dysrhythmias.
Electrocardiography is performed widely throughout the
health care field, including ambulances, ambulatory clinics,
emergency departments (EDs), and in-patient hospital units.
Standard electrocardiography machines are small, selfcontained,
and portable, thus allowing them to be used in
virtually any setting. As a result, clinicians, nurses, and many
other health care providers should be familiar with the procedure
of standard 12-lead electrocardiography. Emergency
clinicians should also be familiar with the alternative leads and
other accessory techniques available in electrocardiography,
as well as the pitfalls of lead misplacement, misconnection,
and tracing artifacts.