Technical Aspects of ECG

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
Outline

Procedures of ECG Recording

Basic ECG
ECG Errors and Artifacts

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
ECG Lead Placement

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
Procedures in ECG Recording

preparing the patient

• make sure the patient is comfortable
• expose contact areas adequately
• rub contact areas with alcohol
• apply ECG cream or lotion to each area
• do not smudge to adjacent areas

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
Procedures in ECG Recording

attach the cable and electrodes

• bipolar or limb leads
– right arm - RA (red)
– left arm - LA (yellow)
– right leg - ground (black)
– left leg - LL (green)

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
Limb Leads Placement

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
aVR aVL

aVF
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Technical Aspects of ECG /
Roy E. Garrido, M.D.
Einthoven’s Triangle

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
Procedures in ECG Recording

• chest or precordial leads

– V1 - 4th ICS at the
RPSB
– V2 - 4th ICS at the
LPSB
– V3 - midway between
V2 and V4
– V4 - 5th ICS at the
LMCL
– V5 - 5th ICS at the
LAAL – V3R - midway between V1
– V6 - 5th ICS at the and V4R
LMAL
– V4R - 5th ICS at the RMCL
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Technical Aspects of ECG /
Roy E. Garrido, M.D.
Chest Leads Placement

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
ECG Regions

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
ECG Paper

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
ECG Paper

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
Procedures in ECG Recording

turn on the machine

• check the stylus
• speed usually at 25
mm/sec
• introduce a 1 mV
standardization pulse
• 1 square wave should
consist of 10 small
squares

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Technical Aspects of ECG /
Roy E. Garrido, M.D.
 15 /
Technical Aspects of ECG /
Roy E. Garrido, M.D.
Procedures in ECG Recording

get limb leads then the chest leads

each lead should contain at least 5 complexes
all ECG complexes should be within the printed
lines
• double small complexes
• half large complexes
• indicate by 2x or 1/2
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Technical Aspects of ECG /
Roy E. Garrido, M.D.
 17 /
Technical Aspects of ECG /
Roy E. Garrido, M.D.
Procedures in ECG Recording

label all tracings

• patient’s name (include middle name)
• patient’s ID number
• age
• sex
• date and time ECG was taken

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Technical Aspects of ECG /
Roy E. Garrido, M.D.