BICOL UNIVERSITY

COLLEGE OF NURSING
LEGAZPI CITY, ALBAY

ELECTRO

CARDIOGRAM

NCM 112:SKILLS LABORATORY

SUBMITTED BY:
FAYE DOMINI P. FEDERIS
 ELECTROCARDIOGRAM
(ECG)
What is an ELECTROCARDIOGRAM (ECG)?
An electrocardiogram (ECG) is a medical test that detects heart problems
by measuring the electrical activity generated by the heart as it
contracts.
A doctor may recommend an ECG for people who may be at risk of heart
disease because there is a family history of heart disease, or because
they smoke, are overweight, have diabetes, high cholesterol or high
blood pressure.
A doctor may also recommend an ECG for people who are displaying
symptoms such as chest pain, breathlessness, dizziness, fainting or
fast or irregular heartbeats.
The ECG is a safe and non-invasive procedure with no known risks.
ECG tracings normally consist of three identifiable waveforms: the P
wave, the QRS complex, and the T wave. The P wave depicts atrial
depolarization; the QRS complex, ventricular depolarization; and the T wave,
ventricular repolarization.
Computerized ECG machines use small electrode tabs that peel off a sheet
and adhere to the patient’s skin. The entire ECG tracing is displayed on a
screen so abnormalities can be corrected before printing; then it’s printed on
one sheet of paper. Electrode tabs can remain on the patient’s chest, arms,
and legs to provide continuous lead placement for serial ECG studies.

PURPOSES OF ECG
To help identify primary conduction abnormalities, cardiac
arrhythmias, cardiac hypertrophy, pericarditis, electrolyte
imbalances, myocardial ischemia, and the site and extent of
myocardial infarction.
To monitor recovery from an MI.
To evaluate the effectiveness of cardiac medication.
To assess pacemaker performance
To determine effectiveness of thrombolytic therapy and the resolution
of ST-segment depression or elevation and T-wave changes.
 ELECTROCARDIOGRAM
(ECG)
TYPES OF ECG

Transthoracic Echocardiogram (TTE). It is the most

common type of echocardiogram and is noninvasive. A
device called transducer is placed on the patient’s chest and
transmits ultrasound waves into the thorax. These waves
bounce off the structures of the heart, creating images and
sounds that are shown in a monitor.

Transesophageal Echocardiogram (TOE). It is a special type

of echocardiography that uses an endoscope to assist the
transducer down to the esophagus where it produces a more
detailed image of the heart than a transthoracic
echocardiogram.

Stress Echocardiogram. An echocardiogram that is

performed while the patient is using a treadmill or
stationary bicycle. This type can be used to measure the
function of the heart both at rest and while exercising.

Dobutamine Stress Echocardiogram. For patients who are

unable to exercise on a treadmill, a drug called dobutamine is
given instead through a vein that stimulates the heart in a
similar manner as exercise. This type of echocardiogram is
used to evaluate coronary artery disease and measures the
effectiveness of cardiac therapeutic regimen.

Doppler echocardiogram. Measures and assess the blood

flow through the heart and blood vessels.
 ELECTROCARDIOGRAM
(ECG)
ECG PROCEDURE
Patient Preparation for Electrocardiography (ECG)
Explain to the patient the need to lie still, relax, and breathe normally
during the procedure.
Note current cardiac drug therapy on the test request form as well as
any other pertinent clinical information, such as chest pain or
pacemaker.
Explain that the test is painless and takes 5 to 10 minutes.

Implementation
Place the patient in a supine or semi-Fowler’s position.
Expose the chest, ankles, and wrists.
Place electrodes on the inner aspect of the wrists, on the medical
aspect of the lower legs, and on the chest.
After all electrodes are in place, connect the lead wires.
Press the START button and input any required information.
Make sure that all leads are represented in the tracing. If not,
determine which electrode has come loose, reattach it, and restart
the tracing.
All recording and other nearby electrical equipment should be
properly grounded.
Make sure that the electrodes are firmly attached.

Nursing Interventions
Disconnect the equipment, remove the electrodes, and remove the
gel with a moist cloth towel.
If the patient is having recurrent chest pain or if serial ECG’s are
ordered, leave the electrode patches in place.
 ECG Interpretations
Normal Results
1. P wave that doesn’t exceed 2.5 mm (0.25 mV) in height or last longer
than 0.12 second.
2. PR interval (includes the P wave plus the PR segment) persisting for
0.12 to 0.2 second for heart rates above 60 beats/min.
3. QT interval that varies with the heart rate and lasts 0.4 to 0.52 second
for heart rates above 60 beats/min.
4. Voltage of the R wave leads V1 through V6 that doesn’t exceed 27
mm.
5. Total QRS complex lasting 0.06 to 0.1 second.

For mitral valve: Anterior and posterior mitral valve leaflets separating
in early diastole and attaining maximum excursion rapidly, then moving
toward each other during ventricular diastole; after atrial contraction,
mitral valve leaflets coming together and remaining together during
ventricular systole.
For aortic valve: Aortic valve cusps moving anteriorly during systole
and posteriorly during diastole.
For tricuspid valve: The motion of the valve resembling that of the
mitral valve.
 ECG Interpretations (cont.)
Normal Results
For pulmonic valve: Movement occurring posterior during atrial systole
and ventricular ejection, cusp moving anteriorly, attaining its most
anterior position during diastole.
For ventricular cavities: Left ventricular cavity normally an echo-free
space between the interventricular septum and the posterior left
ventricular wall.
Right ventricular cavity: Normally an echo-free space between the
anterior chest wall and the interventricular septum.

Abnormal Results
1. Myocardial infarction (MI), right or left ventricular hypertrophy,
arrhythmias, right or left bundle-branch block, ischemia, conduction
defects or pericarditis, and electrolyte abnormalities.
2. Abnormal wave forms during angina episodes or during exercise.

In mitral stenosis: Valve narrowing abnormally because of the leaflets’

thickening and disordered motion; during diastole, both mitral valve
leaflets moving anteriorly instead of posteriorly.
In mitral valve prolapse: One or both leaflets ballooning into the left
atrium during systole.
In aortic insufficiency: Aortic valve leaflet fluttering during diastole.
In stenosis: Aortic valve thickening and generating more echoes.
In bacterial endocarditis: Disrupted valve motion and fuzzy echoes
usually on or near the valve.
Large chamber size: May indicate cardiomyopathy, valvular disorders, or
heart failure: small chamber size: may indicate restrictive pericarditis.
Hypertrophic cardiomyopathy: Identified by a systolic anterior motion
of the mitral valve and asymmetrical septal hypertrophy.
Myocardial ischemia or infarction: May cause absent or paradoxical
motion in ventricular walls.
Pericardial effusion: Fluid accumulates in the pericardial space, causing
an abnormal echo-free space.
In large effusions: Pressure exerted by excess fluid restricting
pericardial motion.
 ELECTROCARDIOGRAM
(ECG)
Precautions
The recording equipment and other nearby electrical equipment
should be properly grounded to prevent electrical interference.
Double-check color codes and lead markings to be sure connectors
march.
Make sure that the electrodes are firmly attached, and reattached
them if loose skin contact is suspended. Don’t use cables that are
broken, frayed, or bare.

Interfering Factors
These are factors that may affect the outcome of echocardiography:
Patient doing unnecessary movement during the procedure.
Incorrect placement of the transducer over the desired test area.
Metallic objects within the examination field, which may hinder
organ visualization and cause unclear images
Patients who are dehydrated, resulting in failure to demonstrate
the boundaries between organs and tissue structures.
Patients who have a severe chronic obstructive pulmonary disease
have a significant amount of air and space between the heart and
the chest cavity. Airspace does not conduct ultrasound waves well.
In obese patients, the space between the heart and the
transducers is greatly enlarged; therefore, the accuracy of the test
is decreased.

Complications
Skin sensitivity to the electrodes.