ECG Laboratory Activity

 
Objectives:

1.  Describe the normal ECG tracing and identify different waveforms and intervals

2.  Give the normal values for the parameters observed from the ECG tracing

3.  Discuss the steps in basic ECG interpretation

Activity #1
Identify the parts of the basic ECG waveform and give their normal values
 

 
 

 
 
Waveforms/intervals Normal values
1. P wave <.12 seconds

2. QRS Complex .06-.10 seconds

3. T wave .16 seconds
0.12 to 0.20 seconds
4. PR interval
5. QT interval
6. ST segment
7. PR segment .05-.12 seconds
 

 
Guide Questions:

1.     What is the relationship of each waveform to the cardiac cycle? Explain each

P wave - Indicates atrial depolarization, or contraction of the atrium.

QRS complex - Indicates ventricular depolarization, or contraction of the ventricles.

T wave - Indicates ventricular repolarization

ST segment - Indicates early ventricular repolarization

PR interval - Indicates AV conduction time

QT interval - Represents ventricular depolarization and repolarization (sodium influx

and potassium efflux)

2.     What are the different types of ECG leads?

Limb Leads (Bipolar)
Augmented Limb Leads (Unipolar)
Chest Leads (Unipolar)

3.     Explain the Einthoven’s triangle.

An imaginary equilateral triangle having the heart at its center and formed by
lines that represent the three standard limb leads of the electrocardiogram. The triangle
is composed of the leads I, II, and III forming the shape. Leads aVL, aVR and aVF
perpendicularly intersect each side to the triangle.

4.     How do you determine ECG axis?

  The axis of the ECG is the major direction of the overall electrical activity of the
heart. It can be normal, leftward (left axis deviation, or LAD), rightward (right axis
deviation, or RAD) or indeterminate (northwest axis).

Since the left ventricle makes up most of the heart muscle under normal circumstances,
normal cardiac axis is directed downward and slightly to the left:

Normal Axis = QRS axis between -30° and +90°.

Abnormal axis deviation, indicating underlying pathology, is demonstrated by:

 Left Axis Deviation = QRS axis less than -30°.

Right Axis Deviation = QRS axis greater than +90°.

Extreme Axis Deviation = QRS axis between -90° and 180° (AKA “Northwest
Axis”).

There are several complementary approaches to estimating QRS axis, which are
summarized below:

The Quadrant Method – (Lead I and aVF)

Three Lead analysis – (Lead I, Lead II and aVF)

Isoelectric Lead analysis

Super SAM the Axis Man

 
Activity #2
 
Identify proper limb lead placement:

Limb lead Placement

Red  Right Arm
Yellow  Left Arm
Black  Right Foot
Green  Left Foot

5.     Identify proper chest lead placement

Chest leads Placement

 V1  4th intercostal space right of sternal border
 V2  4th intercostal space left of sternal border
 V3  Between leads V2 and V4
 V4 Left 5th intercostal space midclavicular line
 V5  Level with V4 left anterior axillary line
 V6  Level with V5 at left midaxillary line
 
Guide Questions:
 
1.     What are the myocardial areas associated with each chest lead?

Anterior wall V2 to V4

Septal wall V1 and V2

Lateral wall I, aVL, V5, V6

Inferior wall II, III, aVF

Posterior wall V1 to V4

2.     What is the blood supply of the myocardial areas associated with the
chest leads?

  Left Anterior Descending artery

Anterior wall V2 to V4 (LAD)
  – Diagonal branch
  Left Anterior Descending artery
Septal wall V1 and V2 (LAD)
– Septal branch
  Left Coronary Artery (LCA)
Lateral wall I, aVL, V5, V6
  – Circumflex branch
Right Coronary Artery (RCA)
  Inferior wall II, III, aVF
– Posterior descending branch
  Left Coronary Artery (LCA)
– Circumflex branch
  Posterior wall V1 to V4 Right Coronary Artery (RCA)
  – Posterior descending b
ranch
 
 
 
 
Activity #3
Interpret the following ECG tracings:

A. Normal Sinus Rhythm

Sinus? (Y/N)  Yes

Rate  84 bpm

Rhythm  Regular

Axis  Normal axis

ST segment  none
abnormalities?

 
B. Sinus Tachycardia

Sinus? (Y/N)  yes

Rate  162 bpm

Rhythm Regular

Axis  Normal axis

ST segment abnormalities?  none

C. Sinus Bradycardia

Sinus? (Y/N)  Yes

Rate  42 bpm

Rhythm  Regular

Axis  Normal axis

ST segment abnormalities?  none

D. Asystole