Electrocardiodigram

Definition

Electrocardiogram: A recording of the electrical activity of the heart.

Abbreviated ECG and EKG. An ECG is a simple, noninvasive procedure.

Electrodes are placed on the skin of the chest and connected in a specific order

to a machine that, when turned on, measures electrical activity all over the

heart. Output usually appears on a long scroll of paper that displays a printed

graph of activity on a computer screen. The initial diagnosis of heart attack is

usually made through observation of a combination of clinical symptoms and

characteristic ECG changes. An ECG can detect areas of muscle deprived of

oxygen and/or dead tissue in the heart. If a medication is known to sometimes

adversely affect heart function, a baseline ECG may be ordered before the

patient starts taking the medicine, and follow-up testing may occur at regular

intervals to look for any changes.

Brief description :

The overall goal of performing an ECG is to obtain information about the

electrical function of the heart. Medical uses for this information are varied and

often need to be combined with knowledge of the structure of the heart and

physical examination signs to be interpreted. Some indications for performing

an ECG include the following:

 Chest pain or suspected myocardial infarction (heart attack), such as ST

elevated myocardial infarction (STEMI) or non-ST elevated myocardial

infarction (NSTEMI)
  Symptoms such as shortness of breath, murmurs, fainting, seizures,

funny turns, or arrhythmias including new onset palpitations or

monitoring of known cardiac arrhythmias

 Medication monitoring (e.g., drug-induced QT prolongation, Digoxin

toxicity) and management of overdose (e.g., tricyclic overdose)

 Electrolyte abnormalities, such as hyperkalemia

 Perioperative monitoring in which any form of anesthesia is involved

(e.g., monitored anesthesia care, general anesthesia). This

includes preoperative asessment and intraoperative and postoperative

monitoring.

 Cardiac stress testing

 Computed tomography angiography (CTA) and magnetic resonance

angiography (MRA) of the heart (ECG is used to "gate" the scanning so

that the anatomical position of the heart is steady)

Nursing ethics indication

The evolution of EKG from a string galvanometer to the modern-day advanced

computerized machine has led to its use as a diagnostic and screening tool,

making it the gold standard for diagnosing various cardiac diseases.

Owing to its widespread use in the field of medicine, the EKG has several

indications listed below:

  Symptoms are the foremost indication in use for the EKG which

includes palpitation, dizziness, cyanosis, chest pain, syncope, seizure,

and poisoning

 Symptoms or signs associated with heart disease including tachycardia,

bradycardia and clinical conditions including hypothermia, murmur,

shock, hypotension, and hypertension

 To detect myocardial injury, ischemia, and the presence of prior

infarction as well

 Rheumatic heart disease

 EKG changes in cases like drowning and electrocution are very valuable

in the determination of necessary interventions

 Detecting pacemaker or defibrillator device malfunction, evaluate their

programming and function, verify the analysis of arrhythmias and

monitor for delivery of the appropriate electrical pacing in patients with

defibrillators and pacemakers

 Evaluation of metabolic disorders

Nursing ethics contraindications

There are no absolute contraindications for EKG. The relative contraindications

to its use include:

 Patient refusal
  Allergy to the adhesive used to affix the leads

Nursing care and patient preparation

ECG merely requires special preparation. Before the procedure, a brief

history regarding drugs and allergy to adhesive gel is necessary. The

temperature of the room must be kept optimal to avoid shivering. The patient

should be in a gown, and electrode sites identified. For good contact between

body surface and electrodes, it is advised to shave the chest hair and then apply

the electrocardiographic adhesive gel for electrodes. Any metallic object like

jewelry or watch requires removal, if possible. Limb and precordial leads

should be accurately placed to avoid vector misinterpretation. The patient must

lie down and relax before recording the standard 10-second strip.
References

Fye WB. A history of the origin, evolution, and impact of

electrocardiography. Am. J. Cardiol. 1994 May 15;73(13):937-49.