Background

Electrocardiography, which is also commonly referred to as Elektrokardiogram (ECG or EKG from the German word) is a medical procedure that is employed in the recognition of the electrical events of the heart over a certain duration. It is a non-invasive technique that assist the healthcare practitioners to evaluate the heart rhythm and identify structural and functional changes in the heart as well as come up with diagnoses for different heart diseases. 

Electrocardiography 

ECG is one of the essential tools used in cardiology mostly when it comes to diagnosis and management of the heart functions. 

History 

Willem Einthoven has been identified as the first person to come up with the string galvanometer in approximately 1901 and this increased the accuracy of ECG signals. He also abelled peculiar waves using the names: P wave, QRS complex, T wave. 

Indications

Assess Heart Health: Anomalies in the heart rhythm or any form of arrhythmias and, diagnose any forms of heart ailments including heart attack, heart diseases or any structural change in the heart. 

Monitor Heart Conditions: The treatments for heart complications including drugs or an implantable cardioverter defibrillator (ICD) must be monitored. 

Screening: Generally, as a component of regular health assessment or pre-operative assessments and for the patients with high risk factors for cardiovascular diseases. 

Symptom Evaluation: Helps in determining the nature of symptoms that may indicate heart disorders including chest pain, shortness of breath, palpitations, and episodes of fainting. 

Physical Examinations: Particularly carried out during annual physical examinations regardless of the presence of the symptoms to check for potential heart issues in such populations at risk as the elderly or those with hypertension, diabetes or a family history of a heart disease. 

Pre-operative evaluation: An ECG is typically performed as a check on a person before the surgery because the patient might experience a heart problem while being operated on. 

Monitoring medications: Some drugs have an adverse effect on the heart rhythm. Such medicines can be rightly managed with the help of an ECG. 

Contraindications

Allergy to the lead adhesive used for lead attachment 

Skin Conditions 

Patient refusal  

Outcomes

Equipment

Electrodes 

Cables 

ECG Machine 

Display 

Paper or Digital Recording 

Software 

Power Supply 

Patient preparation

Explanation: Inform the patient about the procedure and its relevance. 

Clothing: Make sure the patient undresses at least to the chest level so it is easier to place the electrodes on the chest. 

Skin Preparation: It is necessary to prepare the skin area, which is going to be covered with electrodes, clean it from the oils and other debris that can distort the signal. 

Electrode Placement: Ensure that the electrodes are placed on the recommended areas such as on the chest and arms as standard placement. 

Recording: Make sure the patient is comfortable and try to reduce their movements, then you connect the leads and begin the recording of the ECG. 

Completion: Upon recording completion disconnect electrodes and let the patient put their clothes on. 

Follow-up: Give any post-procedure instructions whether after the results of the procedure or any additional medical actions that the patient needs to undertake. 

Patient position 

Position the patient comfortably lying down, ideally on their back. 

The preferred position is supine. 

Preparation

Step 1-Position the patient flat on the bed, and preferably partially undress to ensure that the chest area which will contain the electrodes should be free and easily accessible. 

Describe the procedure to the patient to alleviate any anxiety and obtain informed consent. 

Step 2-Placement of Electrodes: 

If oils or lotions are present on the skin, then the area where the electrodes are going to be placed should be washed to get rid of them. 

Place electrodes with small adhesive backing to predetermined areas of the patient’s limbs and chest. The standard positions are: 

Limbs: The electrodes will be attached to the wrists and the ankles. 

Chest: Self-adhesive electrodes are attached to the front of the chest ergonomically to provide electrical activity in V1-V6 positions. 

Step 3-Recording: 

Once the electrodes are in place, attach the leads by running them through the lead wires that connect to the ECG machine. 

Turning the ECG machine on begins the recording process of the ECG. The machine could magnify electrical signals produced by the heart at each instance of the heartbeat. 

Step 4-Monitoring: 

During such recoding, one needs to check on the quality of the signal to ascertain that all the electrodes are in contact with the skin and filtering out any interferences. 

Tell the patient they should talk or move less during the time that the recording is being taken. 

Step 5-End of Recording: 

Generally, a standard ECG recording is carried out in a few seconds to a few minutes based on the parameters of recording and required acquires. 

After the recording is over, disconnect the electrodes from the patient and pull them off, being very careful not to hurt the patient. 

Step 6-Analysis: 

The recorded data is processed by the ECG machine and is often interpreted by a Physician (preferably a cardiologist) or a Technologist. 

ECG waveform is recorded electrical activity of the heart displayed as series of peaks and valleys (P waves, QRS complex, T waves) which are analyzed to evaluate the heart’s rhythm and dysfunction. 

Step 7-Documentation: 

Take note of the result of the ECG: Cardiological measurements like PR and QT and the analysis of rhythm: Sinus and atrial fibrillation. 

Discuss the findings with the patient’s general practitioner or other specialist for further discussion and referrals if needed. 

Step 8-Follow-up: 

Depending on abnormalities based on ECG, the doctor may advise on other tests or treatments needed regarding the abnormalities. 

Complications

Skin Irritation: As for the risks or dangers, skin irritation may occur if skin has a direct contact with the electrodes or with adhesive used in the attachment of electrodes. 

Allergic Reactions: In individuals, there are instances where one may be allergic to the adhesive used on electrodes or the materials used on the electrodes thus may lead to skin reactions or skin related problems. 

Discomfort: This procedure mostly takes 30 minutes, and during this process some of the patients may complain of discomfort from electrodes and the need to be still while the test is being carried out. 

Misinterpretation of Results: Any change in the position of the electrodes or the position of the patient’s body causes adverse effects on the readings that could impact the diagnosing and treating of the patient. 

Electrical Interference: Interference from other electrical equipment or signals that are around may sometimes interfere with the procedure. 

References

Electrocardiogram – StatPearls – NCBI Bookshelf (nih.gov) 

References

Electrocardiogram – StatPearls – NCBI Bookshelf (nih.gov)