An electrocardiogram (ECG or EKG, abbreviated from the German
Elektrokardiogramm) is a graphic produced by an electrocardiograph,
which records the electrical voltage in the heart in the form of a continuous
strip graph. It is the prime tool in cardiac electrophysiology, and has a
prime function in screening and diagnosis of cardiovascular diseases.
Lead placement
An ECG is constructed by measuring electrical potential between various
points of the body using a galvanometer. Leads I, II and III are measured
over the limbs: I is from the right to the left arm, II is from the right arm to the
left leg and III is from the left arm to the left leg. From this, the imaginary point
V is constructed, which is located centrally in the chest above the heart. The
other nine leads are derived from potential between this point and the three
limb leads (aVR, aVL and aVF) and the six precordial leads (V1-6).
Related Topics:
Electrical potential -
Galvanometer
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Therefore, there are twelve leads in total. Each, by their nature, record
information from particular parts of the heart:
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• The inferior leads (leads II, III and aVF) look at electrical
activity from the vantage point of the inferior region (wall) of the
heart. This is the apex of the left ventricle.
• The lateral leads (I, aVL, V5 and V6) look at the electrical
activity from the vantage point of the lateral wall of the heart, which
is the lateral wall of the left ventricle.
• The anterior leads, V1 through V6, and represent the anterior
wall of the heart, or the frontal wall of the left ventricle.
• aVR is rarely used for diagnostic information, but indicates if
the ECG leads were placed correctly on the patient.
Understanding the usual and abnormal directions, or vectors,
of depolarization and repolarization yields important diagnostic
information. The right ventricle has very little muscle mass. It
leaves only a small imprint on the ECG, making it more difficult
to diagnose than changes in the left ventricle.
Rela
ted
Topi
cs:
Ventr
icle
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The leads measure the average electrical activity
generated by the summation of the action potentials of the
heart at a particular moment in time. For instance, during
normal atrial systole, the summation of the electrical
activity produces an electrical vector that is directed from
the SA node towards the AV node, and spreads from the
right atrium to the left atrium (since the SA node resides
in the right atrium). This turns into the P wave on the EKG,
which is upright in II, III, and aVF (since the general
electrical activity is going towards those leads), and
inverted in aVR (since it is going away from that lead).
It is important to remember that the 12-lead ECG provides
spatial information about the heart's electrical activity in 3
approximately orthogonal directions:
Right Left
Superior Inferior
Anterior Posterior
Each of the 12 leads represents a particular
orientation in space, as indicated below (RA = right
arm; LA = left arm, LF = left foot):
Bipolar limb leads (frontal plane):
Lead I: RA (-) to LA (+) (Right Left, or lateral)
Lead II: RA (-) to LF (+) (Superior Inferior)
Lead III: LA (-) to LF (+) (Superior Inferior)
Augmented unipolar limb leads (frontal
plane):
Lead aVR: RA (+) to [LA & LF] (-)
(Rightward)
Lead aVL: LA (+) to [RA & LF] (-)
(Leftward)
Lead aVF: LF (+) to [RA & LA] (-)
(Inferior)
Unipolar (+) chest leads
(horizontal plane):
Leads V1, V2, V3: (Posterior
Anterior)
Leads V4, V5, V6:(Right Left, or
lateral)
Behold: Einthoven's Triangle! Each of the 6 frontal plane leads has a
negative and positive orientation (as indicated by the '+' and '-' signs). It is
important to recognize that Lead I (and to a lesser extent Leads aVR and
aVL) are right ⇔left in orientation. Also, Lead aVF (and to a lesser extent
Leads II and III) are superior ⇔inferior in orientation. The diagram below
further illustrates the frontal plane hookup.
LOCATION OF CHEST ELECTRODES IN 4TH AND 5TH INTERCOSTAL
SPACES:
V1: right 4th intercostal space
V2: left 4th intercostal space
V3: halfway between V2 and V4
V4: left 5th intercostal space, mid-clavicular line
V5: horizontal to V4, anterior axillary line
V6: horizontal to V5, mid-axillary line
