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List the 3 types of leads

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Standard limb leads, Augmented leads, Chest leads. Lead wires are color coded.

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Lead wire color codes

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Right arm- white. Left arm- black. Right leg- green. Left leg- red. Chest leads- brown.

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Multichannel recorder

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Monitors all 12 leads but records 3 leads at the same time and switches automatically, recording all 4 sets of the three leads.

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Standard Limb Leads

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bipolar- measure flow of electrical current in two directions at the same time. Labeled lead I, II, and III.

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Lead I

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records tracings from right arm(-) to left arm(+)

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Lead II

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records tracings from right arm (-) to left leg(+)

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Lead III

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records tracings from left arm(-) to left leg(+)

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right arm

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is always NEGATIVE

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left arm

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can be either positive or negative, depending on the view/lead being used

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left leg

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is always POSITIVE

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Augmented Leads

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The voltage is very low so the waves will be very small. Tracings are increased in size by the ECG machine in order to be interpreted. Unipolar- measure toward one electrode on the body. Labeled as aVR, aVL, and aVF.

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aVR

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records electrical activity from the heart to the right arm. usually a negative deflection.

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aVL

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records electrical activity from the heart to the left arm.

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aVF

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records electrical activity from the heart to the left leg.

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Chest Leads

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also known as pericardial leads. Unipolar. Placed on specific places on the chest. Labeled as V1-V6. Record activity between six points on the chest and within the heart.

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Signal processing

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Amplifies the electrical impulse and converts it to a mechanical action on the output display.

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Output display

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Part of the ECG machine that displays the tracings usually in a printed form on a 12 lead ECG machine.

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Speed

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Control on the ECG machine that regulates how fast/slow the paper runs during the tracing. Common speed is 25 mm/sec. Increasing the speed would allow the waveforms to be analyzed more easily- they would appear wider.

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Gain

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Control on the ECG machine that regulates the output/hight of the ECG waveform. Normal setting is 10 mm/mV.

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Artifact

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Unwanted marks on the ECG machine tracing caused by activity other than the heart's electrical activity.

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Artifact filter

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Usual setting between 40-150 Hz. Will correct only the printed output.

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The ECG waveform is indicative of:

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How the heart is functioning electrically

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The Einthoven triangle is formed by the following three limb leads:

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Right arm, left arm, left leg

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All of the following are types of leads from the 12-lead ECG EXCEPT:

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Abdomen

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Which of the following is NOT considered a bipolar lead?

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aVR

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The proper location to place the V1 lead is the:

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Fourth intercostal space, right sternal border

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For the proper placement of V3, you must have placed which other two leads on the patient's chest?

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V2 and V4

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Unipolar leads include all the lead types EXCEPT:

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Standard

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To obtain a 12-lead ECG tracing, you must apply how many lead wires and electrodes to the patient?

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10

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The proper location to place the V2 lead is the:

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Fourth intercostal space, left sternal border

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The three types of leads that make up a 12-lead ECG consist of:

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3 standard, 3 augmented, and 6 chest leads

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Identify the basic function(s) of the electrocardiograph.

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(all of the above) Input, Signal processing, Output display.

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The signal processing occurs inside the ECG machine, and it:

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(all of the above) Amplifies the electrical impulse, Converts the impulse into mechanical actions on the display, Prepares the signal for transfer to the output display or printed report.

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The most common setting for standard speed rate for the ECG machine is:

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25 mm/sec

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The gain control is normally set at:

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10 mm/mV

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The LCD display is an area on the 12-lead ECG machine where the following information is available to view:

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(all of the above) Patient data/information, Information from the ECG computer, Status of the electrodes.

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Often it is difficult to read the ECG tracing when the rate is fast. Where should you set the speed control rate to be able to interpret the ECG tracing more easily?

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50 mm/sec

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The usual setting for the artifact filter is:

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40 Hz

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You are preparing to conduct a 12-lead ECG on a patient. As you are gathering your supplies, you notice that five of the electrodes are made by one company and the other five electrodes are made by another company. What is your next step?

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Find a complete set of 10 electrodes that are the same

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Which type of electrode is preferred for use in a hospital or acute care setting?

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Silver electrodes

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The ECG graph paper represents time horizontally and voltage vertically. What time and voltage are represented by one large box?

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0.20 second and 0.5 mV

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As you are conducting a 12-lead ECG, a red line appears at the bottom of the ECG graph paper. What does this mean?

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The ECG paper is running low and needs to be replaced soon

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Each little box on the ECG paper horizontally represents:

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0.04 second

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Each little box on the ECG paper vertically represents:

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0.1 mV

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One second on the ECG tracing equals

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25mm, or 5 heavy lines.

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What are the advantages of using dot matrix paper instead of the standard grid paper?

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(all of the above) Dot matrix paper requires less ink, Dot matrix paper is easier to read, Dot matrix paper produces sharper photocopies.

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What substances can accidentally erase the ECG tracing?

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(all of the above) Alcohol, Sunlight, X-ray film.

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How long must the ECG tracing be maintained as part of a patient's medical record?

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7 years

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When the paper speed is 25 mm/sec, there are how many boxes per minute?

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300 boxes per minute

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Which one of these is NOT a method to calculate heart rates?

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1-minute method

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Which method is the ONLY one to be used for irregular rhythms?

answer

6-second method

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When estimating the heart rate with the 6-second method, you must locate 6 seconds on a rhythm strip, count the number of complexes, and multiply by:

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10

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Which method is only used for measuring irregular heart beats?

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6 second method

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1500 method

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Most accurate for use of regular rhythms. Count the number of small boxes between two R waves, them divide by 1500.

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R-R method

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Determine the number of large boxes between the two R waves, then divided by 300. Useful for a regular rhythm.

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To perform an ECG with accuracy, the best source to obtain specific information about the machine is:

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The manufacturer's instructions

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Computerized interpretation of the ECG tracing:

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Must be validated by a physician

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A multichannel ECG monitors all 12 leads but usually records how many leads at one time?

answer

3 leads

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What are some reasons you may change the speed of the ECG tracing?

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(all of the above) Rhythm rate is too fast, Can't clearly identify the waves because they are too close together, Per physician's orders.

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If you attempt to record an ECG and no tracing appears, what should you do?

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Re-check the lead wires to make sure they are placed correctly

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The term bradycardia means:

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Slow heart rate

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The term tachycardia means:

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Fast heart rate

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(T/F) Lead V4 placement is the fifth intercostal space at the midclavicular line.

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True

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(T/F) Each of the 12 leads of an ECG tracing represents a single view of the heart.

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True

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(T/F) The chest (precordial) leads are the bipolar type of leads.

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False- chest leads are unipolar. Standard limb leads are bipolar.

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(T/F) The artifact filter selection is used to reduce artifacts due to muscle tremors and slight patient movement.

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True

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(T/F) Only one-time electrodes must be used with an application of gel or paste conduction material.

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False --> Only reusable electrodes must be used with an application of gel or paste conduction material.

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(T/F) The ECG paper consists of horizontal lines that measure voltage and vertical lines that measure the time period.

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False --> Horizontal lines measure time, vertical lines measure voltage.

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(T/F) A method used to estimate the heart rate is to locate a 6-second strip, count the number of complexes, and then multiply by 10.

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True

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(T/F) To reduce the size of the ECG tracing by half, set the gain to 5 mm/mV; to double the ECG tracing size, set the gain to 20 mm/mV.

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True

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(T/F) Signal processing occurs inside the ECG machine, amplifying the electrical impulse and converting it into a tracing display.

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True

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(T/F) To be able to interpret the information, the ECG machine increases the size of the waveforms in leads aVR, aVL, and aVF.

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True

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(T/F) A standard 12-lead ECG uses 12 electrodes.

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False --> 10 leads

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(T/F) If disposable electrodes are left on a patient's skin for more than two readings, inaccurate ECG tracings may result.

answer

True

Electrocardiography ch3

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