class心电图教程第二科.ppt

Standard Limb Leads (Bipolar) Bipolar lead: One positive and one negative electrode And they are….. Leads I, II, and III Standard Limb Leads (Bipolar) Electrodes on RA, LA, and LL Form a triangle over the thorax Einthoven’s triangle 13 Leads I, II, and III 14 Augmented Limb Leads (Unipolar) Unipolar: One limb electrode is positive Other 2 are electrically connected → indifferent reference point with zero potential at center of heart The small electrical potential is magnified aVR, aVL, aVF Gives us: 6 limb leads Frontal plane 15 Precordial leads 6 unipolar chest leads V1 to v6 16 Anatomical Landmarks Manubrium Suprasternal Notch Angle of Louis 4th ICS 5th ICS Midclavicular line Ant. axillary line Midaxillary line 17 Anatomic placement of the chest leads V1: 4th ICS, R of sternum V2: 4th ICS, L of sternum V3: midway between V2 and V4 V4: 5th ICS, midclavicular line V5: anterior axillary line, same level as V4 V6: midaxillary line, same level as V4 18 Anatomical Relationship of Leads Inferior wall II, III, aVF Anterior wall V1 – V4 Lateral wall I, aVL, V5, V6 Non-standard Leads Right-sided chest leads v1R – V6R More sensitive to the presence of right ventricular MI Most sensitive lead is V4R Dextrocardia – gives normal R wave progression 19 Posterior leads V7, V8, V9 Detects posterior wall MI 20 Pediatric ECG Placement Principal reason for pediatric ECG: Assessment of possible chamber enlargement MD may order additional leads: RVH: Add a V3R or V4R LVH: Add a V7 ECG Procedures Ensure patient ID, review indication Inpatient will have an order Check ID band Outpatient will have a requisition Verify correct patient Explain test/requirements of patient Introduce self Explain preparation for test Patient removes clothing above waist Provide women with a hospital gown – open at front Patient to remove jewelry interfering with electrode placement Patient supine, as comfortable as possible ECG Procedures Enter demographics in ECG Identify proper electrode sites