Which of the following statements is true with respect to electrocardiograms?

The formal procedure for obtaining an ECG is given in Chapter 13, Electrocardiogram. Every ECG should be approached in a systematic, stepwise way. Many automated ECG machines can give a preliminary interpretation of a tracing; however, all automated interpretations require analysis and sign-off by a physician. Determine each of the following:

  • Standardization. With the ECG machine set on 1 mV, a 10-mm standardization mark (0.1 mV/mm) is evident (Figure 19–1).
  • Axis. If the QRS is upright (more positive than negative) in leads I and aVF, the axis is normal. The normal axis range is –30 degrees to +105 degrees.
  • Intervals. Determine the PR, QRS, and QT intervals (Figure 19–2). Intervals are measured in the limb leads. The PR should be 0.12–0.20 s, and the QRS, < 0.12 s. The QT interval increases with decreasing heart rate, usually < 0.44 s. The QT interval usually does not exceed one half of the RR interval (the distance between two R waves).
  • Rate. Count the number of QRS cycles on a 6-s strip and multiply that number by 10 to roughly estimate the rate. If the rhythm is regular, you can be more exact in determining the rate by dividing 300 by the number of 0.20-s intervals (usually depicted by darker shading) and then extrapolating for any fraction of a 0.20-s segment.
  • Rhythm. Determine whether each QRS is preceded by a P wave, look for variation in the PR interval and RR interval (the duration between two QRS cycles), and look for ectopic beats.
  • Hypertrophy. One way to detect LVH is to calculate the sum of the S wave in V1 or V2 plus the R wave in V5 or V6. A sum > 35 indicates LVH. Some other criteria for LVH are R > 11 mm in aVL or R in I + S in III > 25 mm.
  • Infarction or Ischemia. Check for ST-segment elevation or depression, Q waves, inverted T waves, and poor R-wave progression in the precordial leads (see Myocardial Infarction).

Figure 19–1.

Which of the following statements is true with respect to electrocardiograms?

Examples of 10-mm standardization mark and time marks and standard ECG paper running at 25 mm/s.

Figure 19–2.

Which of the following statements is true with respect to electrocardiograms?

Diagram of the ECG complexes, intervals, and segments. The U wave is normally not well seen.

Equipment

Bipolar Leads

  • Lead I: Left arm to right arm
  • Lead II: Left leg to right arm
  • Lead III: Left leg to left arm

Precordial Leads:

V1 to V6 across the chest (see Figure 13–9).

ECG Paper:

With the ECG machine set at 25 mm/s, each small box represents 0.04 s, and each large box 0.2 s (see ...

ECG; EKG

An electrocardiogram (ECG) is a test that records the electrical activity of the heart.

Which of the following statements is true with respect to electrocardiograms?

If your heart has been beating too fast, or you've been having chest pain, both you and your doctor will want to find out what's causing the problem so you can get it treated. One way to diagnose heart problems is with a test of the heart's electrical activity, called an electrocardiogram or ECG, or EKG for short. Your heart is controlled by an electrical system, much like the electricity that powers the lights and appliances in your home. Electrical signals make your heart contract so that it can pump blood out to your body. Heart disease, abnormal heart rhythms, and other heart problems can affect those signals. Using an ECG, your doctor can identify problems in your heart's electrical system and diagnose heart disease. So, how is an ECG done? First you'll lie down on a table. You'll have to lie very still while the test is done. Small patches, called electrodes, will be attached to several places on your arms, legs, and chest. The patches won't hurt, but some of the hair in those areas may be shaved so the patches will stick to your skin. The patches are then attached to a machine. You'll notice that when the machine is turned on, it produces wavy lines on a piece of paper. Those lines represent the electrical signals coming from your heart. If the test is normal, it should show that your heart is beating at an even rate of 60 to 100 beats per minute. Many different heart conditions can show up on an ECG, including a fast, slow, or abnormal heart rhythm, a heart defect, coronary artery disease, heart valve disease, or an enlarged heart. An abnormal ECG may also be a sign that you've had a heart attack in the past, or that you're at risk for one in the near future. If you're healthy and you don't have any family or personal history of heart disease, you don't need to have an ECG on a regular basis. But if you are having heart problems, your doctor may recommend getting this test. An ECG is pretty accurate at diagnosing many types of heart disease, although it doesn't always pick up every heart problem. You may have a perfectly normal ECG, yet still have a heart condition. If your test is normal but your doctor suspects that you have a heart problem, he may recommend that you have another ECG, or a different type of test to find out for sure.

Which of the following statements is true with respect to electrocardiograms?

The electrocardiogram (ECG) is used extensively in the diagnosis of heart disease, from congenital heart disease in infants to myocardial infarction and myocarditis in adults. Several different types of electrocardiogram exist.

Which of the following statements is true with respect to electrocardiograms?

This picture shows an ECG (electrocardiogram, EKG) of a person with an abnormal rhythm (arrhythmia) called an atrioventricular (AV) block. P waves show that the top of the heart received electrical activity. Each P wave is usually followed by the tall (QRS) waves. QRS waves reflect the electrical activity that causes the heart to contract. When a P wave is present and not followed by a QRS wave (and heart contraction), there is an atrioventricular block, and a very slow pulse (bradycardia).

Which of the following statements is true with respect to electrocardiograms?

Routine lab tests are recommended before beginning treatment of high blood pressure to determine organ or tissue damage or other risk factors. These lab tests include urinalysis, blood cell count, blood chemistry (potassium, sodium, creatinine, fasting glucose, total cholesterol and HDL cholesterol), and an ECG (electrocardiogram). Additional tests may be recommended based on your condition.

Which of the following statements is true with respect to electrocardiograms?

An electrocardiogram is a test that measures the electrical activity of the heart. This includes the rate and regularity of beats as well as the size and position of the chambers, any damage to the heart, and effects of drugs or devices to regulate the heart.

Which of the following statements is true with respect to electrocardiograms?

An ECG is very useful in determining whether a person has heart disease. During an ECG electrodes are affixed to each arm and leg and to the chest.

Which of the following statements is true with respect to electrocardiograms?

Action potentials generated by heart cells produce weak electrical currents that spread throughout the body. These currents can be detected at the surface of the body and amplified using an instrument known as an electrocardiograph. The graphic recording produced by an electrocardiograph of the heart electric activity is called an electrocardiogram, or ECG.

If your heart has been beating too fast, or you've been having chest pain, both you and your doctor will want to find out what's causing the problem so you can get it treated. One way to diagnose heart problems is with a test of the heart's electrical activity, called an electrocardiogram or ECG, or EKG for short. Your heart is controlled by an electrical system, much like the electricity that powers the lights and appliances in your home. Electrical signals make your heart contract so that it can pump blood out to your body. Heart disease, abnormal heart rhythms, and other heart problems can affect those signals. Using an ECG, your doctor can identify problems in your heart's electrical system and diagnose heart disease. So, how is an ECG done? First you'll lie down on a table. You'll have to lie very still while the test is done. Small patches, called electrodes, will be attached to several places on your arms, legs, and chest. The patches won't hurt, but some of the hair in those areas may be shaved so the patches will stick to your skin. The patches are then attached to a machine. You'll notice that when the machine is turned on, it produces wavy lines on a piece of paper. Those lines represent the electrical signals coming from your heart. If the test is normal, it should show that your heart is beating at an even rate of 60 to 100 beats per minute. Many different heart conditions can show up on an ECG, including a fast, slow, or abnormal heart rhythm, a heart defect, coronary artery disease, heart valve disease, or an enlarged heart. An abnormal ECG may also be a sign that you've had a heart attack in the past, or that you're at risk for one in the near future. If you're healthy and you don't have any family or personal history of heart disease, you don't need to have an ECG on a regular basis. But if you are having heart problems, your doctor may recommend getting this test. An ECG is pretty accurate at diagnosing many types of heart disease, although it doesn't always pick up every heart problem. You may have a perfectly normal ECG, yet still have a heart condition. If your test is normal but your doctor suspects that you have a heart problem, he may recommend that you have another ECG, or a different type of test to find out for sure.

How the Test is Performed

You will be asked to lie down. The health care provider will clean several areas on your arms, legs, and chest, and then will attach small patches called electrodes to those areas. It may be necessary to shave or clip some hair so the patches stick to the skin. The number of patches used may vary.

The patches are connected by wires to a machine that turns the heart's electrical signals into wavy lines, which are often printed on paper. The doctor reviews the test results.

You will need to remain still during the procedure. The provider may also ask you to hold your breath for a few seconds as the test is being done.

It is important to be relaxed and warm during an ECG recording because any movement, including shivering, can alter the results.

Sometimes this test is done while you are exercising or under light stress to look for changes in the heart. This type of ECG is often called a stress test.

How to Prepare for the Test

Make sure your provider knows about all the medicines you are taking. Some drugs can interfere with test results.

Do not exercise or drink cold water immediately before an ECG because these actions may cause false results.

How the Test will Feel

An ECG is painless. No electricity is sent through the body. The electrodes may feel cold when first applied. In rare cases, some people may develop a rash or irritation where the patches were placed.

Why the Test is Performed

An ECG is used to measure:

  • Any damage to the heart
  • How fast your heart is beating and whether it is beating normally
  • The effects of drugs or devices used to control the heart (such as a pacemaker)
  • The size and position of your heart chambers

An ECG is often the first test done to determine whether a person has heart disease. Your provider may order this test if:

  • You have chest pain or palpitations
  • You are scheduled for surgery
  • You have had heart problems in the past
  • You have a strong history of heart disease in the family

Normal Results

Normal test results most often include:

  • Heart rate: 60 to 100 beats per minute
  • Heart rhythm: Consistent and even

What Abnormal Results Mean

Abnormal ECG results may be a sign of:

  • Damage or changes to the heart muscle
  • Changes in the amount of the electrolytes (such as potassium and calcium) in the blood
  • Congenital heart defect
  • Enlargement of the heart
  • Fluid or swelling in the sac around the heart
  • Inflammation of the heart (myocarditis)
  • Past or current heart attack
  • Poor blood supply to the heart arteries
  • Abnormal heart rhythms (arrhythmias)

Some heart problems that can lead to changes on an ECG test include:

  • Atrial fibrillation/flutter
  • Heart attack
  • Heart failure
  • Multifocal atrial tachycardia
  • Paroxysmal supraventricular tachycardia
  • Sick sinus syndrome
  • Wolff-Parkinson-White syndrome

Risks

Considerations

The accuracy of the ECG depends on the condition being tested. A heart problem may not always show up on the ECG. Some heart conditions never produce any specific ECG changes.

References

Brady WJ, Harrigan RA, Chan TC. Basic electrocardiographic techniques. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 14.

Ganz L, Link MS. Electrocardiography. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 48.

Mirvis DM, Goldberger AL. Electrocardiography. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Version Info

Last reviewed on: 5/8/2022

Reviewed by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Which of the following statements is true with respect to electrocardiograms?