ECG


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electrocardiogram

 (ECG, EKG) [e-lek″tro-kahr´de-o-gram″]
the record produced by electrocardiography; a tracing representing the heart's electrical action derived by amplification of the minutely small electrical impulses normally generated by the heart.
Normal electrocardiogram. Heart action during P-R interval: (1) Atrial contraction begins at peak of P wave. (2) P-R interval—atrial contraction. (3) Ventricles relaxed. Heart action during QRS complex: (1) Ventricular contraction begins at peak of R. (2) A-V (mitral and tricuspid) valves close, causing S1 sound. (3) Ventricles contract. (4) Atrial relaxation begins. Heart action during S-T segment: (1) Semilunar valves open (aortic and pulmonic). (2) Ejection of blood from ventricles–systole. Heart action during T wave: (1) Slowing of ejection from ventricles. (2) Closure of semilunar valves (aortic and pulmonic) causing S2 sound. Heart action during T-P interval: (1) Relaxation of ventricles. (2) A-V valves open. (3) Filling of ventricles, causing S3 sound.

ECG

Abbreviation for electrocardiogram.

ECG

electrocardiogram.

ECG

(ē′sē′jē′)
n. Chiefly British
1. An electrocardiogram.
2. An electrocardiograph.

ECG

1 abbreviation for electrocardiogram.
2 abbreviation for electrocardiograph.
3 abbreviation for electrocardiography.
4 abbreviation for echoencephalogram.

ECG

Abbreviation for:
echocardiography
electrocardiogram
electrocardiography
equine chorionic gonadotropin

ECG

1. Electrocardiogram, see there, EKG.
2. Echocardiogram, see there.

ECG

Abbreviation for electrocardiogram.

ECG

Abbrev. for ELECTROCARDIOGRAM.
Fig. 140 ECG. A tracing of the electric currents that initiate the heartbeat. The broken line indicates diastole, the solid line systole.click for a larger image
Fig. 140 ECG . A tracing of the electric currents that initiate the heartbeat. The broken line indicates diastole, the solid line systole.

ECG (electrocardiogram)

a recording of the electrical changes occurring as the heart beats (see HEART, CARDIAC CYCLE that can be used in the diagnosis of heart malfunction. Each cardiac cycle produces three distinct ECG waves, designated as P, QRS and T. These waves represent changes in electrical potential between two regions on the surface of the heart. The spread of atrial depolarization creates the P wave; spread of ventricular depolarization is represented by the QRS wave; repolarization of the ventricles produces the T wave. To obtain an ECG, electrodes are attached to various parts of the body surface, usually both arms and the left leg.

ECG or EKG

A record of the waves that relates to the electrical impulses produced at each beat of the heart.
Enlarge picture

Electrocardiogram

Synonym/acronym: ECG, EKG.

Common use

To evaluate the electrical impulses generated by the heart during the cardiac cycle to assist with diagnosis of cardiac arrhythmias, blocks, damage, infection, or enlargement.

Area of application

Heart.

Contrast

None.

Description

The cardiac muscle consists of three layers of cells: the inner layer called the endocardium, the middle layer called the myocardium, and the outer layer called the epicardium. The systolic phase of the cardiac cycle reflects the contraction of the myocardium, whereas the diastolic phase takes place when the heart relaxes to allow blood to rush in. All muscle cells have a characteristic rate of contraction called depolarization. Therefore, the heart will maintain a predetermined heart rate unless other stimuli are received.

The monitoring of pulse and blood pressure evaluates only the mechanical activity of the heart. The electrocardiogram (ECG), a noninvasive study, measures the electrical currents or impulses that the heart generates during a cardiac cycle (see figure of a normal ECG at end of monograph). Electrical impulses travel through a conduction system beginning with the sinoatrial (SA) node and moving to the atrioventricular (AV) node via internodal pathways. From the AV node, the impulses travel to the bundle of His and onward to the right and left bundle branches. These bundles are located within the right and left ventricles. The impulses continue to the cardiac muscle cells by terminal fibers called Purkinje fibers. The ECG is a graphic display of the electrical activity of the heart, which is analyzed by time intervals and segments. Continuous tracing of the cardiac cycle activity is captured as heart cells are electrically stimulated, causing depolarization and movement of the activity through the cells of the myocardium.

The ECG study is completed by using 12, 15, or 18 electrodes attached to the skin surface to obtain the total electrical activity of the heart. Each lead records the electrical potential between the limbs or between the heart and limbs. The ECG machine records and marks the 12 leads (most common system used) on the strip of paper in the machine in proper sequence, usually 6 in. of the strip for each lead. The ECG pattern, called a heart rhythm, is recorded by a machine as a series of waves, intervals, and segments, each of which pertains to a specific occurrence during the contraction of the heart. The ECG tracings are recorded on graph paper using vertical and horizontal lines for analysis and calculations of time, measured by the vertical lines (1 mm apart and 0.04 sec per line), and of voltage, measured by the horizontal lines (1 mm apart and 0.5 mV per 5 squares). A pulse rate can be calculated from the ECG strip to obtain the beats per minute. The P wave represents the depolarization of the atrial myocardium; the QRS complex represents the depolarization of the ventricular myocardium; the P-R interval represents the time from beginning of the excitation of the atrium to the beginning of the ventricular excitation; and the ST segment has no deflection from baseline, but in an abnormal state may be elevated or depressed. An abnormal rhythm is called an arrhythmia

The ankle-brachial index (ABI) can also be assessed during this study. This noninvasive, simple comparison of blood pressure measurements in the arms and legs can be used to detect peripheral artery disease (PAD). A Doppler stethoscope is used to obtain the systolic pressure in either the dorsalis pedis or the posterior tibial artery. This ankle pressure is then divided by the highest brachial systolic pressure acquired after taking the blood pressure in both arms of the patient. This index should be greater than 1. When the index falls below 0.5, blood flow impairment is considered significant. Patients should be scheduled for a vascular consult for an abnormal ABI. Patients with diabetes or kidney disease, as well as some elderly patients, may have a falsely elevated ABI due to calcifications of the vessels in the ankle causing an increased systolic pressure. The ABI test approaches 95% accuracy in detecting PAD. However, a normal ABI value does not absolutely rule out the possibility of PAD for some individuals, and additional tests should be done to evaluate symptoms.

This procedure is contraindicated for

    N/A

Indications

  • Assess the extent of congenital heart disease
  • Assess the extent of myocardial infarction (MI) or ischemia, as indicated by abnormal ST segment, interval times, and amplitudes
  • Assess the function of heart valves
  • Assess global cardiac function
  • Detect arrhythmias, as evidenced by abnormal wave deflections
  • Detect peripheral artery disease (PAD)
  • Detect pericarditis, shown by ST segment changes or shortened P-R interval
  • Determine electrolyte imbalances, as evidenced by short or prolonged Q-T interval
  • Determine hypertrophy of the chamber of the heart or heart hypertrophy, as evidenced by P or R wave deflections
  • Evaluate and monitor cardiac pacemaker function
  • Evaluate and monitor the effect of drugs, such as digitalis, antiarrhythmics, or vasodilating agents
  • Monitor ECG changes during an exercise test
  • Monitor rhythm changes during the recovery phase after an MI

Potential diagnosis

Normal findings

  • Normal heart rate according to age: range of 60 to 100 beats/min in adults
  • Normal, regular rhythm and wave deflections with normal measurement of ranges of cycle components and height, depth, and duration of complexes as follows:
    • P wave: 0.12 sec or three small blocks with amplitude of 2.5 mm
    • Q wave: less than 0.04 mm
    • R wave: 5 to 27 mm amplitude, depending on lead
    • T wave: 1 to 13 mm amplitude, depending on lead
    • QRS complex: 0.1 sec or two and a half small blocks
    • ST segment: 1 mm

Abnormal findings related to

  • Arrhythmias
  • Atrial or ventricular hypertrophy
  • Bundle branch block
  • Electrolyte imbalances
  • Heart rate of 40 to 60 beats/min in adults
  • MI or ischemia
  • PAD
  • Pericarditis
  • Pulmonary infarction
  • P wave: An enlarged P wave deflection could indicate atrial enlargement; an absent or altered P wave could suggest that the electrical impulse did not come from the SA node
  • P-R interval: An increased interval could imply a conduction delay in the AV node
  • QRS complex: An enlarged Q wave may indicate an old infarction; an enlarged deflection could indicate ventricular hypertrophy; increased time duration may indicate a bundle branch block
  • ST segment: A depressed ST segment indicates myocardial ischemia; an elevated ST segment may indicate an acute MI or pericarditis; a prolonged ST segment (or prolonged QT) may indicate hypocalcemia. A shortened ST segment may indicate hypokalemia
  • Tachycardia greater than 120 beats/min
  • T wave: A flat or inverted T wave may indicate myocardial ischemia, infarction, or hypokalemia; a tall, peaked T wave with a shortened QT interval may indicate hyperkalemia

Critical findings

    Adult

  • Acute changes in ST elevation are usually associated with acute MI or pericarditis.
  • Asystole
  • Heart block, second- and third-degree with bradycardia less than 60 beats/min
  • Pulseless electrical activity
  • Pulseless ventricular tachycardia
  • Premature ventricular contractions (PVCs) greater than three in a row, pauses greater than 3 sec, or identified blocks
  • Unstable tachycardia
  • Ventricular fibrillation
  • Pediatric

  • Asystole
  • Bradycardia less than 60 beats/min
  • Pulseless electrical activity
  • Pulseless ventricular tachycardia
  • Supraventricular tachycardia
  • Ventricular fibrillation
  • It is essential that a critical finding be communicated immediately to the requesting health-care provider (HCP). A listing of these findings varies among facilities.

  • Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. Notification processes will vary among facilities. Upon receipt of the critical value the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, Hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical value, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

Interfering factors

  • Factors that may impair the results of the examination

    • Anatomic variation of the heart (i.e., the heart may be rotated in both the horizontal and frontal planes).
    • Distortion of cardiac cycles due to age, gender, weight, or a medical condition (e.g., infants, women [may exhibit slight ST segment depression], obese patients, pregnant patients, patients with ascites).
    • High intake of carbohydrates or electrolyte imbalances of potassium or calcium.
    • Improper placement of electrodes or inadequate contact between skin and electrodes because of insufficient conductive gel or poor placement, which can cause ECG tracing problems.
    • ECG machine malfunction or interference from electromagnetic waves in the vicinity.
    • Inability of the patient to remain still during the procedure, because movement, muscle tremor, or twitching can affect accurate test recording.
    • Increased patient anxiety, causing hyperventilation or deep respirations.
    • Medications such as barbiturates and digitalis.
    • Strenuous exercise before the procedure.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in assessing cardiac (heart) function.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex, anesthetics, or sedatives. Ask if the patient has had a heart transplant, implanted pacemaker, or internal cardiac defibrillator.
  • Obtain a history of the patient’s cardiovascular system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Inform the patient that it may be necessary to remove hair from the site before the procedure. Address concerns about pain related to the procedure and explain that there should be no discomfort related to the procedure. Inform the patient that the procedure is performed by an HCP and takes approximately 15 min.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Instruct the patient to remove jewelry and other metallic objects from the area to be examined.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure the patient has complied with pretesting preparations.
  • Ensure the patient has removed all external metallic objects from the area to be examined prior to the procedure.
  • Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
  • Record baseline values.
  • Place patient in a supine position. Expose and appropriately drape the chest, arms, and legs.
  • Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
  • Prepare the skin surface with alcohol and remove excess hair. Use clippers to remove hair from the site, if appropriate. Dry skin sites.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Apply the electrodes in the proper position. When placing the six unipolar chest leads, place V1 at the fourth intercostal space at the border of the right sternum, V2 at the fourth intercostal space at the border of the left sternum, V3 between V2 and V4, V4 at the fifth intercostal space at the midclavicular line, V5 at the left anterior axillary line at the level of V4 horizontally, and V6 at the level of V4 horizontally and at the left midaxillary line. The wires are connected to the matched electrodes and the ECG machine. Chest leads (V1, V2, V3, V4, V5, and V6) record data from the horizontal plane of the heart.
  • Place three limb bipolar leads (two electrodes combined for each) on the arms and legs. Lead I is the combination of two arm electrodes, lead II is the combination of right arm and left leg electrodes, and lead III is the combination of left arm and left leg electrodes. Limb leads (I, II, III, aVl, aVf, and aVr) record data from the frontal plane of the heart.
  • The machine is set and turned on after the electrodes, grounding, connections, paper supply, computer, and data storage device are checked.
  • If the patient has any chest discomfort or pain during the procedure, mark the ECG strip indicating that occurrence.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • When the procedure is complete, remove the electrodes and clean the skin where the electrode was applied.
  • Evaluate the results in relation to previously performed ECGs. Denote cardiac rhythm abnormalities on the strip.
  • Monitor vital signs and compare with baseline values. Protocols may vary among facilities.
  • Instruct the patient to immediately notify an HCP of chest pain, changes in pulse rate, or shortness of breath.
  • Recognize anxiety related to the test results and be supportive of perceived loss of independence and fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
  • Nutritional Considerations: Abnormal findings may be associated with cardiovascular disease. Nutritional therapy is recommended for the patient identified to be at risk for developing coronary artery disease (CAD) or for individuals who have specific risk factors and/or existing medical conditions (e.g., elevated LDL cholesterol levels, other lipid disorders, insulin-dependent diabetes, insulin resistance, or metabolic syndrome). Other changeable risk factors warranting patient education include strategies to encourage patients, especially those who are overweight and with high blood pressure, to safely decrease sodium intake, achieve a normal weight, ensure regular participation of moderate aerobic physical activity three to four times per week, eliminate tobacco use, and adhere to a heart-healthy diet. If triglycerides also are elevated, the patient should be advised to eliminate or reduce alcohol. The 2013 Guideline on Lifestyle Management to Reduce Cardiovascular Risk published by the American College of Cardiology (ACC) and the American Heart Association (AHA) in conjunction with the National Heart, Lung, and Blood Institute (NHLBI) recommends a “Mediterranean”-style diet rather than a low-fat diet. The new guideline emphasizes inclusion of vegetables, whole grains, fruits, low-fat dairy, nuts, legumes, and nontropical vegetable oils (e.g., olive, canola, peanut, sunflower, flaxseed) along with fish and lean poultry. A similar dietary pattern known as the Dietary Approach to Stop Hypertension (DASH) makes additional recommendations for the reduction of dietary sodium. Both dietary styles emphasize a reduction in consumption of red meats, which are high in saturated fats and cholesterol, and other foods containing sugar, saturated fats, trans fats, and sodium.
  • Social and Cultural Considerations: Numerous studies point to the prevalence of excess body weight in American children and adolescents. Experts estimate that obesity is present in 25% of the population ages 6 to 11 yr. The medical, social, and emotional consequences of excess body weight are significant. Special attention should be given to instructing the child and caregiver regarding health risks and weight control education.
  • Recognize anxiety related to test results, and be supportive of fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Provide contact information, if desired, for the American Heart Association (www.americanheart.org), the NHLBI (www.nhlbi.nih.gov), or the Legs for Life (www.legsforlife.org).
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include antiarrhythmic drugs, apolipoprotein A and B, AST, atrial natriuretic peptide, BNP, blood gases, blood pool imaging, calcium, chest x-ray, cholesterol (total, HDL, LDL), CT cardiac scoring, CT thorax, CRP, CK and isoenzymes, echocardiography, echocardiography transesophageal, exercise stress test, glucose, glycated hemoglobin, Holter monitor, homocysteine, ketones, LDH and isos, lipoprotein electrophoresis, lung perfusion scan, magnesium, MRI chest, MI infarct scan, myocardial perfusion heart scan, myoglobin, PET heart, potassium, pulse oximetry, sodium, triglycerides, and troponin.
  • Refer to the Cardiovascular System table at the end of the book for related tests by body system.

Exercise Stress Test

Synonym/acronym: Exercise electrocardiogram, ECG, EKG, graded exercise tolerance test, stress testing, treadmill test.

Common use

To assess cardiac function in relation to increased workload, evidenced by dysrhythmia or pain during exercise.

Area of application

Heart.

Contrast

None.

Description

The exercise stress test is a noninvasive study to measure cardiac function during physical stress. Exercise electrocardiography is primarily useful in determining the extent of coronary artery occlusion by the heart’s ability to meet the need for additional oxygen in response to the stress of exercising in a safe environment. The patient exercises on a treadmill or pedals a stationary bicycle to increase the heart rate to 80% to 90% of maximal heart rate determined by age and gender, known as the target heart rate. Every 2 to 3 min, the speed and/or grade of the treadmill is increased to yield an increment of stress. The patient’s electrocardiogram (ECG) and blood pressure are monitored during the test. The test proceeds until the patient reaches the target heart rate or experiences chest pain or fatigue. The risks involved in the procedure are possible myocardial infarction (1 in 500) and death (1 in 10,000) in patients experiencing frequent angina episodes before the test. Although useful, this procedure is not as accurate as cardiac nuclear scans for diagnosing coronary artery disease (CAD).

For patients unable to complete the test, pharmacological stress testing can be done. Medications used to pharmacologically exercise the patient’s heart include vasodilators such as dipyridamole and adenosine or dobutamine (which stimulates heart rate and pumping force). Stress testing should be discontinued when maximal performance has been reached or if certain criteria occur as noted in the Contraindications section. The patient’s ECG and blood pressure are monitored during the exercise phase. The test proceeds until the stimulated exercise portion is completed when a radiotracer, such as technetium-99m or sestamibi, is injected and images are taken by a gamma camera during the stimulated portion to compare with images taken at rest.

This procedure is contraindicated for

  • A variety of circumstances that may be considered absolute or relative depending on the facility’s providers:

  • Abnormal EKG changes causing symptoms related to the possibility of stress-induced infarction.
  • Acute myocardial infarction (AMI) (within 2 days) related to the possibility of stress-induced reinfarction.
  • Acute myocarditis related to low stress tolerance.
  • Aortic dissection related to the possibility of stress-induced tears and rupture.
  • Chest pain related to the possibility of stress-induced infarction.
  • Heart failure with symptoms (e.g., shortness of breath) related to low stress tolerance.
  • Mental or physical (e.g., severe leg claudication) impairment that prevents the patient from performing the required exercise.
  • Significant hypertension or hypotension.
  • Stenotic valvular disease with symptoms related to low stress tolerance from having the heart work harder to pump blood through the narrow valve.
  • Very fast (tachyarrhythmias) or very slow (bradyarrhythmias) heart rate.

Indications

  • Detect dysrhythmias during exercising, as evidenced by ECG changes
  • Detect peripheral artery disease (PAD), as evidenced by leg pain or cramping during exercising
  • Determine exercise-induced hypertension
  • Evaluate cardiac function after myocardial infarction or cardiac surgery to determine safe exercise levels for cardiac rehabilitation as well as work limitations
  • Evaluate effectiveness of medication regimens, such as antianginals or antiarrhythmics
  • Evaluate suspected CAD in the presence of chest pain and other symptoms
  • Screen for CAD in the absence of pain and other symptoms in patients at risk

Potential diagnosis

Normal findings

  • Normal heart rate during physical exercise. Heart rate and systolic blood pressure rise in direct proportion to workload and to metabolic oxygen demand, which is based on age and exercise protocol. Maximal heart rate for adults is normally 150 to 200 beats/min.

Abnormal findings related to

  • Activity intolerance related to oxygen supply and demand imbalance
  • Bradycardia
  • CAD
  • Chest pain related to ischemia or inflammation
  • Decreased cardiac output
  • Dysrhythmias
  • Hypertension
  • PAD
  • ST segment depression of 1 mm (considered a positive test), indicating myocardial ischemia
  • Tachycardia

Critical findings

    N/A

Interfering factors

  • The following factors may impair interpretation of examination results because they create an artificial state that makes it difficult to determine true physiological function:

  • Anxiety or panic attack.
  • Drugs such as beta blockers, cardiac glycosides, calcium channel blockers, coronary vasodilators, and barbiturates.
  • High food intake or smoking before testing.
  • Hypertension, hypoxia, left bundle branch block, and ventricular hypertrophy.
  • Improper electrode placement.
  • Potassium or calcium imbalance.
  • Viagra should not be taken in combination with nitroglycerin or other nitrates 24 hr prior to the procedure because it may result in a dangerously low blood pressure.
  • Wolff-Parkinson-White syndrome (anomalous atrioventricular excitation).

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in assessing the heart’s ability to respond to an increasing workload.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex or medications used to pharmacologically exercise the patient’s heart.
  • Obtain a history of the patient’s cardiovascular system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Inquire if the patient has had any chest pain within the past 48 hr or has a history of anginal attacks; if either of these has occurred, inform the health-care provider (HCP) immediately because the stress test may be too risky and should be rescheduled in 4 to 6 wk.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some discomfort may be experienced during the stimulated portion of the test. Inform the patient that the procedure is performed in a special department by an HCP specializing in this procedure and takes approximately 30 to 60 min.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Record a baseline 12-lead ECG and vital signs.
  • Instruct the patient to wear comfortable shoes and clothing for the exercise.
  • Instruct the patient to fast, restrict fluids, and avoid tobacco products for 4–6 hr prior to the procedure. Protocols may vary among facilities.
  • Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.

Intratest

  • Potential complications:
  • Myocardial infarction (MI)

  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure the patient has complied with dietary and tobacco restrictions for at least 4 to 6 hr prior to the procedure.
  • An IV access may be established for emergency use.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Have emergency equipment readily available.
  • Instruct the patient to void prior to the procedure and to change into the gown provided.
  • Place electrodes in appropriate positions on the patient and connect a blood pressure cuff to a monitoring device. If the patient’s oxygen consumption is to be continuously monitored, connect the patient to a machine via a mouthpiece or to a pulse oximeter via a finger lead.
  • Instruct the patient to walk on a treadmill (most commonly used) and use the handrails to maintain balance or to peddle a bicycle. As stress is increased, inform the patient to report any symptoms, such as chest or leg pain, dyspnea, or fatigue.
  • Turn the treadmill on at a slow speed, and increase in speed and elevation to raise the patient’s heart rate. Increase the stress until the patient’s predicted target heart rate is reached.
  • Instruct the patient to report symptoms such as dizziness, sweating, breathlessness, or nausea, which can be normal, as speed increases. The test is terminated if pain or fatigue is severe; maximum heart rate under stress is attained; signs of ischemia are present; maximum effort has been achieved; or dyspnea, hypertension (systolic blood pressure greater than 200 mm Hg, diastolic blood pressure greater than 110 mm Hg, or both), tachycardia (greater than 200 beats/min minus person’s age), new dysrhythmias, chest pain that begins or worsens, faintness, extreme dizziness, or confusion develops.
  • After the exercise period, allow a 3- to 15-min rest period with the patient in a sitting position. During this period, the ECG, blood pressure, and heart rate monitoring is continued.
  • Remove the electrodes and cleanse the skin of any remaining gel or ECG electrode adhesive.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Instruct the patient to resume usual activity, as directed by the HCP.
  • Instruct the patient to contact the HCP to report any anginal pain or other discomforts experienced after the test.
  • Nutritional Considerations: Abnormal findings may be associated with cardiovascular disease. Nutritional therapy is recommended for the patient identified to be at risk for developing CAD or for individuals who have specific risk factors and/or existing medical conditions (e.g., elevated LDL cholesterol levels, other lipid disorders, insulin-dependent diabetes, insulin resistance, or metabolic syndrome). Other changeable risk factors warranting patient education include strategies to encourage patients, especially those who are overweight and with high blood pressure, to safely decrease sodium intake, achieve a normal weight, ensure regular participation of moderate aerobic physical activity three to four times per week, eliminate tobacco use, and adhere to a heart-healthy diet. If triglycerides also are elevated, the patient should be advised to eliminate or reduce alcohol. The 2013 Guideline on Lifestyle Management to Reduce Cardiovascular Risk published by the American College of Cardiology (ACC) and the American Heart Association (AHA) in conjunction with the National Heart, Lung, and Blood Institute (NHLBI) recommends a “Mediterranean”-style diet rather than a low-fat diet. The new guideline emphasizes inclusion of vegetables, whole grains, fruits, low-fat dairy, nuts, legumes, and nontropical vegetable oils (e.g., olive, canola, peanut, sunflower, flaxseed) along with fish and lean poultry. A similar dietary pattern known as the Dietary Approach to Stop Hypertension (DASH) diet makes additional recommendations for the reduction of dietary sodium. Both dietary styles emphasize a reduction in consumption of red meats, which are high in saturated fats and cholesterol, and other foods containing sugar, saturated fats, trans fats, and sodium.
  • Social and Cultural Considerations: Numerous studies point to the prevalence of excess body weight in American children and adolescents. Experts estimate that obesity is present in 25 % of the population ages 6 to 11 yr. The medical, social, and emotional consequences of excess body weight are significant. Special attention should be given to instructing the child and caregiver regarding health risks and weight control education.
  • Recognize anxiety related to test results, and be supportive of fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Provide contact information, if desired, for the American Heart Association (www.americanheart.org), the NHLBI (www.nhlbi.nih.gov), or the Legs for Life (www.legsforlife.org). Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include antiarrhythmic drugs, apolipoprotein A and B, AST, atrial natriuretic peptide, BNP, blood gases, blood pool imaging, calcium, chest x-ray, cholesterol (total, HDL, LDL), CT cardiac scoring, CT thorax, CRP, CK and isoenzymes, echocardiography, echocardiography transesophageal, electrocardiogram, glucose, glycated hemoglobin, Holter monitor, homocysteine, ketones, LDH and isos, lipoprotein electrophoresis, lung perfusion scan, magnesium, MRI chest, MI infarct scan, myocardial perfusion heart scan, myoglobin, PET heart, potassium, pulse oximetry, sodium, triglycerides, and troponin.
  • Refer to the Cardiovascular System table at the end of the book for related tests by body system.

ECG

electrocardiogram

electrocardiogram

; ECG graphic representation of heart action (Table 1)
Table 1: Features of the normal electrocardiogram (ECG) waveform
ECG feature and durationComment
P wave ≤0.12 secondsDepolarization of the atria
QRS complex ≤0.1 secondsDepolarization of the ventricles
T waveVentricular repolarization
PR interval 0.12-0.22 secondsThe time, in seconds, from the start of the P wave to the start of the QRS complex, representing the time taken for the electrical activation (of the cardiac conduction system) to pass from the sinus node, through the atrium, the atrioventricular node and the His-Purkinje system to the ventricle
QT interval
Male: ≤0.44 seconds
Female: ≤0.46 seconds
The time, in seconds, from the start of the QRS complex to the end of the T wave, representing the time taken for the depolarization and repolarization of the ventricular myocardium
ST segmentThe period between the end of the QRS complex and the start of the T wave; in the normal heart, all myocardial cells are depolarized by this phase of the ECG

ECG,

ECG

electrocardiogram. Called also EKG.

eCG

equine chorionic gonadotropin. Called also pregnant mare serum gonadotropin.

EKG, ECG

electrocardiogram.
References in periodicals archive ?
Key players of the ECG equipment market include Medtronic, GE Healthcare, Philips Healthcare, Schiller AG, Nihon Kohden, CardioComm Solutions, Inc.
According to the report, ECG telemetry device manufacturers and providers are focusing on technological advancement and product innovation to have an edge over their competitors.
A total of 506 subjects (23%) showed major and 276 (13%) showed minor ECG abnormalities at baseline, for an overall incidence of 36%.
When using a decentralized model, the majority of collection, transcription, cleaning and interpretation of ECG data are conducted by the sponsor and the individual monitoring site.
At the same time, these results also demonstrate the value proposition ECG offers to investors by underscoring our ability to effectively manage and grow our investments and thus ensure our ability to generate attractive and ongoing returns for our investors and clients," he added.
According to the ECG Puzzler, a short PR interval is one that is less than 0.
Like the ECG it is an entirely safe test and produces a picture of the heart where excessive thickness of the muscle can be easily measured.
In addition to taking an ECG reading, doctors should look for abnormal blood-pressure measurements and listen for heart murmurs, he said.
6 percent) use panels of physicians who bill for overreading computer-generated ECGs.
The ability to automatically detect AFib using mobile technology like the AliveCor Mobile ECG has now proven to be an effective and important step the detection of AFib so physicians can intervene before potentially life-threatening conditions, like strokes, occur.
Delivery of the following medical supplies Lot 1: ECG electrodes, distributed access, banana plugsLot 2: ECG electrodes, distributed access, banana plug with cableLot 3: ECG electrodes, distributed access, push buttonLot 4: ECG electrodes, Central Terminal, carboxylic push button, MRT suitableLot 5: ECG electrodes, Central Terminal, buttonLot 6: ECG electrodes adaptation with alligator clipLot 7: ECG electrodes, security portLot 8: ECG electrodes, security access, rE[micro]ntgentransluzentLot 9: ECG electrodes, banana plugs rE[micro]ntgentransluzent,Lot 10: RF / neutral electrode.