12 Lead ECG

Today we want to talk a little bit about the placement of the 12 lead ECG. An ECG, an electrocardiogram, is a graphical representation of the electrical activity of the heart. And an ECG is usually indicated ordered necessary for things such as chest pain, dyspnea, asyncope, acute coronary syndrome, pulmonary ebolism, and possibly myocardial infarction, or what is commonly known as a heart attack. You need to get that graphical picture of the electrical activity of the heart, and so it’s very important that you place the leads in the appropriate places. You begin then, in order to get the proper picture by placing four of the leads on the appendages, or the limbs, the arms and the legs. This is normally done distally, at the wrists and ankles, however it can be done proximally if necessary. So you begin with the four limbs, arms and legs, and then we’ve got these letters here V1 through V6 to let us know which lead goes where. And beginning at V1 then we begin at the right side of the sternum at the fourth intercostal space, you place one there. V2 is then left of the sternum at the fourth intercostal space, so these would be on either sides of the sternum but horizontal to each other. At V3 you go halfway between V2 and V4, so lets find out where V4 goes so that we know where V3 in that midway point between the two goes. V4 is left of the midclavicular line at the fifth intercostal space, so if you get that correct – the midclavicular line at the fourth intercostal space – then V3 will go midway between V2 and V4. V5 and V6 are both placed horizontally to V4 and they go out to the anterior axillary and midaxillary line as you work your way out. Sometimes its necessary to mirror this setup on the righthand side to get a more complete picture of what you’re trying to determine the electrical activity of the heart region for these various reasons already mentioned.

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