ECGs (NC)

Question 1

What is the angle of Louis/sternal angle/manubriosternal joint?

Answer 1

manubriosternal angle, the articulation of the manubrium and body of the sternum, continuous with the second rib

Question 2

What is the anterior axillary line?

Answer 2

extends down from anterior axillary skinfold (where pectoralis major muscle inserts)

Question 3

Why can the breast and nipple not be relied upon for anatomical landmarks for cardiac structures with g the thorax?

Answer 3

They are not static structures

Question 4

How to find the 4th intercostal space?

Answer 4

Run finger form the top of the sternum until you find a bony ridge. (This is the sternal angle)
Slide finger down to locate the second intercostal space.
Count down two intercostal spaces to find the 4th intercostal space

Question 5

What is the most common electrode misplacement? What can this cause? When to suspect this misplacement?

Answer 5

Placing V1 and V2 superiority in the second or third intercostal space
Can cause an incomplete bundle branch block pattern, anterior T wave inversion and poor R wave progression.
Suspect if there is a biphasic P wave in V2

Question 6

What prep might you have to consider?

Answer 6

Wash hands before making contact with the patient
Patient should like on bed at 45* undressed to the waist and hands at their sides
Remove watche, bangles, necklaces from patient
Must have clean and dry skin for good electrical conductivity
Might be necessary to shave patient with consent is large volume of hair

Question 7

Where to place limb electrodes

Answer 7

One on each wrist at the base of the palms.
One on the medial aspect on each ankle, just above the medial malleus

Ankles must not be touching and hands not in contact with body

Question 8

The 4 longer limb wires should clip to the corresponding limb via colour

Answer 8

L/yellow:left arm
R/red:right arm
F/green: les leg
N/black (the neutra lead): right leg

Question 9

Why do you place limb electrodes on bony areas

Answer 9

Reduces interference from skeletal muscle

Question 10

Where do the six electrode stickers get applied to the chest wall?

Answer 10

V1: 4th intercostal space, right sternal angle
V2: 4th intercostal space, left sternal
V4: 5th intercostal space, mid clavicular line (V4 normally placed before V3)
V3: midway between V2 and V4
V5: 5th intercostal space, anterior axillary line, at same horizontal level as V4
V6: 5th intercostal space, mid-axillary line, at same horizontal Evel as V4