Electrocardiography

Electrocardiography
ECG of a heart in normal sinus rhythm
ICD-10-PCS	R94.31
ICD-9-CM	89.52
MeSH	D004562
MedlinePlus	003868
[edit on Wikidata]

Electrocardiography is the process of producing an electrocardiogram (ECG or EKG^[a]), a recording of the heart's electrical activity through repeated cardiac cycles.^[4] It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the heart^[5] using electrodes placed on the skin. These electrodes detect the small electrical changes that are a consequence of cardiac muscle depolarization followed by repolarization during each cardiac cycle (heartbeat). Changes in the normal ECG pattern occur in numerous cardiac abnormalities, including:

• Cardiac rhythm disturbances (such as atrial fibrillation^[6] and ventricular tachycardia^[7]),
• Inadequate coronary artery blood flow (such as myocardial ischemia^[8] and myocardial infarction^[9]),

• and electrolyte disturbances, such as hypokalemia.^[10]

Traditionally, "ECG" usually means a 12-lead ECG taken while lying down as discussed below. However, other devices can record the electrical activity of the heart such as a Holter monitor but also some models of smartwatch are capable of recording an ECG. ECG signals can be recorded in other contexts with other devices.

In a conventional 12-lead ECG, ten electrodes are placed on the patient's limbs and on the surface of the chest. The overall magnitude of the heart's electrical potential is then measured from twelve different angles ("leads") and is recorded over a period of time (usually ten seconds). In this way, the overall magnitude and direction of the heart's electrical depolarization is captured at each moment throughout the cardiac cycle.^[11]

There are three main components to an ECG:^[12]

• The P wave, which represents depolarization of the atria.
• The QRS complex, which represents depolarization of the ventricles.
• The T wave, which represents repolarization of the ventricles.

During each heartbeat, a healthy heart has an orderly progression of depolarization that starts with pacemaker cells in the sinoatrial node, spreads throughout the atrium, and passes through the atrioventricular node down into the bundle of His and into the Purkinje fibers, spreading down and to the left throughout the ventricles.^[12] This orderly pattern of depolarization gives rise to the characteristic ECG tracing. To the trained clinician, an ECG conveys a large amount of information about the structure of the heart and the function of its electrical conduction system.^[13] Among other things, an ECG can be used to measure the rate and rhythm of heartbeats, the size and position of the heart chambers, the presence of any damage to the heart's muscle cells or conduction system, the effects of heart drugs, and the function of implanted pacemakers.^[14]

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