Browse the corpus

An electrocardiogram (abbreviated as EKG or ECG) represents a recording of the heart's electrical activity. Willem Einthoven first invented it in 1902. An EKG is an integral part of the initial evaluation of a patient suspected of having a cardiac-related problem. This activity reviews the basic anatomy and electrical conduction system of the heart, illustrates the indications of ECG, and outlines the preparation, technique, and clinical significance. The article also highlights inter-professional teamwork and collaboration to enhance the delivery of quality care to patients. Objectives: Explain the indications for obtaining an ECG. Describe the procedure for obtaining an ECG. Review the clinical significance of ECG. Outline interprofessional team strategies for improving care coordination and communication to advance ECG and improve patient outcomes. Access free multiple choice questions on this topic.

The electrocardiogram (abbreviated as ECG or EKG) represents an electrical tracing of the heart and is recorded non-invasively from the surface of the body. The word ECG derives from the German language. In German, it is elektro-kardiographie. In 1902, the Dutch physician Einthovan invented ECG, and his tremendous input in clinical studies for about ten years led to full recognition of the clinical potential of the technique.[1] Many arrhythmias and ECG changes associated with angina and atherosclerosis were identified by 1910. William Einthoven was named the "father of electrocardiography" and was awarded Nobel Prize in Medicine in 1924 for his hard work that laid the foundation of the most fundamental technique for investigating heart disorders. ECG was soon recognized as a robust screening and clinical diagnostic tool, and today it is used globally in almost every healthcare setting.[2] ECG is a non-invasive diagnostic modality that has a substantial clinical impact on investigating the severity of cardiovascular diseases.[3] ECG is increasingly being used for monitoring patients on antiarrhythmics and other drugs, as an integral part of preoperative assessment of patients undergoing non-cardiac surgery, and for screening individuals in high-risk occupations and those participating in sports. Also, ECG serves as a research tool for surveillance and experimental trials of drugs with recognized cardiac effects.[4] Cardiovascular disease, as the number one cause of death, puts a great emphasis on healthcare providers developing skills and knowledge in interpreting ECGs to provide the best care promptly. Many healthcare providers find the advanced interpretation of ECG findings a complicated task. Errors in the analysis can lead to misdiagnosis, delaying the appropriate treatment. This activity seeks to provide a general understanding of the ECG mechanisms, interpretation techniques, and commonly encountered ECG findings.

An electrocardiogram is a safe, non-invasive, painless test with no major risks or complications. An allergic reaction or skin sensitivity to the adhesive gel can occur and usually resolves as soon as the electrode patches are removed and, in most cases, do not require any treatment. Artifacts and distortions pose serious diagnostic difficulties and may result in an inaccurate interpretation of the ECGs, potentially resulting in an adverse therapeutic intervention.[23][24] There can be a potential for misdiagnosis due to the inadvertent misplacement of ECG leads.[25][26]

The use of an electrocardiogram has expanded from simple heart rate and essential rhythm monitoring to interpreting complex arrhythmias, myocardial infarction, and other ECG abnormalities. The rapid detection of myocardial infarction has substantially reduced the door-to-balloon time for reperfusion therapy. Nurses' skills regarding assessment and comprehensive knowledge of the dysrhythmias can prevent stroke in atrial fibrillation and improve patient outcomes from the emergency department presentation through discharge and follow-up.[61] Cardiology board-certified pharmacists can make appropriate medication recommendations for several medications, particularly antiarrhythmics, based on ECG readings and patient history, working in conjunction with the cardiologist. ECG outcomes in management are noticeable in every department within the interprofessional healthcare team. Interaction among clinicians (MDs and DOs, including specialists, NPS, and PAs), nurses, patient care assistants, pharmacists, and ECG technicians is critical to providing the most effective patient care. Interprofessional collaboration and teamwork in the hospital setting prevent significant medical errors through multiple checkpoints and ensure timely emergency care in cardiac emergencies. For better outcomes, excellent professional ethics, patient satisfaction, and staff proficiency in evaluating ECGs are mandatory. There should be effective, open communication between interprofessional team members with appropriate role clarity, shared policies, and strategies to improve system-related issues to drive optimal patient outcomes.[62][63][64] [Level 5]

Continuous EKG monitoring is one of the current technologies used in the emergency department, intensive, post-anesthesia, and cardiac care units. Often, nurses are the first care responders in these hospital settings. The first interaction of the EKG view puts great responsibility on the nurses in managing technical aspects of the EKG monitoring and decision-making on the clinical grounds with information received from the monitor. The current practice includes that nurses initially interpret the EKG, gather data, and promptly notify the physician-in-charge to ensure an appropriate management plan.[65]

Among the healthcare providers in a hospital setting, especially in intensive and cardiac care units where round-the-clock monitoring of critical patients is required, nurses play a very crucial role in cardiac monitoring. It is the nurse's responsibility to assess the patient's clinical condition, monitor, and ensure that an excellent quality of care is delivered. The nurses' should monitor the continuous EKG monitoring very carefully and have competency in initial interpretation. Their knowledge about correct EKG leads placement, analysis, and thrombolytic treatment in acute coronary syndrome patients have significant implications for reducing morbidity and mortality.[66]