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this ECG tutorial was written to help

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you to spot patterns on patients ECGs

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every ECG is recorded and displayed in

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the same way

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it displays the electrical activity in a

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patient's heart across a 10 second

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period the electrical activity is

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displayed on 12 graphs the 12 leads of

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the ECG each of these individual leads

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refers to an electrical camera which is

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pointed at a different place on the

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patient's heart it's not conventional to

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box off the individual graphs of the 12

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lead ECG and this is one of the reasons

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that it looks so complex to the beginner

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in this tutorial we'll show you each of

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the individual graphs to help you to see

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what you're looking at let's start by

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reminding ourselves of the names of the

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leads on the right-hand side of the ECG

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are the six chest leads these are simply

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named in order v1 v2 v3 v4 v5 and v6

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on the left-hand side of the ECG are the

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sixth limb leads the naming here isn't

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quite so simple but on the left are

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leads one two and three and adjacent to

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them other leads AVR AVL and AVF each of

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the individual leads of the ECG are

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recorded and displayed for only one

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quarter of the ten-second duration of

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the ECG ie 2.5 seconds is therefore

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conventional to display a longer

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10-second recording from one of the

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leads at the bottom of the ECG this

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usually comes from lead to and is known

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as the rhythm strip as the name suggests

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we use this to look at abnormalities of

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rhythm as you can see from this rhythm

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strip the patient's heartbeat 13 times

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during the 10 seconds that this ECG took

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to record each of these individual

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heartbeats is recorded four times as you

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can see any ECG complex immediately

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above or below another refers to the

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same heartbeat

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now we've identified the 12 graphs or

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leads on the ECG let's remind ourselves

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where they're being recorded from let's

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start with the limb leads on the left

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hand side of the ECG these graphs all

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record from electrical cameras pointing

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at the sides top and bottom of the

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patient's hard here lead one looks into

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the left hand side of the patient's

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heart here is lead to it looks up the

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patient's left leg into the bottom left

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of the heart and lead three looks up the

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patient's right leg into the bottom

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right hand side of the heart lead AVR

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looks from high above the patient's

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right shoulder into the top right of the

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heart AVL from high above the left

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shoulder into the top left of the heart

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and lead a VF straight up between the

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patient's legs at the bottom of their

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heart next let's look at the six chest

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leads which look into the patient's

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heart like arrows stuck through the

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patient's chest firstly lead v1 looks

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into the patient's heart from the front

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just off to the right imagine each of

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the chest leads recording through an

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arrow stuck straight through one of the

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stickers stuck to the patient's chest

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wall each therefore record subsequently

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further round towards the patient's left

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as each of the stickers is stuck further

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round towards the patient's left armpit

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in this view you can clearly see how the

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limb leads and chest leads differ the

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limb leads the purple arrows record the

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left right top and bottom of the

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patient's heart the chest leads record

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the front rotating round to left hand

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side of the patient's heart

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you could also note that some of the

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arrows look pretty similar for example

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lead 1 AVL and v6 we can therefore

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assign groups of leads which look at

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different aspects of the patient's heart

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three main groups are referred to in

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clinical practice the inferior leads

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refer to the bottom of the patient's

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heart the anterior leads refer to the

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front of the patient's heart and the

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lateral leads refer to the left hand

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side of the patient's heart

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in this tutorial we've reminded

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ourselves what the 12 leads of the ECG

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are and how they're displayed on the

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printout in order to competently read an

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ECG you need to know this information

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but as with any other skill the key is

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practice so it's time to start looking

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at some more ECGs