Recognising ECG landmarks

Electrocardiograms (ECGs) have become an integrated part of an ambulance clinician's toolkit, with thousands being performed each year (Brady et al, 2012). Invented in 1903 by Willem Einthoven, a dutch physiologist, the ECG has become a necessary non-invasive diagnostic tool for identifying cardiac and non-cardiac conditions, such as electrolyte imbalances, pulmonary embolisms, various coronary syndromes, cardiomyopathy and arrhythmias (Brady et al, 2012; Harrigan et al, 2012).

This article is designed to support clinicians in locating the landmarks which are vital for correct ECG electrode placement (Figure 1). It is imperative for clinicians to be trained in ECG electrode placement and maintain their skills (Brady et al, 2012; Health and Care Professions Council (HCPC), 2016).

While the 12-lead ECG is an essential diagnostic tool, inaccurate lead placement can result in a wave amplitude change, causing misinterpretation—and potentially, inappropriate treatment for patients (Kania et al, 2013; Dougherty et al, 2015). McCann et al (2007) and Karnia et al (2013) highlight inaccurate placement of the electrodes on the chest and limbs prior to the recording taking place as a significant issue. Harrigan et al (2012) suggest that inaccuracies could lead to up to 24% of ECGs being incorrect; however, there has been little research carried out in the out-of-hospital environment.