Indications
- • Chest pain / palpitations / syncope / collapse
- • Acute breathlessness
- • Suspected electrolyte abnormality or drug toxicity
- • Pre-op screening (selected)
Contraindications
- ⚠ None — adapt placement around dressings or amputation
Equipment
- • 12-lead ECG machine
- • Electrodes ×10
- • Razor + alcohol wipes
- • Patient ID labels
Technique
- • Explain procedure, expose chest, supine 45°
- • Clean / shave skin where needed
- • Limb leads: RA, LA, RL, LL (red, yellow, green, black)
- • Chest leads: V1 4th ICS R sternal edge · V2 4th ICS L · V4 5th ICS MCL · V3 between V2-V4 · V5 anterior axillary same level · V6 mid-axillary
- • Patient still + relaxed; record
- • Check name, date, calibration (1 mV = 10 mm, 25 mm/s)
Complications
- ⚠ Skin irritation
- ⚠ Misdiagnosis from incorrect lead placement (esp. V1/V2 too high → poor R-progression)
Aftercare
- • Label with name, date, time, clinical context
- • Show to senior immediately if STEMI, complete heart block, VT, prolonged QT
Clinical pearls
- • Right-sided / posterior leads for inferior STEMI (rule out RV infarct, posterior MI)
- • If patient has tremor, change filter or stabilise limbs
- • Always compare with prior ECG if available
Perform under supervision until competent. Follow local SOPs and consent policy.
