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The epicardium is the first layer of the ventricles to repolarize, followed by the myocardium. The endocardium is the last layer to repolarize.

The plateau phase of depolarization has been shown to last longer in endocardial cells than in epicardial cells. This causes repolarization to start from the apex of the heart and move upwards.

Since repolarization is the spread of negative current as membrane potentials decrease back down to the resting membrane potential, the red arrow in the animation is pointing in the direction opposite of the repolarization.

This therefore creates a positive deflection in the ECG, and creates the T wave. It may also affect the high frequency band of the QRS.

The earliest sign is hyperacute T waves, peaked T waves due to local hyperkalemia in ischemic myocardium.

Over a period of hours, a pathologic Q wave may appear and the T wave will invert. Over a period of days the ST elevation will resolve.

Pathologic Q waves generally will remain permanently. The left anterior descending LAD artery supplies the anterior wall of the heart, and therefore causes ST elevations in anterior leads V 1 and V 2.

An ECG tracing is affected by patient motion. Some rhythmic motions such as shivering or tremors can create the illusion of cardiac arrhythmia.

Distortion poses significant challenges to healthcare providers, [47] who employ various techniques [49] and strategies to safely recognize [50] these false signals.

Improper lead placement for example, reversing two of the limb leads has been estimated to occur in 0.

Numerous diagnoses and findings can be made based upon electrocardiography, and many are discussed above. Overall, the diagnoses are made based on the patterns.

For example, an "irregularly irregular" QRS complex without P waves is the hallmark of atrial fibrillation ; however, other findings can be present as well, such as a bundle branch block that alters the shape of the QRS complexes.

ECGs can be interpreted in isolation but should be applied — like all diagnostic tests — in the context of the patient.

For example, an observation of peaked T waves is not sufficient to diagnose hyperkalemia; such a diagnosis should be verified by measuring the blood potassium level.

Conversely, a discovery of hyperkalemia should be followed by an ECG for manifestations such as peaked T waves, widened QRS complexes, and loss of P waves.

The following is an organized list of possible ECG-based diagnoses. The word is derived from the Greek electro , meaning related to electrical activity; kardia , meaning heart; and graph , meaning "to write".

From Wikipedia, the free encyclopedia. Not to be confused with other types of electrography or with echocardiography. Main article: Cardiac electrophysiology.

Main article: Electrocardiography in myocardial infarction. Lexico Dictionaries. Retrieved 20 January Archived from the original on 2 October Retrieved 11 February Basic arrhythmias 7th ed.

Philadelphia: Saunders. ECG Medical Training. Retrieved 24 June Textbook of veterinary medical nursing.

Oxford: Butterworth-Heinemann. Preventive Services Task Force recommendation statement". Annals of Internal Medicine.

Federal Aviation Administration. Retrieved 27 December World Health Organization. Retrieved 1 August MIT Technology Review. Retrieved 1 April Retrieved 25 August Stanford Health Care.

Journal of the American College of Cardiology. Society for Cardiological Science and Technology. Retrieved 21 October Retrieved 24 May Retrieved 27 May Nurses Learning Network.

Cables and Sensors. Retrieved 11 July Pediatric and Fundamental Electrocardiography. Developments in Cardiovascular Medicine. BioMed Research International.

Retrieved 15 August Archived from the original on 22 March December Advances in Physiology Education. Bibcode : BpJ Indian Pacing and Electrophysiology Journal.

J Electrocardiol. Estonian Journal of Engineering. Clinical Cardiology. Tex Heart Inst J. Hodder Education. Simple Cardiology. Retrieved 20 October CV Physiology.

Retrieved 22 October Joe; Hillis, J. Stanley; Rothbaum, Donald A. Kenneth; Hall, W. Dallas; Hurst, J. Willis eds.

January Circulation Research. Journal of Cardiovascular Pharmacology and Therapeutics. J Am Coll Cardiol. International Journal of Cardiology. Physio-Control, Inc.

Journal of Medical Case Reports. American Heart Journal. John November In Knowlden, Patricia E. Oxford Dictionary of National Biography online ed. Oxford University Press.

Subscription or UK public library membership required. J Physiol. Arch Neerl Sc Ex Nat. Origins, pioneers, and contributors".

N Engl J Med. Clinics of the Virginia Mason Hospital. Taro Takemi". Takemi Program in International Health.

Emergency medicine. Emergency department Emergency medical services Emergency nursing Emergency psychiatry Golden hour Medical emergency International emergency medicine Pediatric emergency medicine Pre-hospital emergency medicine Major trauma Trauma center Triage.

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