Continuous ST segment monitoring

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Limb electrodes are placed on the torso to reduce muscle artifact during limb movement and to avoid tethering the patient in bedside cardiac monitoring.

The right arm (RA) electrode is placed in the infraclavicular fossa close to the right shoulder, the left arm (LA) electrode is placed in the infraclavicular fossa close to the left shoulder, and the left leg (LL) electrode is placed below the rib cage on the left side of the abdomen. The ground or reference electrode (RL) can be placed anywhere, but it is usually placed on the right side of the abdomen.

Lead placements for monitoring systems as follow:

The five electrodes replacement. Only one precordial lead can be monitored and recorded at the same time
A 12-lead electrodes replacement. Anatomic locations for precordial leads are the same as for recording a standard ECG. Limb leads are relocated on sub clavicle and lover abdominal areas instead of wrists and ankles
An example of continuous monitoring of ST segment resolution. Note to initial phase of ST segment re-elevation

References

1. Drew BJ, Califf RM, Funk M, et al. Practice Standards for ECG Monitoring in Hospital Settings; An AHA Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical Care Nurses. Circulation 2004,110,2721-46

2. Zorkun C, The Effects of Primary Coronary Angioplasty Techniques and Pharmacotherapy on Left Ventricular Function and Myocardial Perfusion, Doctoral Thesis, CM UJ, Krakow, 2006


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