How to Set Up a 12 Lead Ekg: 10 Steps (with Pictures) (2024)

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Co-authored byChris M. Matsko, MD

Last Updated: January 4, 2024References

1. 1

   Tell your doctor about all medicines you are taking. This is important because some medicines change the rate at which your heart beats and could affect the results. This includes over-the-counter medications and herbal supplements.

   • Do not drink cold water right before the test. You need to stay warm so that you do not shiver.^[3]
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   Allow the doctor to prepare you. You may be asked to take off your shirt or put on a hospital gown. This will make it easier for the doctor to put the electrodes directly onto your skin.^[4]

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   • If your skin is dirty, the doctor may clean and wipe the areas where the electrodes will go.
   • If you have hair on your chest, arms, or legs where the doctor wants to put the leads (electrodes), you may be shaved first. This will help the leads stick correctly.^[5]

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   Wait while the doctor prepares the electrodes. The 12 lead EKG uses 10 electrodes. They will be put directly onto your skin. They may feel slightly cold, but they will not hurt. The electrodes measure your body’s electricity. They do not put electricity into your body.^[6][7]

   • The doctor may use gel, spray, or tape to fix them in place and create a good connection.
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   Watch the doctor place the chest electrodes. There will be six chest electrodes which must be placed as follows:^[8][9]

   • Electrode 1 will go to the right of the sternum in the fourth intercostal space. The intercostal space is the space between the ribs.
   • Electrode 2 will go to the left of the sternum in the fourth intercostal space.
   • Electrode 3 will be in between electrodes 2 and 4.
   • Electrode 4 will go on midclavicular line in the fifth intercostal space. The midclavicular line is a vertical line that goes through the middle of the collarbone.
   • Electrode 5 is horizontally level with electrode 4 in the anterior axillary line. The anterior axillary line runs down your body from the collarbone, 3/4ths of the distance from the middle of your collarbone to the end.
   • Electrode 6 is horizontally level with electrode 4 in the mid-axillary line. The midaxillary line runs down your side from your armpit to your waist.
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   Observe as the doctor places electrodes on your limbs. The other four electrodes will go on your arms and legs and do not have to be placed as precisely. The doctor will likely avoid areas with a lot of hair, protruding bones, or muscles, but will place them as follows:^[10][11]

   • One electrode on each arm between your wrist and your shoulder.
   • One electrode on each leg between your ankle and your thigh.
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   Wait while the EKG runs. Chances are the doctor will just ask you to lie still. In order to get accurate results, it is important that you do not move or shiver.^[12]

   • You will need to lie flat on your back so that you are relaxed with all of your limbs supported.
   • The doctor may ask you to hold your breath briefly during the test.
   • As the test runs, you may be able to see the results displayed on the monitor. If so, you may see a graph displaying a peak when your heart beats.
7. 7

   Allow the doctor to remove the electrodes. When the test is over, the doctor will pull the leads off you. This will also not hurt. You may have a slight red mark from the suction afterwards, but this should go away after a few minutes.

   • The doctor will inform you that the test is over and that you can get dressed again.
   • It may be possible to learn what the results are immediately.

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1. 1

   Ask the doctor why you needed the EKG. The doctor may have performed the EKG as part of a regular check-up or because he was concerned about symptoms you have. The doctor is more likely to do an EKG if:^[13]

   • You have a history of heart disease in your family.
   • You have heart disease, have a pacemaker, or are on medications that could affect your heart.
   • You will have surgery.
   • You have reported chest pain, having a pounding heartbeat, breathing difficulties, or fatigue.
   • Your doctor heard abnormal sounds when listening to your heart.
2. 2

   Recognize normal results. If the EKG shows no abnormalities or problems you will get the following information about your heart beat:^[14]

   • A heart rate that is neither too fast nor too slow. For an adult it should be between 60 and 100 beats per minute. Athletes who are in extremely good shape may have a slightly lower heart beat.
   • A steady rhythm. Your heartbeat should be regular and steady when you are at rest. There should be no missing beats and no extra beats.
3. 3

   Discuss any abnormal results with your doctor. If your results come back showing an abnormal heart rate, she may send you to a cardiologist for additional tests. Possible abnormal results may indicate:^[15][16]

   • Tachycardia. This condition occurs when your heart beats too quickly.
   • Bradycardia. This occurs when your heart beats too slowly.
   • Arrhythmia. A heart arrhythmia occurs when your heart beats irregularly. This can happen due to problems with the electrical signals controlling the heartbeat or as a side effect of medications such as beta blockers, amphetamines, or other drugs.
   • A previous or current heart attack. The EKG may reveal areas of your heart that have been damaged.
   • An enlarged heart with areas that are thickened.
   • Valve problems.
   • An insufficient blood supply to part of the heart.

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