Académique Documents
Professionnel Documents
Culture Documents
a biphasic deflection
Basics of 12 Lead ECG's:Vector
Basics of 12 Lead ECG's
Vector
By understanding this concept of vector and knowing the
"normal" vector of each of the 12 leads of the 12 lead
ECG it becomes quite easy to identify problems in the
direction of depolarization. It is also from this knowledge
that one identifies the Mean QRS Axis. Using the six limb
leads we identify the axis in relation to what is known as
the frontal plane. Two major factors help to determine
this mean QRS Axis, they are:
1. The anatomical position of the heart
2. The direction of ventricular depolarization.
Basics of 12 Lead ECG's:
Determining AXIS
Technique #1: Two Lead Method or Quadrant Method
This method uses just two leads of the six limb leads and works
well in critical situations to get a general idea of the Mean Axis
of the QRS. We will look at Lead 1 and at Lead AVF for this
technique.
Basics of 12 Lead ECG's
Determining AXIS
1. Leads 1 and AVF divide
the thorax into quadrants,
(Left, Normal, Right, No Man's)
2. If leads 1 and AVF are both
upright then the Axis is normal.
3. If lead 1 is upright and lead AVF
is downward the Axis is Left.
Basics of 12 Lead ECG's
Determining AXIS
Physiological UPRIGHT /
UPRIGHT NEGATIVE
Left Axis BIPHASIC
Pathological
UPRIGHT NEGATIVE NEGATIVE
Left Axis
UPRIGHT
Right Axis NEGATIVE BIPHASIC UPRIGHT
NEGATIVE
Extreme Right
NEGATIVE NEGATIVE NEGATIVE
Axis
Axis
Lead I upright
Lead II upright
Lead III upright Normal Axis
0° to + 90°
Axis Pathologic LAD
-30° to -90°
Lead I Upright
Lead II Negative
Lead III Negative
Physiological
LAD
0° to -30°
LI Upright
LII Biphasic
Lead I upright LIII Negative
Lead II upright
Lead III upright Normal Axis
0° to + 90°
Basics of 12 Lead ECG's
Causes of Abnormal Axis
Left Axis Deviation = An axis between -30 and -90
May be normal in the elderly and very obese
Due to high diaphragm during pregnancy, ascites, or ABD
tumors
Left Anterior Hemiblock
Left Bundle Branch Block
WPW Syndrome
Congenital Lesions
Right Vent. Pacer or ectopic rhythms
Emphysema
Axis
Physiological
LAD
0° to -30°
LI Upright
LII Biphasic
Lead I upright LIII Negative
Lead II upright
Lead III upright Normal Axis
0° to + 90°
Axis Pathologic LAD
-30° to -90°
Extreme RAD
-90 ° to 180 ° Lead I Upright
Lead II Negative
Lead III Negative
Physiological
Lead I Negative
Lead II Negative LAD
Lead III Negative 0° to -30°
LI Upright
Lead I Negative LII Biphasic
Lead I upright LIII Negative
Lead II Biphasic Lead II upright
Lead III Positive Lead III upright Normal Axis
0° to + 90°
RAD
+90 ° to +180 °
Basics of 12 Lead ECG's
Causes of Abnormal Axis
Right Axis Deviation = An axis between +120 and
+180
Can be normal variant
Right Vent. Hypertrophy
Right Bundle Branch Block
Left Posterior Hemiblock
Left Ventricular ectopic rhythms
Some right Vent. Ectopic rhythms
WPW Syndrome
Axis Pathologic LAD
-30° to -90°
Extreme RAD
-90 ° to 180 ° Lead I Upright
Lead II Negative
Lead III Negative
Physiological
Lead I Negative
Lead II Negative LAD
Lead III Negative 0° to -30°
LI Upright
LII Biphasic
Lead I upright LIII Negative
Lead II upright
Lead III upright Normal Axis
0° to + 90°
Basics of 12 Lead ECG's
Causes of Abnormal Axis