ECG (homework) Sital Karki D. QRS axis determination 9.

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.

1. Leads 1 and AVF divide the thorax into quadrants, (Left, Normal, Right, and 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. 4. If lead AVF is upright and lead 1 is downward then the Axis is Right 5. If both leads are downward then the Axis is extreme Right Shoulder and most often is Vent. Tachy

ECG (homework) Sital Karki 10. Using the Hexaxial Diagram to find the degree of Axis Deviation

Marked RAD

-90 -120 aVR -150

-60
LAD

-30 aVL 0 I

180

150 30 120 III 60 90 aVF II

Normal Axis -30 to +100

RAD

1. To determine the axis a scale must be used such as the one at the left. 2. First you must find the most equiphasic QRS complex in the six limb leads. This is done by adding and subtracting the number of squares each QRS complex has above the baseline and below the baseline in each lead. 3. The axis will be perpendicular (right angle) to this lead. If the perpendicular lead has a positive QRS, orient the axis to the positive pole of this lead. If it is negative then orient it to the negative pole. 4. Left Axis Deviation = An axis between -30 and -90 5. Right Axis Deviation = An axis between +120 and +180 6. Extreme Right Axis Deviation = An axis between -90 and +180