The mean electrical axis (MEA) of the QRS complex is usually determined in the frontal plane.

represents the direction (expressed in degrees) of the net or average direction of activation of the entire
ventricular myocardium.

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There are three common methods of calculating the MEA in the frontal plane. All of these are merely
approximations. Individuals should use whichever method they feel comfortable with.


The Vector Method: Using leads I, II or III and the frontal plane diagram, calculate the

algebraic sum of the QRS deflections in any two leads (this does not include the P wave or the T
wave). Let us for example consider using the complexes of leads I and III. Plot the algebraic
sum of lead I on its axis on the frontal plane diagram. Similarly plot the algebraic sum of the
QRS complex of lead III on its axis on the frontal plane diagram. Draw lines perpendicular to the
their respective axes at the points plotted on the lead axes I and III. Note the point of
intersection of these two perpendicular lines. A line drawn from this intersect to the center of the
diagram describes the MEA. See the example below:

III.3 . the R waves are equally tall in leads II and III. Therefore the mean electrical axis must be directed at right angles to lead I. the mean QRS axis must be directed at 90° to that lead. 5. Reasoning in a reverse manner. * As a general rule. 5. the mean electrical axis must be at right angles to 0° or at either -90° or +90°. for example. A MEA of 100 to -75 degrees in the dog or 160 to -75 degrees in the cat suggests right ventricular enlargement. The MEA also helps determine the nature of aberrant conduction disturbances (so called bundle branch block). the depolarization forces would be oriented away from the positive pole of lead aVF and that .3 the mean electrical axis could have been calculated a second way. the mean QRS axis points midway between any two leads that show tall R waves of equal height. you are answering this question: In what general direction or toward which lead axis is the QRS complex predominantly oriented? In Fig. Recall from Chapter 3 that if a wave of depolarization is oriented at right angles to any lead axis. These waves indicate that the heart is electrically vertical (vertical electrical axis). Now look at Fig. a biphasic complex (RS or QR) is recorded in that lead.php?sectionkey=5 Mean QRS Axis: Calculation In calculating the mean QRS axis. In Fig. if you find a biphasic complex in any of the extremity leads.vetgo. 5.8 Why should I bother determining the MEA? Determining the MEA is very useful to identify right ventricular enlargement. notice the tall R waves in leads II. http://www. Do you see any biphasic QRS complexes? Obviously lead I is biphasic and shows an RS pattern. Therefore by simple inspection the mean electrical QRS axis can be seen to be directed between the positive poles of leads II and III and toward the positive pole of lead aVF (+90°). and aVF.3 again. If the axis were -90°. Since lead I on the hexaxial lead scale is at 0°. In Fig.lead would show a negative complex. therefore the axis must be +90°. .htm E.3 . lead aVF shows a positive complex (tall R wave). The mean QRS vector represents the mean electrical vector generated by ventricular depolarization. Mean QRS complex The cardiac dipole can be represented as a vector with magnitude and direction. Measurement of the angle of this vector provides an important part of clinical electrocardiographic analyses. 5. . A left axis shift would occur if there is a left ventricular hypertrophy or right ventricular infarction. A right axis shift would occur if there is right ventricular hypertrophy or left ventricular infarction.A normal axis (or normal direction) of the QRS vector generally lies between 0 and 90 degrees.pbworks.