ECG LEADS

Chapter 3
 introduction

The heart produces electrical currents

The body acts as a conductor of electricity

 introduction

An ECG is a recording of the

electrical activity of the heart

Different “views” of the heart can

be recorded using different
electrodes
 INtroduction

Electrodes are able to measure the voltages of the cardiac

current
Electrodes
 Electrodes

V1: Fourth intercostal space to the right of the sternum.

V2: Fourth intercostal space to the Left of the sternum.

V3: Directly between leads V2 and V4.

V4: Fifth intercostal space at midclavicular line.

V5: Level with V4 at left anterior axillary line.

V6: Level with V5 at left midaxillary line. (Directly

under the midpoint of the armpit)
Electrode placement
Electrode and Lead are not the same thing.
 Leads

12 possible leads

Six limb (extremity) leads

Bipolar leads: I, II, and III

Unipolar leads: aVR, aVL, aVF

Six chest (precordial) leads

 limb leads

Electrodes

Right arm

Left arm

Left leg

Right leg (ground)

 lead i

LA = electrical voltages of the

heart that are transmitted to the left
arm

RA = electrical voltages of the

heart that are transmitted to the
right arm

The electrocardiograph sustracts

RA from LA and the difference
appears as lead I.
 lead i

Lead one ‘travels’ horizontally.

Its left pole (LA) is postive and its

right pole (RA) is negative.

Therefore, lead I = LA minus RA

Shows a positive wave when an

impluses moves towards the left
arm, negative wave when an impuse
moves away from the left arm.
 Lead II

Lead II points downward

diagonally

Lower pole (LL) is positive

and upper pole (RA) is
negative.

Lead II = LL minus RA
 Lead III

Lead III points downward

diagonally

Lower pole (LL) is positive and

upper pole (LA) is negative.

Lead III = LL minus LA

Bipolar Leads
 Unipolar or Augmented limb
leads

Record the electrical voltages at

one location rather than relative to
the voltage at another electrode
 limb leads

aVR + aVL + aVF = 0

 Limb leads

Bipolar leads & Unipolar (or augmented) leads

Frontal plane
Limb leads
 chest leads

V1 to V6

unipolar

horizontal plane

front to back
Chest Leads
ALL 12 leads

Frontal Plane

Horizontal
Plane
 Monitor leads

12 leads are not always necessary

Sample of a monitor lead

V1 (positive)

Right shoulder (negative)

Left shoulder (ground)

Holter Monitors