ECG LEADS

SYSTEM

Dr. Noor-un-Nisa Memon

Assistant Professor
Physiology DEPT, JSMU
LEARNING OBJECTIVES:
•To list the ‘’12’’ leads of ECG,
•To appreciate the site of attachment of
each lead,
• Recognize the “normal” appearance of
each lead,
•Recognize the “normal” appearance of
different waves,
•To understand the method of recording of
ECG.
 ELECTROCARDIOGRAPHY
It is a transthoracic interpretation of the electrical activity of the
heart, over a period of time, as detected by electrodes attached
to the surface of the skin and recorded by a device external to
the body.
• These electrodes detect the tiny electrical
changes on the skin that arises from the
heart’s muscles.
• Electrophysiologic pattern of depolarizing and
repolarizing during each heart beat.
• It is very commonly performed to detect any
cardiac problems
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ECG MACHINES
• 0, is the origin preceding the cycle
• P is the atrial systole contraction pulse
• Q is the downward deflection immediately
preceding ventricular contraction
• R is the peak of ventricular contraction
• S is the downward deflection
• T is the recovery of venticles
• U is the successor of T wave but not observed
 ECG RECORDING PAPER
• SPEED:-
• ECG machines can run
at 50 or 25 mm/sec.
• Minor lines:
• Major grid:
• AXIS:- VOLTAGE

• Horizontal:
• Vertical:
TIME
 ECG LEADS
Electrical cable attaching the electrodes
to the ECG recorder.
May also refer to the tracing of the
voltage difference between two of the
electrodes and is what is actually
produced by the ECG recorder,

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 12 LEAD ECG
The leads of the 12
lead ECG are
divided into:-
6 Limb Leads,
and
6 Precordial or
Chest Leads.
 LIMB LEADS
Looks the heart in vertical plane;
BIPOLAR: UNIPOLAR:
Lead I aVR
Lead II aVL
Lead III Avf
 STANDERD LIMB LEADS;
I TO III
• First six leads of the 12-lead ECG:-
– Come from four electrodes on the patient’s arms
and legs,
– Called bipolar or standard leads.

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 Lead I
• CONSISTS OF:-
– Positive electrode on the left arm ,
– Negative electrode on the right arm,

• Produces upward deflection of the QRS,

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 Lead II
• CONSISTS OF:-
– Positive electrode on the left foot,
– Negative electrode on the right arm,
• Shows most upright QRS complexes and most prominent P
waves,
• Is favorite monitoring lead in many ICUs and telemetry units,
• Long lead II,

• ,
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 Lead III
• CONSISTS OF:-
– Positive electrode on the left foot,
– Negative electrode on the left arm.

• Produces upward QRS deflection.

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 AUGMENTED LIMB LEADS;
aVR, AVl, aVF
– Use single positive monitoring electrode,
– Their tracings are augmented,i.e increased in size by
the ECG machine in order to be interpreted.
– Magnify the voltage up to 50% compared to the
standard leads,
– Called:-
• Augmented, or
• Unipolar leads.

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 Lead aVR
• Consists of positive electrode on the right arm,
• Only limb lead on the right side of the body,

• Is the only lead with downward deflected QRS (in

normal ECG)

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 Lead aVL
• Consists of positive electrode on the left arm,
• looks to the right and down,

• Produces the least upright QRS among the limb

leads,

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 Lead aVF
• Consists of positive electrode on the left leg,
• Looks straight up to the center of the chest,
• Known as inferior lead (along with leads II and III)
because all look upward.

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PLACEMENT OF LIMB LEADS
 CHEST LEADS (The V Leads)
PRECORDIAL LEADS:-
Looks the heart in horizontal plane;

V1 V4
V2 V5
V3 V6
 CHEST LEADS (The V Leads)
• The Precordial Chest
Leads Record The
Heart’s Electrical
Activity In The
Transverse Or
Horizontal Plane.
 CHEST LEADS (The V Leads)
• The Precordial Chest
Leads Record The
Heart’s Electrical
Activity In The
Transverse Or
Horizontal Plane.
 Chest leads V1 to V6
• CHEST (PRECORDIAL) LEADS:
– Lie across anterior chest,
– Measure the mean vector in the horizontal
plane,
– Each Chest Lead Is Made Positive & The
Whole Body Is Considered Negative.

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 CHEST LEADS

• Lead V1 :-
– located at right sternal border,
fourth intercostal space
– lies above right ventricle and septum

• Lead V2 :-
– located at the left side of sternum,
fourth intercostal space

• Lead V3 :-
– located midway between leads V2
and V4
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 Chest leads
• Lead V4 :-
– located at the midclavicular line, fifth
intercostal space

• Lead V5 :-
– located at the anterior axillary line, fifth
intercostal space

• Lead V6 :-
– located at the midaxillary line, fifth
intercostal space, above lateral wall of the
left ventricle

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Precordial Leads= V1-V6
 Einthoven’s Law
• The potential difference between the bipolar
limb leads measured simultaneously will at
any given moment have the values II=I+III
• Einthoven triangle
• An equilateral triangle used as a model of the
standard limb leads used in
electrocardiography