# Basics of 12 Lead ECG's Vector

There are three basic "laws" of Electrocardiography. These "laws" have to do with the direction of flow of electrical conduction in the heart or what we term as vector.

H. Conner REMT-P

- + = H. Movement of the electrical impulse towards the positive electrode will result in a positive deflection on the ECG. Conner REMT-P .Basics of 12 Lead ECG's Vector 1.

Conner REMT-P .Basics of 12 Lead ECG's Vector 2. + = H. Movement of the electrical impulse toward the negative electrode will result in a negative deflection on the ECG.

- + = H. Movement of an electrical impulse perpendicular to a line between the positive and negative electrodes results in a bi-phasic (part upright and part downward) deflection on the ECG.Basics of 12 Lead ECG's Vector 3. Conner REMT-P .

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. The anatomical position of the heart 2. It is also from this knowledge that one identifies the Mean QRS Axis. Conner REMT-P . Two major factors help to determine this mean QRS Axis. The direction of ventricular depolarization. H. they are: 1. Using the six limb leads we identify the axis in relation to what is known as the frontal plane.

H. Conner REMT-P .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.

If leads 1 and AVF are both upright then the Axis is normal. Normal. 3. H. Leads 1 and AVF divide the thorax into quadrants. Right. No Man's) 2. (Left.Basics of 12 Lead ECG's Determining AXIS 1. Conner REMT-P . If lead 1 is upright and lead AVF is downward the Axis is Left.

Tachy H. Conner REMT-P . If both leads are downward then the Axis is extreme Right Shoulder and most often is Vent. If lead AVF is upright and lead 1 is downward then the Axis is Right 5.Basics of 12 Lead ECG's Determining AXIS 4.

Conner REMT-P .Basics of 12 Lead ECG's Determining AXIS Method 2 : Three Lead technique This method uses the three limb leads I. H. III to determine the axis of the QRS. II.

Conner REMT-P .LEAD 1 Normal Physiological Left Axis Pathological Left Axis Right Axis Extreme Right Axis UPRIGHT UPRIGHT UPRIGHT LEAD 2 UPRIGHT UPRIGHT / BIPHASIC NEGATIVE UPRIGHT BIPHASIC NEGATIVE LEAD 3 UPRIGHT NEGATIVE NEGATIVE NEGATIVE UPRIGHT NEGATIVE NEGATIVE NEGATIVE H.

Conner REMT-P .Basics of 12 Lead ECG's Determining AXIS Method # 3: Using the Hexaxial Diagram to find the degree of Axis Deviation This technique is a little hard to learn but it is also the most accurate( + or ± 100 to 150) H.

150° 30° 120° III 90° aVF RAD 60° II Normal Axis -30° +100° -30 toto+120 H.Basics of 12 Lead ECG's Determining AXIS Marked RAD -90° -120° aVR -150° -60° LAD -30° aVL 0° I 180° To determine the axis a scale must be used such as the one at the left. Conner REMT-P .

Basics of 12 Lead ECG's Determining AXIS Marked RAD -90° -120° aVR -150° -60° LAD -30° aVL 0° I 180° 150° 30° 120° III 90° aVF RAD First you must find the most equiphasic QRS complex in the six limb leads. H. Conner REMT-P 60° II Normal Axis -30° +100° -30 toto+120 . 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.

H. If the perpendicular lead has a positive QRS. Conner REMT-P -30 -30° to +100° to +120 . orient the axis to the positive pole of this lead. If it is negative then orient it to the negative pole.Basics of 12 Lead ECG's Determining AXIS Marked RAD -90° -120° aVR -150° -60° LAD -30° aVL 0° I 180° 150° 30° 120° III 90° aVF RAD 60° II Normal Axis The axis will be perpendicular (right angle) to this lead.

or ABD tumors Left Anterior Hemiblock Left Bundle Branch Block WPW Syndrome Congenital Lesions Right Vent.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. Pacer or ectopic rhythms Emphysema H. Conner REMT-P .

Ectopic rhythms WPW Syndrome H.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. Conner REMT-P .

Basics of 12 Lead ECG's Causes of Abnormal Axis Extreme Right Axis Deviation = An axis between -90 and +180 Ventricular ectopic rhythms Right Vent. Conner REMT-P . Paced rhythms Less commonly seen in patients with cardiomyopathies and in those with multiple MI's H.