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Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Gail Walraven Basic Arrhythmias Seventh Edition.

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Presentation on theme: "Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Gail Walraven Basic Arrhythmias Seventh Edition."— Presentation transcript:

1 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Gail Walraven Basic Arrhythmias Seventh Edition

2 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Appendix C 12-Lead Electrocardiography

3 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Rule of Electrical Flow Current flowing toward a positive electrode creates an upright deflection. Current flowing toward a negative electrode creates a downward deflection. When the lead is at right angles to the current, the line is isoelectric (neither upright nor downward).

4 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Lead A combination of electrodes that reflects flow of electricity between two points on opposing sides of the heart.

5 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Leads Bipolar leads have one positive and one negative electrode. Unipolar leads have a positive electrode, but the opposing electrode is created by combining other electrodes into a central terminal, an electrically neutral point situated to reference the center of the heart.

6 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Electrode Placement for MCL 1

7 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Frontal and Horizontal Planes

8 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Electrode Placement – Frontal Plane

9 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Standard Lead Lines Lead I:right arm to left arm Lead II:right arm to left leg Lead III:left arm to left leg

10 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Standard Limb Leads

11 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Augmented Leads aVR:central terminal to right arm aVL:central terminal to left arm aVF:central terminal to left leg

12 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Augmented Limb Leads

13 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Frontal Plane Leads

14 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Frontal Plane Leads

15 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Horizontal Plane Leads

16 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Electrode Placement Precordial Leads V 1 : right sterna border, fourth intercostals space V 2 : left sterna border, fourth intercostals space V 3 : midway between V 2 and V 4 V 4 : midclavicular line, fifth intercostal space V 5 : anterior axillary line, fifth intercostal space V 6 : midaxillary line, fifth intercostal space

17 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Vector The arrow used to indicate direction and magnitude of electrical flow.

18 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Lead Axis An imaginary line from the positive electrode to the negative electrode for each lead, depicted by an arrow (vector).

19 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Mean QRS Axis The axis of the heart as a whole; the aggregate of all the electrical vectors in the heart.

20 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Lead Axis vs.Mean QRS Axis When the two are parallel, the deflections are either positive or negative. When the two are perpendicular, the complexes are biphasic.

21 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ EKG Deflections

22 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Wave Definitions

23 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Frontal Plane Vectors

24 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Horizontal Plane Vectors

25 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Mean QRS Axis

26 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Estimating QRS Axis

27 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Standard Layout of 12-Lead EKG

28 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Features of a Normal 12-Lead EKG All waves upright (except aVR) Small Q waves in lateral leads (I, aVL, V 6 ) T waves in V 1 -V 6 should be smooth, gradual T wave: positive, negative, or biphasic in V 1 ; positive in V 2 –V 6 QRS transition from V 1 (small R, large S) to V 6 (small Q, large R), roughly equiphasic in V 3 (V 4 )

29 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Normal 12-Lead Wave Forms (Example 1)

30 Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ Normal 12-Lead Wave Forms (Example 2)


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