Determining AXIS: 12 Lead ECG's

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Presentation transcript:

Determining AXIS: 12 Lead ECG's Using the Hexaxial Diagram to find the degree of Axis Deviation This technique is a little hard to learn but it is very accurate (+ or – 100 to 150) Emily Koch, RN, BSN, ACNPc Clinician III 4 East UVA Health System

Basics of 12 Lead ECG's Determining AXIS To determine the axis a scale must be used such as the one at the left. Each physician uses a slightly different degree as the upper limit of normal, but typically 105-110 degrees.

Basics of 12 Lead ECG's Determining AXIS First you must find the most equiphasic QRS complex in the six limb leads. 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.

Basics of 12 Lead ECG's Determining AXIS Locate the lead perpendicular to the lead with the most isoelectric QRS. If the perpendicular lead has a positive QRS, orient the axis to the positive pole of this lead. If it is negative then orient it to the negative Pole of this lead.

Basics of 12 Lead ECG's Determining AXIS If there is a lead with a QRS that is taller than the lead perpendicular to the most isoelectric, the axis is the mean of the two. Remember: If the tallest lead has a positive QRS, orient the axis to the positive pole of this lead. If it is negative then orient it to the negative pole.

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, or ABD tumors Left Anterior Hemiblock Left Bundle Branch Block WPW Syndrome Congenital Lesions Right Vent. Pacer or ectopic rhythms Emphysema

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. Ectopic rhythms WPW Syndrome

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

Normal ECG Most isoelectric is aVL. II is perpendicular and has mostly positive QRS. It also has the tallest QRS. Axis is 60 degrees and NORMAL

Determine Axis Answer: aVR is most isoelectric III is perpendicular and has tallest QRS QRS is III is mostly negative so axis is oriented to negative pole of lead III Axis is -60 degrees. LEFT axis deviation