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5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
5 precordial axis
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5 precordial axis

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  • Counterclockwise rotation, indeterminate axis
  • A LBBB doesn’t always cause late r-wave progression, but it is common.
  • A RBBB will always cause early r-wave progression
  • Transcript

    • 1. 12-Lead Electrocardiography a comprehensive course Adam Thompson, EMT-P, A.S.
    • 2. Frontal Axis
    • 3. Precordial Axis• Sometimes called Z axis• Clockwise or Counterclockwise rotation
    • 4. Precordial Axis Frontal Plane Axis Precordial Axis ERAD Right Axis Pathological Early Transition Late Transition Deviation Left Axis Counterclockwise Clockwise -90 to 180 90 to 180 Deviation Rotation Rotation -30 to -90• Ventricular • May be normal • Pregnancy • Posterior wall • SometimesRhythm • LPFB • LAFB infarction Normal,• Paced • Pulmonary • WPW • RVH especially inRhythm disease • RBBB women • Pulmonary• Dextrocardia • RVH disease • WPW • Anterior MI• Electrolyte • RBBB • LBBB • LVHderangement • WPW • Hyperkalemia • LAFB • Dextrocardia • Q-waves, MI • LBBB •Venrticular • Lung Disease Rhythm
    • 5. Precordial Axis Precordial Leads = V LeadsSometimes called Chest Leads
    • 6. Precordial Axis 4 1 3 3 • The main impulse travels 2 2 down then to the left.Mean vectorCardiac vector
    • 7. Precordial Axis 4 1 3 3 2 2 V1 V2 V3 V6Mean vector V4 V5Cardiac vector
    • 8. Precordial Axis• The normal transition zone is between V3 and V4.• V1 should be predominately negative.• V6 should be mostly positive.
    • 9. Precordial AxisLets take a look at a 12-lead
    • 10. Precordial AxisIs V1 mostly negative?
    • 11. Precordial AxisIs V6 mostly positive?
    • 12. Precordial AxisWhere is the transition?
    • 13. Precordial AxisThe Precordial Axis is Normal
    • 14. Precordial Axis V1 V2 V3 V4 V5 V6Now picture the precordial leads in this pattern.
    • 15. Precordial Axis V1 V2 V3 V4 V5 V6Normal transition
    • 16. Precordial Axis V1 V2 V3 V4 V5 V6Early transition = Counterclockwise Rotation
    • 17. Precordial Axis V1 V2 V3 V4 V5 V6Late transition = Clockwise Rotation
    • 18. Precordial Axis
    • 19. Precordial AxisEarly Transition - Counterclockwise Rotation
    • 20. Precordial AxisEarly Transition - Counterclockwise Rotation
    • 21. Precordial Axis Another Example
    • 22. Precordial AxisLate Transition - Clockwise Rotation
    • 23. Precordial Axis Frontal Plane Axis Precordial Axis ERAD Right Axis Pathological Early Transition Late Transition Deviation Left Axis Counterclockwise Clockwise -90 to 180 90 to 180 Deviation Rotation Rotation -30 to -90• Ventricular • May be normal • Pregnancy • Posterior wall • SometimesRhythm • LPFB • LAFB infarction Normal,• Paced • Pulmonary • WPW • RVH especially inRhythm disease • RBBB women • Pulmonary• Dextrocardia • RVH disease • WPW • Anterior MI• Electrolyte • RBBB • LBBB • LVHderangement • WPW • Hyperkalemia • LAFB • Dextrocardia • Q-waves, MI • LBBB •Venrticular • Lung Disease Rhythm
    • 24. Precordial AxisAxis Determination Normal R-wave progression Thompson 93ECG - 20ECG – 20This is a rare example of an isolated Lateral Wall Infarct. This injury pattern is nearly always due to an occlusion to the LeftCircumflex (LCx). 5 Easy Steps
    • 25. Precordial AxisAxis Determination Thompson 100 Early R-wave progressionECG – 26ECG – 26This ECG is an example of Right Bundle Branch Block (RBBB). RBBB is presentwhen a wide supraventricular rhythm presents with a positive terminal deflection in V1.Other findings include appropriate T-wave discordance, and a slurred S-wave in Lead I
    • 26. Precordial AxisAxis Determination Late R-wave progression Thompson 90ECG – 17ECG – 17This is an example of an Antero-Septal MI, with some lateral wall extension. This is likely due to a proximal occlusion of the LeftAnterior Descending coronary artery (LAD). The LAD, termed ―Widow Maker‖, supplies predominately the left ventricle.
    • 27. Bundle Branch BlocksLeft Bundle Branch Block V1 1 2 3
    • 28. Bundle Branch BlocksRight Bundle Branch Block V1 1 2 3
    • 29. Bundle Branch Blocks V1 V1
    • 30. Bundle Branch BlocksV1 = RBBBV1 GT = LBBB
    • 31. RBBB Morphologies
    • 32. LBBB Morphologies
    • 33. Bundle Branch Blocks Frontal Plane Axis Precordial Axis ERAD Right Axis Pathological Early Transition Late Transition Deviation Left Axis Counterclockwise Clockwise -90 to 180 90 to 180 Deviation Rotation Rotation -30 to -90• Ventricular • May be normal • Pregnancy • Posterior wall • SometimesRhythm • LPFB • LAFB infarction Normal,• Paced Rhythm • Pulmonary • WPW • RVH especially in• Dextrocardia disease • RBBB women • Pulmonary• Electrolyte • RVH disease • WPW • Anterior MIderangement • RBBB • LBBB • LVH • WPW • Hyperkalemia • LAFB • Dextrocardia • Q-waves, MI • LBBB •Venrticular • Lung Disease Rhythm
    • 34. Bundle Branch Blocks
    • 35. Bundle Branch Blocks
    • 36. The End “Its finally over” …Well almost.More to come in lesson three.

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