6 axis practice

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6 axis practice

  1. 1. 12-Lead Electrocardiography a comprehensive course Adam Thompson, EMT-P, A.S.
  2. 2. Practice
  3. 3. PracticeIdentify the rate & regularity
  4. 4. PracticeIdentify the rate & regularity
  5. 5. PracticeIdentify the rate & regularity
  6. 6. PracticeIdentify the rate & regularity 1 2 3
  7. 7. PracticeIdentify the rate & regularity 1 2 3 300 ÷ 3 = 100
  8. 8. HR ≈ 100 PracticeIdentify the rhythm
  9. 9. HR ≈ 100 PracticeIdentify the rhythm
  10. 10. HR ≈ 100 PracticeIdentify the rhythm
  11. 11. HR ≈ 100 Normal Sinus PracticeNormal Sinus Rhythm
  12. 12. HR ≈ 100 Normal SinusPracticeFrontal Axis?
  13. 13. HR ≈ 100 Normal SinusPracticeFrontal Axis?
  14. 14. HR ≈ 100 Normal SinusPracticeFrontal Axis?
  15. 15. Practice • Equiphasic lead is aVF. • Find lead perpendicular to aVF
  16. 16. Practice • Equiphasic lead is aVF. • Find lead perpendicular to aVF
  17. 17. HR ≈ 100 Normal SinusPracticeFrontal Axis?
  18. 18. Practice • Lead I is positive • Frontal axis is about 0
  19. 19. Practice • Lead I is positive • Frontal axis is about 0 • That is in normal quadrant.
  20. 20. HR ≈ 100 Normal Sinus Frontal axis is normal PracticeFrontal Axis = Normal, about 0
  21. 21. HR ≈ 100 Normal Sinus Frontal axis is normal PracticePrecordial Axis
  22. 22. HR ≈ 100 Normal Sinus Frontal axis is normal PracticeEarly Transition, Counterclockwise Rotation
  23. 23. PracticeLets try another
  24. 24. Practice
  25. 25. PracticeDetermine Rate & Rhythm
  26. 26. HR ≈ 75 Normal Sinus PracticeDetermine Rate & Rhythm
  27. 27. HR ≈ 75 Normal Sinus PracticeDetermine Frontal Axis
  28. 28. Quadrant Method -90 ERAD LAD180 0 RAD Normal 90
  29. 29. HR ≈ 75 Normal Sinus PracticeDetermine Frontal Axis
  30. 30. Quadrant Method Lead I aVFNormal Positive (+) Positive (+) RAD Negative (-) Positive (+) LAD Positive (+) Negative (-)ERAD Negative (-) Negative (-)
  31. 31. Cheat Sheet Normal Physiologic Pathologic Right Axis Extreme Indeterminate Axis Left Left Right Axis Axis 0 to 90 0 to -30 -30 to -90 90 to 180 -90 to 180 ?Lead ILead IILead III
  32. 32. HR ≈ 75 Normal Sinus PracticeDetermine Frontal Axis
  33. 33. HR ≈ 75 Normal Sinus Pathological Left Axis PracticeDetermine Precordial Axis
  34. 34. Precordial Axis V1 V2 V3 V4 V5 V6Early transition = Counterclockwise Rotation
  35. 35. HR ≈ 75 Normal Sinus Pathological Left Axis Practice Counterclockwise ZDetermine Precordial Axis
  36. 36. Pathologies 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 • Anterior MIderangement • RBBB • LBBB • LVH • WPW • Hyperkalemia • LAFB • Dextrocardia • Q-waves, MI • LBBB •Venrticular • Lung Disease Rhythm
  37. 37. END1. Rate & Rhythm2. Axis Determination3. Intervals4. Morphology5. STE-Mimics6. Ischemia, Injury, & Infarct

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