5 precordial axis

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  • 1. 12-Lead Electrocardiographya 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 AxisPrecordial Axis ERAD Right AxisPathologicalEarly Transition Late TransitionDeviationLeft AxisCounterclockwiseClockwise-90 to 18090 to 180Deviation RotationRotation -30 to -90 Ventricular May be normal Pregnancy Posterior wall SometimesRhythm LPFB LAFB infarction Normal, Paced Pulmonary WPW RVHespecially 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 Axis4 133 The main impulse travels 22down then to the left.Mean vectorCardiac vector 7. Precordial Axis4 133 22 V1 V2V3 V6Mean vector V4 V5Cardiac vector 8. Precordial Axis The normal transition zone is betweenV3 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 V2V3 V4V5V6Now picture the precordial leads in this pattern. 15. Precordial Axis V1 V2V3 V4V5V6Normal transition 16. Precordial AxisV1 V2V3V4V5 V6Early transition = Counterclockwise Rotation 17. Precordial Axis V1 V2 V3V4V5 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 AxisPrecordial Axis ERAD Right AxisPathologicalEarly Transition Late TransitionDeviationLeft AxisCounterclockwiseClockwise-90 to 18090 to 180Deviation RotationRotation -30 to -90 Ventricular May be normal Pregnancy Posterior wall SometimesRhythm LPFB LAFB infarction Normal, Paced Pulmonary WPW RVHespecially 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 DeterminationNormal R-wave progressionThompson 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 DeterminationThompson 100Early 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 DeterminationLate 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 BlockV1 1 2 3 28. Bundle Branch BlocksRight Bundle Branch BlockV1123 29. Bundle Branch Blocks V1 V1 30. Bundle Branch BlocksV1 = RBBBV1GT = LBBB 31. RBBB Morphologies 32. LBBB Morphologies 33. Bundle Branch Blocks Frontal Plane AxisPrecordial Axis ERAD Right AxisPathologicalEarly Transition Late TransitionDeviationLeft AxisCounterclockwiseClockwise-90 to 18090 to 180Deviation RotationRotation -30 to -90 Ventricular May be normal Pregnancy Posterior wall SometimesRhythm LPFB LAFB infarction Normal, Paced Rhythm Pulmonary WPW RVHespecially 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.