6 axis practice
Post on 24-May-2015
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12-Lead Electrocardiography
a comprehensive course
Adam Thompson, EMT-P, A.S.
Axis
Practice
Practice
Practice
Identify the rate & regularity
Practice
Identify the rate & regularity
Practice
Identify the rate & regularity
Practice
Identify the rate & regularity
1 2 3
Practice
Identify the rate & regularity
1 2 3
300 ÷ 3 = 100
Practice
Identify the rhythm
HR ≈ 100
Practice
Identify the rhythm
HR ≈ 100
Practice
Identify the rhythm
HR ≈ 100
Practice
Normal Sinus Rhythm
HR ≈ 100
Normal Sinus
Practice
Frontal Axis?
HR ≈ 100
Normal Sinus
Practice
Frontal Axis?
HR ≈ 100
Normal Sinus
Practice
Frontal Axis?
HR ≈ 100
Normal Sinus
Practice
• Equiphasic lead is aVF.
• Find lead perpendicular to aVF
Practice
• Equiphasic lead is aVF.
• Find lead perpendicular to aVF
Practice
Frontal Axis?
HR ≈ 100
Normal Sinus
Practice
• Lead I is positive• Frontal axis is
about 0
Practice
• Lead I is positive• Frontal axis is
about 0• That is in normal
quadrant.
Practice
Frontal Axis = Normal, about 0
HR ≈ 100
Normal Sinus
Frontal axis is normal
Practice
Precordial Axis
HR ≈ 100
Normal Sinus
Frontal axis is normal
Practice
Early Transition, Counterclockwise Rotation
HR ≈ 100
Normal Sinus
Frontal axis is normal
Practice
Lets try another
Practice
Practice
Determine Rate & Rhythm
Practice
Determine Rate & Rhythm
HR ≈ 75
Normal Sinus
Practice
Determine Frontal Axis
HR ≈ 75
Normal Sinus
Quadrant Method
ERAD LAD
RAD Normal
180 0
-90
90
Practice
Determine Frontal Axis
HR ≈ 75
Normal Sinus
Quadrant Method
Lead I aVF
Normal Positive (+) Positive (+)
RAD Negative (-) Positive (+)
LAD Positive (+) Negative (-)
ERAD Negative (-) Negative (-)
Cheat SheetNormal
Axis0 to 90
PhysiologicLeft
0 to -30
PathologicLeft
-30 to -90
Right Axis
90 to 180
Extreme Right Axis
-90 to 180
Indeterminate
Axis?
Lead I
Lead II
Lead III
Practice
Determine Frontal Axis
HR ≈ 75
Normal Sinus
Practice
Determine Precordial Axis
HR ≈ 75
Normal Sinus
Pathological Left Axis
Precordial Axis
V1
V2
V3
V4
V5V6
Early transition = Counterclockwise Rotation
Practice
Determine Precordial Axis
HR ≈ 75
Normal Sinus
Pathological Left Axis
Counterclockwise Z
PathologiesFrontal Plane Axis Precordial Axis
ERAD-90 to 180
Right Axis Deviation90 to 180
Pathological Left Axis Deviation-30 to -90
Early TransitionCounterclockwise
Rotation
Late TransitionClockwise Rotation
• Ventricular Rhythm• Paced Rhythm• Dextrocardia• Electrolyte derangement
• May be normal• LPFB• Pulmonary disease• RVH• RBBB• WPW• Dextrocardia•Venrticular Rhythm
• Pregnancy• LAFB• WPW• Pulmonary disease• LBBB• Hyperkalemia• Q-waves, MI
• Posterior wall infarction• RVH• RBBB
• Sometimes Normal, especially in women• Anterior MI• LVH• LAFB• LBBB• Lung Disease
END
1. Rate & Rhythm2. Axis Determination3. Intervals4. Morphology5. STE-Mimics6. Ischemia, Injury, & Infarct
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