Module 3

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Chapter 3: 

Chapter 3 Lead Morphology and Placement

Electrocardiography: 

Electrocardiography The recording of the heart’s electrical impulses by way of electrodes on the skin. Willem Einthoven: “Father of electrocardiography” and the inventor of the EKG machine.

Bipolar Leads: 

Bipolar Leads Three leads, all with positive and negative poles. Lead I: Right arm to left arm. Left arm is positive electrode. Lead II: Right arm to left foot. Left foot is positive electrode. Lead III: Left arm to left foot. Left foot is positive electrode.

Bipolar Leads (cont’d): 

Bipolar Leads (cont’d) Figure 3-1: The Bipolar Leads

Triaxial Diagram: 

Triaxial Diagram Formed by joining the lines representing Leads I, II, and III at the middle.

Triaxial Diagram (cont’d): 

Triaxial Diagram (cont’d) Figure 3-2: The Triaxial Diagram

Einthoven’s Triangle: 

Einthoven’s Triangle Formed by joining the lines representing leads I, II, and III at their ends.

Einthoven’s Triangle (cont’d): 

Einthoven’s Triangle (cont’d) Figure 3-3: Einthoven’s Triangle

Einthoven’s Law: 

Einthoven’s Law Lead I + Lead III = Lead II. Lead II should have the tallest QRS complex of the bipolar leads.

Einthoven’s Law (cont’d): 

Einthoven’s Law (cont’d) Figure 3-4: Einthoven’s Law

Augmented Leads: 

Augmented Leads Three leads, all with only a positive pole (unipolar leads). AVR: On right arm. AVL: On left arm. AVF: On left foot. EKG machine augments the waveforms’ size.

Augmented Leads (cont’d): 

Augmented Leads (cont’d) Figure 3-5: The Augmented Leads

Triaxial Diagram with Augmented Leads: 

Triaxial Diagram with Augmented Leads Figure 3-6: Triaxial Diagram with Augmented Leads

Hexiaxial Diagram: 

Hexiaxial Diagram Formed by joining the lines representing leads I, II, III, AVR, AVL, and AVF at the middle.

Hexiaxial Diagram (cont’d): 

Hexiaxial Diagram (cont’d) Figure 3-7: The Hexiaxial Diagram

Bipolar and Augmented Leads Are Also Called:: 

Bipolar and Augmented Leads Are Also Called: Frontal leads, as they are all located on the front of the body. Standard leads. Limb leads.

Precordial (Chest) Leads: 

Precordial (Chest) Leads Six unipolar leads that see the heart from the horizontal plane. All are positive electrodes. V1 V2 V3 V4 V5 V6

Precordial Leads (cont’d): 

Precordial Leads (cont’d) Figure 3-8: The Precordial Leads

Continuous Monitoring: 

Continuous Monitoring Allows monitoring of rhythm for a prolonged time. Requires altered electrode placement to minimize artifact. Bedside monitoring: Patient attached to an EKG machine by a cable. Telemetry: Remote cardiac monitoring of ambulatory patients.

Bedside Monitor: 

Bedside Monitor Figure 3-9: Bedside Monitor

Lead Placement for Continuous Monitoring: 

Lead Placement for Continuous Monitoring Figure 3-10: Lead Placement for Continuous Monitoring

12-Lead Electrode Placement Animation: 

12-Lead Electrode Placement Animation Click here to view an animation showing 12-Lead Electrode Placement. Back to Directory

Rule of Electrical Flow Animation: 

Rule of Electrical Flow Animation Click here to view an animation showing the Rule of Electrical Flow. Back to Directory

Electrocardiographic Truths: 

Electrocardiographic Truths Positive QRS written by impulse travelling toward positive electrode. Negative QRS from impulse travelling away from positive electrode. Isoelectric QRS from impulse travelling perpendicular to positive electrode. Flat line written when there is no impulse at all.

Electrocardiographic Truths(cont’d): 

Electrocardiographic Truths(cont’d) Figure 3-11: Electrocardiographic Truths

Normal Vector: 

Normal Vector Vector: Arrow depicting the direction of current flow. Normal vector of heart’s current is top to bottom, right to left.

Normal Vector (cont’d): 

Normal Vector (cont’d) Figure 3-12: Normal Vector

Normal QRS Deflections: 

Normal QRS Deflections Lead I: QRS should be positive.

Normal QRS Deflection in Lead I: 

Normal QRS Deflection in Lead I Figure 3-13: Normal QRS Deflection in Lead I

Normal QRS Deflections (cont’d): 

Normal QRS Deflections (cont’d) Lead II: QRS should be positive.

Normal QRS Deflection in Lead II: 

Normal QRS Deflection in Lead II Figure 3-14: Normal QRS Deflection in Lead II

Normal QRS Deflections (cont’d): 

Normal QRS Deflections (cont’d) Lead III: QRS should be positive.

Normal QRS Deflection in Lead III: 

Normal QRS Deflection in Lead III Figure 3-15: Normal QRS Deflection in Lead III

Normal QRS Deflections (cont’d): 

Normal QRS Deflections (cont’d) AVR: QRS should be negative. AVR is the only frontal lead with a negative QRS.

Normal QRS Deflection in AVR: 

Normal QRS Deflection in AVR Figure 3-16: Normal QRS Deflection in aVR

Normal QRS Deflections (cont’d): 

Normal QRS Deflections (cont’d) AVL: QRS should be positive.

Normal QRS Deflection in AVL: 

Normal QRS Deflection in AVL Figure 3-17: Normal QRS Deflection in aVL

Normal QRS Deflections (cont’d): 

Normal QRS Deflections (cont’d) AVF: QRS should be positive.

Normal QRS Deflection in AVF: 

Normal QRS Deflection in AVF Figure 3-18: Normal QRS Deflection in aVF

Normal QRS Deflections (cont’d): 

Normal QRS Deflections (cont’d) V1: QRS should be negative.

Normal QRS Deflection in V1: 

Normal QRS Deflection in V1 Figure 3-19: Normal QRS Deflection in V1

Normal QRS Deflections (cont’d): 

Normal QRS Deflections (cont’d) V6: QRS should be positive.

Normal QRS Deflection in V6: 

Normal QRS Deflection in V6 Figure 3-20: Normal QRS Deflection in V6

Normal QRS Deflections (cont’d): 

Normal QRS Deflections (cont’d) The precordial leads will show a transition from negative (V1 to V2) to isoelectric (V3 to V4) to positive (V5 to V6).

Normal QRS Deflections (cont’d): 

Normal QRS Deflections (cont’d)

Normal QRS Deflections (cont’d): 

Normal QRS Deflections (cont’d)

Electrode Placement for EKG Video: 

Electrode Placement for EKG Video Click here to view a video showing electrode placement for EKG. Back to Directory

Electrode Placement for Cardiac Monitoring Video: 

Electrode Placement for Cardiac Monitoring Video Click here to view a video showing electrode placement for cardiac monitoring. Back to Directory

The Electrocardiogram Video: 

The Electrocardiogram Video Click here to view a video showing the electrocardiogram. Back to Directory