Electrocardiogram Leads

Goedemorgen:

Introduction
An electrocardiographic lead is pair of electrical conductors For detecting cardiac potential differences.

Bipolar leads will make potential differences at different sites.

It is a routine diagnostic procedure. It is standardised and has universal conventions

What are leads?

Leads I, II, and III are bipolar leads Leads aVR, aVL, and aVF are unipolar leads Leads V1V6 are unipolar leads Clinical Tip: Patients should be treated according to their symptoms, not merely their ECG.

Basic Electrocardiographic Conventions

Placed on both arms and the left leg Called Einthoven's triangle Example: lead II electrocardiogram measured between right arm & left leg . upward deflection in a lead II electrocardiogram = an electrical polarity exists between left leg and right shoulder electrodes >>> left leg electrode being positive.

Downward deflection in a lead II record > the left leg electrode being negative.

How to measure the dipoles?

The net dipole is determined by:

(1) how extensive the wavefront is? (2) the consistency of orientation between individual dipoles at different points in the wavefront

How to measure the dipoles?

Note: dipole is most parallel to lead II. Thus, it has a large component in the lead II direction. >> create a larger voltage on lead II than on leads I or III. Small component on lead III >>oriented nearly perpendicular to lead III.

The net dipole makes: lower portion (+) in contrast to upper portion of body. Postive voltages exists on three sides. from Einthoven's triangle by observing that the net dipole has the arrows point positive direction of leads I, II, and III.

The Standard 12-Lead Electrocardiogram

Recorded from 12 different leads. leads I, II, and III > bipolar leads nine leads > unipolar leads. Three leads are generated by using the limb electrodes. Two electrodes > indifferent electrode. Third limb electrode is made the positive pole of the pair. [augmented unipolar limb leads] The voltage record between the electrode at the right arm and the indifferent electrode = aVR recorded on left arm and lead = aVL recorded from the electrode on left leg = aVF

Chest leads
six specified positions on the chest wall.

precordial or chest leads and are designated as V1 through V6.

when positive electrode is in position 1 and wave of ventricular excitation sweeps away from it > deflection downward. When electrode is in position 6 and the wave of ventricular excitation sweeps toward it, > deflection upward.

Recap

It is a record of the voltage changes that occur on the surface of the body as a result of the propagation of the action potential through the heart during a cardiac cycle.

There are standardized conventions used for recording electrocardio grams.

The magnitude and direction of the net dipole formed by the wavefront of the action potential at any instant in time can be deduced from the magnitude and orientation of the electrocardiogr aphic deflections.

The mean electrical axis describes the orientation of the net dipole at the instant of maximum wavefront propagation during ventricular depolarization and normally falls between 0 degrees and +90 degrees on a polar coordinate system.

The standard 12-lead is widely used to evaluate cardiac electrical activity and consists of a combination of bipolar and unipolar records from limb & chest

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