Tag Archives: hexaxial reference system

QRS AXIS DETERMINATION

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During ECG interpretation, cardiac Axis, or direction of electrical impulses, may be normal (physiologic) or abnormal (pathologic), suggesting abnormal cardiac conductivity. Although every deflection obtained on the ECG will have an axis, we will focus on the ventricular axis. When we think of our cardiac monitoring lead placement, we have to understand cardiac Vectors, which is the […]

Axis Determination – Part VI

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By now you can predict the QRS axis in the frontal plane within 15 degrees as long as you have an equiphasic (or isoelectric) lead in the frontal plane. So what constitutes a normal QRS axis? What is a left axis deviation? A right axis deviation? If you don’t have a copy of the hexaxial […]

Axis Determination – Part V

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In Part IV, I promised that I’d show you a fascinating relationship between the standard 12 lead ECG and the hexaxial reference system. You will recall that to use the hexaxial reference system, you find the most equiphasic (or isoelectric) lead in the frontal plane (first 6 leads of the 12 lead ECG) and look […]

Axis Determination – Part IV

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By now you should have a fairly good grasp of how the hexaxial reference system is derived from the first 6 leads of the 12 lead ECG. Before we break down the finished diagram, let’s look at the hexaxial reference system laying on top of the patient’s anterior chest, with the arrows and leads in […]

Axis Determination – Part III

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In Part II, we discussed the heart’s mean electrical vector and how Einthoven’s Triangle (leads I, II, and III) can be redrawn to form the first 3 spokes of the hexaxial reference system. Essentially, we ended up with a shape like the one on the right. When leads I, II, and III are drawn this […]

Axis Determination – Part II

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In Part I, we looked at Einthoven’s Equilateral Triangle and Einthoven’s Law, and I told you that it was the key to understanding the formation of the hexaxial reference system. But before we delve further into the hexaxial reference system (the instrument we’ll be using to calculate the heart’s QRS axis) we need to address […]

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Comments
michelle
68 Year Old Male: Chest Tightness – Part 1
i see some depression and slight elevation in the st segment in the avr. i would alert the stemi crew to stand by.
2015-07-27 17:15:03
sean morrison
68 Year Old Male: Chest Tightness – Part 1
It's the big one Weezy! LAD
2015-07-27 12:48:03
Ryan Lord
68 Year Old Male: Chest Tightness – Part 1
Had the exact same last night but a known AF patient pain commenced after 2 hours of palpitations and described as like a previous MI. Her rate was up at around the 160 mark... Had the widespread depression but elevated aVR and V1. Discussed with Cath Lab and preceded to A&E next door for review,…
2015-07-27 12:14:23
Brendan
63 Year Old Female, CC: Neck and Arm Pain
Everyone providing oxygen should try and read the results of the AVOID trial...
2015-07-27 03:15:56
Brooks Walsh MD
Computer misses it, but the medic catches it.
Well this blog is a great place to start! We cover most every aspect of emergency electrocardiography, with a variety of authors, and multiple perspectives, usually in a clinical context. If it is a book you are looking for, I prefer Ken Grauer's. I started with Dr Grauer as a paramedic student and I still…
2015-07-27 01:45:18

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