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33 Cards in this Set

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1st Method Axis

Normal Quadrant
between 0 and 90
Lead I is positive.
Lead AVF is positive.
1st Method Axis

Normal Quadrant
at 0 degrees
Lead I is positive.
Lead AVF is isoelectric.
1st Method Axis

Normal Quadrant
at 90 degrees
Lead I is isoelectric.
Lead AVF is positive.
1st Method Axis

Left Quadrant
Lead I is positive.
Lead AVF is negative.
1st Method Axis

Right Quadrant
Lead I is negative.
Lead AVF is positive.
1st Method Axis

Extreme Right Quadrant
Lead I is negative.
Lead AVF is negative.
2nd Method Axis
Pick the least, most isoelectric lead and then look at the perpendicular lead to determine the degrees.
3rd Method Axis
Count the net deflection for Leads I, II & III. Plot and determine to the nearest 15 degrees.
Left Atrial Hypertrophy
Lead V1

2nd part of the p wave is at least one box wide and one box deep.
Right Atrial Hypertrophy
Lead II

Tall peaked p wave greater than or equal to 2.5 mm.
Left Ventricular Hypertrophy
One of the below:

R in AVL ≥ 11 mm.
R in V5 or V6 ≥ 27 mm.
S in V1 plus R in V5 ≥ 35 mm.
Right Ventricular Hypertrophy
Right axis deviation by 2nd and 3rd methods.
R ≥ S in V1 or
R in V1 plus S in V6 ≥ 11 mm
Do not diagnose with RBBB!
Left Bundle Branch Block
Lead V1 has a predominately wide and negative QRS.
Box-like (repolarization changes) QRS in the lateral leads: I, AVL, V6 & V5.
Don't diagnose Hemiblocks, LVH, or MI.
Right Bundle Branch Block
Lead V1 has a predominately positive QRS. Rabbit ear repolarization changes in V1, V2, and/or V3. Wide S wave in Lead I.
Do not diagnose RVH!
Left posterior hemiblock
Axis by the 3rd method greater than or equal to 120.

RVH must be absent.
Left anterior hemiblock
Axis by the 3rd method ≥ -40.

No evidence of Inferior MI.
Acute MI

What to look for.
ST segment elevation over MI
ST segment depression over opposite leads
Old Myocardial Infarction

What to look for.
Significant Q waves over the MI

Significant if 1 box wide or 1/3 the height of the R wave.
Where to look for an

Anterior Infarction
V1, V2, V3, V4

Must be in at least 2 leads.
Where to look for a

Lateral Infarction
Leads I, AVL, V5 & V6

Must be in at least 2 leads.
Where to look for an

Inferior Infarction
Leads II, III & AVF

Must be in at least 2 leads.
Step 1

Differential Diagnosis
PR interval

QRS width in Lead V1 to determine the BBBs.
RBBB=positive, LBBB=negative
Step 2

Differential Diagnosis
Rate
Rhythm
Axis 1, 2, 3
Step 3

Differential Diagnosis
Atrial Hypertrophy
Step 4

Differential Diagnosis
Ventricular Hypertrophy
with LBBB no LVH
with RBBB no RVH
without right axis no RVH
Step 5

Differential Diagnosis
Hemiblocks
determine by axis
Make sure nothing else causes the axis deviation.
LAH, LPH
Step 6

Differential Diagnosis
Myocardial Infartions

Q waves or ST segments over the MI.
Axis Method 3

step 1
Calculate the net QRS deflection in leads 1, II, & III.

II = I + III, within 2.
Axis Method 3

step 2
Plot the net deflections on the Axis wheel.
Axis Method 3

Situation 1
If the net deflection is the same for 2 leads and 0 for the third then the axis is exactly between the 2 leads.
Axis Method 3

Situation 2
If the net deflection is equal in 2 leads but quite a bit greater in the 3rd then the axis is oriented directly at the 3rd lead.
Axis Method 3

Situation 3a
If the net deflection is different in all 3 leads:
look at the relationship of the leads,
the axis is closest to the lead with the greatest net deflection but between th 2 largest leads,...
Axis method 3

Situation 3b
if the absolute difference between the 2 largest leads is ≥ 2 then the axis is 15 from the largest lead towards the next largest lead,
if the absolute difference is less than 2, then the axis is oriented at the largest lead.