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Lead Morphology and Placement

3. Lead Morphology and Placement. Media Directory. Slide 20 12-Lead Electrode Placement Animation Slide 24 Electrode Placement for Cardiac Monitoring Video Slide 25 Electrode Placement for EKG Video Slide 28 Rule of Electrical Flow Animation. Electrocardiography.

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Lead Morphology and Placement

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  1. 3 Lead Morphology and Placement

  2. Media Directory Slide 20 12-Lead Electrode Placement Animation Slide 24 Electrode Placement for Cardiac Monitoring Video Slide 25 Electrode Placement for EKG Video Slide 28 Rule of Electrical Flow Animation

  3. 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

  4. 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 leg. Left leg is positive electrode • Lead III: Left arm to left leg. Left leg is positive electrode

  5. Figure 3-1 The Bipolar Leads

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

  7. Figure 3-2 The Triaxial Diagram

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

  9. Figure 3-3 Einthoven’s Triangle

  10. Einthoven’s Law • Lead I + Lead III = Lead II • Lead II should have the tallest QRS complex of the bipolar leads • Can help determine if leads were inadvertently placed on wrong limb

  11. Figure 3-4 Einthoven’s Law

  12. 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

  13. Figure 3-5 The Augmented Leads

  14. Figure 3-6 Triaxial Diagram with Augmented Leads

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

  16. Figure 3-7 Hexiaxial Diagram

  17. Bipolar and Augmented Leads are also Called • Frontal leads, as they are all located on the front of the body • Standard leads • Limb leads

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

  19. Figure 3-8 The Precordial Leads

  20. 12-Lead Electrode Placement Animation Click on the screenshot to view an animation showing 12-Lead Electrode Placement. Click again to pause the animation. Back to Directory

  21. 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

  22. Figure 3-9 Bedside Monitor

  23. Figure 3-10 Lead Placement for Continuous Monitoring

  24. Electrode Placement forCardiac Monitoring Video Click on the screenshot to view a video showing electrode placement for cardiac monitoring. Click again to pause the video. Back to Directory

  25. Electrode Placement forEKG Video Click on the screenshot to view a video showing electrode placement for EKG. Click again to pause the video. Back to Directory

  26. 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

  27. Figure 3-11 Electrocardiographic Truths

  28. Rule of Electrical Flow Animation Click on the screenshot to view an animation showing the Rule of Electrical Flow. Click again to pause the animation. Back to Directory

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

  30. Figure 3-12 Normal Vector

  31. Normal QRS Deflections • Lead I: QRS should be positive

  32. Figure 3-13 Normal QRS Deflection in Lead I

  33. Normal QRS Deflections • Lead II: QRS should be positive

  34. Figure 3-14 Normal QRS Deflection in Lead II

  35. Normal QRS Deflections • Lead III: QRS should be positive

  36. Figure 3-15 Normal QRS Deflection in Lead III

  37. Normal QRS Deflections • AVR: QRS should be negative • AVR is the only frontal lead with a negative QRS

  38. Figure 3-16 Normal QRS Deflection in aVR

  39. Normal QRS Deflections • AVL: QRS should be positive

  40. Figure 3-17 Normal QRS Deflection in aVL

  41. Normal QRS Deflections • AVF: QRS should be positive

  42. Figure 3-18 Normal QRS Deflection in aVF

  43. Normal QRS Deflections • V1: QRS should be negative

  44. Figure 3-19 Normal QRS Deflection in V1

  45. Normal QRS Deflections • V6: QRS should be positive

  46. Figure 3-20 Normal QRS Deflection in V6

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

  48. Normal QRS Deflections

  49. Normal QRS Deflections

  50. Classroom Response System

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