Mastering ECG leads

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> handwriting by Gaylan

What is the special thing about the

chest leads (precordial leads) ?
chest leads basically determine the electrical activity
of the heart transmitted along the horizontal plane

inste I
·
-
-

· Est
5
wilson central terminal
indifferent
in electrocel

↓
were
L
8

&&

exploring electrode (positive electrodel

e ↳ whatever electrical
transmitted

exploring
that
indifferent
along the
activity

electrode will be able to delect

electrical
activity in relation
will
horizontal plane this

to
be

the

electrode (near Zero electrodel

So chest leads are also unipolar
leads
when we are
recording different chest leads : -

in the central
we don't produce any alteration
Wilson terminal but we are
placing the exploring
electrode at different positions .

what is the potential determined by a chest lead ?

e
-

W chest-
lead
Eng I wilson commen terminal (RA+LA+((/3)
all the
determine the
chest leads

potential
difference between the

during the the potential

cardiac cycle of exploring electrode and

the Virtual electrode doesn't fluctuate the virtual electrode

significantly but exploring electrode do record and as

electrode
we

is
know

almostly
Virtual
zerol
the electrical activity of the heart produced So for practical
purpose
during the different phases in a different way was say mainly the

potential is determined

by exploring electrode

How do you place chest leads ?

-
Remember
for all those six leads

iii!
of the chest wilson

terminal center remain

~ the Same for all of
them , only you change
the position of the
electrode
exploring
&
VI Va
- -

I
.
⑮-xxx
⑧ e -
How you will find
=-
- -

the and intercostal

-
space ?
just outer and inferior
to
sternal angle
UI - 4th intercostal space just right of the Sternum

U2 -> 4th intercostal space just left of the Sternum

V3 - between Ve and Un

Un -> 5th intercostal space in the middavicular line

V5 - 5th intercostal space in the anterior

axillary line

V6 & 5th intercostal space in the

midaxillary line

Note : there are some additional chest leads also

that they can be applied more to the right side or

posteriorly .

please ⑧
Duse the
bony landmarks to determine the Specific
Site where you will put it , don't use the nipples
baz
they are varies from person to person even
in males .

② these are chest leads not breast leads don't put

electrode over the breast
you ,
are supposed to
put the electrode undereath the breast
why ?
,

because ① if you put it on the breast

voltages which are

up may be reduced
picked
② may be you are recording from a higher
intercostal space
③ motion artifacts
Oriention and classification of chest leads :-

-
-

⑩
I -xienedtotheI function
is

· mini n"i"ni⑯
min Left leads

↑
. . . . . . . .

I i (lateral)
I
I
-

!
of depolarization
major ventricular

"I "IIII
Vector

!Ove "
leftward and backward (downward isn't recorded

"I
i
I
by chest leads)

"O :~
-
.

VI

"""Ve
I inIl
li vo Il Il
Ill
-
anomically oriented tothe
-:
I

"
,

Rig ht ,Side
---

the
ioriented to

- Septum"
functionally functionally they :
A

& - are
-
Septal leads functionally they are

Anterior leads

* UI and U2 even though they are placed on the

I
right side of the heart but sensitive
they are more

to the Septal electrical activity

* Us and V6 are anatomically oriented from the

I
.
⑰
&
#

functionally

1
left side and also they are most
sensitive to the left side electical activity (major
ventricular depolarization) ·

* Us and Un are
andronically oriented over the
Septum but functionally they are most sensitive to
anterior electrical
activity (anterior ut or Ischemic changes (

why we need to make this functional classification ?

bcz when we are
determining different types of myocardial
Infarction Signs in the chest leads &

S
 ⑧ if MI is only in the Septal area - Septal
electrical activity is disturbed -
it will be best
determined by Us and Ve So for it analysis or

functional purposes we will call VI and U2 Septal

leads even though oriented over the right
they are

side of the heart

⑧ if there is nt purely on the left side - then

the change is mainly showing in the U5 and V6

⑧ if anterior MI - that will be

there is
showing change of infarction in the U3 and V
⑧ But Sometimes the infarction is more extensive
and it occurred in septum as well as in the
then change
Infarction wiseen
anterior area -> ,
in VI Ve
, , Us , V4 and the
be called anteroseptal it

⑧ that
⑧
is why E
VI-Un are called eseptal -

leads
-

⑧ and if infarction is in anterior part and

extend laterally too -> then this infarction will
be showing changes in V3 , V , Us
VO ,
and

the infarction will be called anterolateral Mit

Canteroapical ut)

· that is why Us -
V6 are called anterolateral
-

leads
-

⑧ and if changes are in Ve , Vs , Un , Vs

this not Very lateral and very septal So this is
the
large (main) anterior MI
How the chest leads are angulated in
referece to each other ?
&
-

30

...
-

↓ 30
⑧
⑳ V 0

i
/1,
I

Un + 30

*
⑳
↳

12