03

Cardiac axis and

ECG relationship
 Cardiac axis

● Electrical axis that reflects the average direction of ventricular

depolarization during ventricular contraction.
● The direction of the depolarization is generally alongside the heart’s
longitudinal axis.
➜ Diagnose the state of the patient.

● The electrical activity of the heart

SA node → AV node → Bundles of His
→ Purkinje Fibres

⇒ Cardiac axis helps to find

direction of electrical activity
 Create
cardiac axis

● 3 limb leads give a view from the

right aVR the left aVL and the foot
aVF.
● 3 virtual leads can be created by
combining information from 3
limb leads.
➜ The heart is looked at the following
angles or vectors.
 Electrical axis and ECG

Depolarization toward a lead Depolarization away from a lead Depolarization 90° to a lead
⇒ Positive deflection ⇒ Negative deflection ⇒ Isoelectric deflection
 Determine the axis
Indeterminate
Left axis
(Northwest) axis: -
90 and 180 degrees. deviation: 0 to -90
degrees

Right axis Normal cardiac

deviation: +90 to access: 0 to 90
+180 degrees. degrees
 Normal cardiac axis

● The QRS axis lie between -30° and +90º.

● The overall direction of electrical activity is
towards leads I, II and III.
● Positive deflection in all of these leads, with lead
II showing the most positive deflection
● Most negative deflection in aVR.
 Left axis deviation
● The QRS axis lie between -90° and -30º.
● Positive deflection in lead I, negative in lead aVF
and lead II
● If lead II is positive, it means the QRS axis is
normal, not left axis deviation
● Cause:
○ Left anterior fascicular block, left
ventricular hypertrophy, left bundle
branch block
○ Mechanical shift of heart in the chest
○ Inferior myocardial infarction
○ Wolff-Parkinson-White syndrome with
“pseudoinfarct” pattern
 Right axis deviation
● The QRS axis lie between +90° and +180º.
● Isoelectric deflection in lead I, positive in lead II
and III
● Cause:
○ Right bundle branch block
○ Right ventricular hypertrophy
○ Left posterior fascicular block
○ Dextrocardia
○ Ventricular rhythms
○ Lateral wall myocardial infarction
○ Wolff-Parkinson-White syndrome
○ Acute right heart strain/pressure
overload
 Extreme axis deviation
● The QRS axis lie between -180º to -90
● If the QRS is negative in lead I and lead aVF, then the axis is indeterminate and sometimes
referred to as “northwestern axis.
● Cause:
○ Ventricular rhythms
○ Paced rhythms
○ Lead misplacement
○ Hyperkalaemia
○ Severe right ventricular hypertrophy
 01 02 03 04
Generate
rule and Determine the Determine the
Look at the above
table
Conclusion: the
patient is normal
example state of Lead 1 state of Lead aVF
(range 0 to 90)