Global Cardio Diabetes Conclave, 7th Edition 2023

23-24th September 2023,Chennai

Unlocking The Cardiac Vector Theory and

Einthoven Equilateral Triangle Model:
A Paradigm Shift OR A Major Transition In
ECG Interpretation?

Dr.T.RAJINI SAMUEL M.D

Associate Professor of Biochemistry
Shri Sathya Sai Medical College and Research Institute
Sri Balaji Vidyapeeth, Chennai
 INTRODUCTION
• Electrocardiogram (ECG) has offered immense
clinical value for more than a century yet its
interpretation remains an arduous task and
• ECG phobia develops in some of the junior
doctors and staff nurses often seeking the help of
medical experts in that field.
• Einthoven used vector concepts for electrical
activity of the heart even before a century.
• But never published a detailed description.
• Many researchers attempted to solve this
problem but resulted in vain.
 OBJECTIVES
1. To formulate and apply the cardiac
vector Theory in ECG interpretation

2. To explain the Einthoven Equilateral

Triangle Model for the application of Novel
ECG Interpretation
 Vector Concepts
Vector = Vector's magnitude x Unit Vector
(O L→) = (OL)(OL^) ;
•Vector has both magnitude and direction but
Scalar has only magnitude and no direction.
• A unit vector is a vector quantity whose
magnitude is one and has direction only.
•Unit vector has no unit and it is dimensionless.
• Lead vector (O L→) that denotes the orientation
of the electrode also has magnitude(strength).
 Lead Vector Concept
• The strength of Bipolar Limb leads and the unipolar
limb leads can be compared using correction factor.
• Similarly, the unipolar limb leads and unipolar
precordial lead strength can be compared using the
augmentation factor of 3/2.
(O L→) = (OL)(OL^) ;
(OL^): Unit vector (no unit and denotes direction only)
• If the magnitude (OL) of this vector is taken as one,
• then (O L→) = 1x(OL^)
• So Lead vector (O L→) is a unit vector multiplied by
magnitude of one and so it is measured in meter.
 Projection Of
Heart Vector On Lead Vector
 Cardiac Vector Theory
• If two vectors are multiplied and the product is a scalar
quantity, then it is called scalar or dot product.
(OH →). (O L→) = (OH) (OL) COSα
OH: magnitude of the Heart Vector
OL: magnitude of the lead vector
(OH →). (OL^) = (OH) COSα or (h→). (l^)= (OH) COSα
Cardiac Vector Hypothesis states that voltage recorded in
a particular lead is the result of dot product between
• Cardiac Vector (electrical field vector in volt/metre) &
• Lead Vector (measured in metre).
Hence voltage (measured in volt) is a scalar quantity.
 Heart Lead Vector Relationship
Heart lead vector relationship causes voltage deflections
in Y: axis. The voltage recorded in a particular lead
depends on
• Both the magnitude and direction of cardiac vector
• Only on the direction of the lead vector.
The velocity of the Cardiac Vector is related with time in
the X:axis of ECG. The ECG intervals will be
• Prolonged if the cardiac vector velocity is lower or the
distance travelled by the vector is increased.
• Shortened if the cardiac vector velocity is increased or
the distance travelled by the Vector is shortened.
 (h→). (l^)= (OH) COSα
Angle cos0⁰ Cos30⁰ cos45⁰ cos60⁰ cos90⁰ 90° < θ < 180°

Value 1 0.866 or 0.707 or 0.5 or 0 Negative

√3/2 1/√2 1/2

The voltage recorded in a particular lead will be

•Positive if both the vectors are in the same direction
•Negative if both the vectors are in opposite direction.
•Maximum if cardiac vector is parallel (0°) to a lead
•Equiphasic (null deflection) if it is perpendicular (90°)
•Increasing as the angle α between the vector decreases
•Decreasing as angle α between the vector increases
 Einthoven’s Equilateral Triangle

• The heart is situated at the centre of the electric

field which it generates and the right arm, left arm
and left leg are the extensions of its electrical field.
• In the hex axial reference system, plot the net
voltages of bipolar limb leads and connect them.
• Similarly, plot the net voltages of unipolar limb
leads and connect them. Each forms equilateral
triangle. The equilateral triangle can be converted
into a circle.
• The diameter of the circle denotes the cardiac
vector (resultant vector).
 Correction Factor 1.154

• Perimeter (circumference) of the circle denotes the

electrical field of the heart with heart at the center of
the circle.
• Each circle have same origin, same orientation, but
different radii because bipolar and unipolar limb leads
have different resistance (their ratio is 4/3).
• The ratio of area of the two circles is 4/3. The square
root of 4/3 is 1.154. The ratio of their radii is 1.154.
• Multiply each unipolar limb lead voltages by correction
factor 1.154 and then plot.
• Two equilateral triangles are on the same circle.
Homogeneous Volume Spherical
Conductor- Einthoven Model
The voltage recorded by the electrodes (Lead I, II, III,
aVR, aVL and aVF denoting right arm, left arm and left
leg) are the vertices of an electrical equilateral triangle.
 Novel ECG
Interpretation Method
• Each cardiac waves can be represented in the form
of circles in the Hex-axial reference system.
• All circles (orientation of the diameter representing
the resultant cardiac vector) should be formed in
the left lower quadrant except QRS which can go
upto - 30 degree.
• When the angle between the ‘QRS’ and ‘T’ circles
increases, it usually denotes ischemia.
• Higher the voltage larger the size of the circle larger.
• Formation of circle and it’s magnitude during ST-
segment indicate the amount of myocardial injury.
 RESULTS
• The relationship between Bipolar and Unipolar Limb
Lead Voltages were applied.
• The net voltages in mm in each lead were taken
from respective ECG and shown in tables 1 and 2.
• Cardiac circles were constructed using MATLAB
software and angle determination was done using
the formulae Tanα = {(1.154 X aVF) / Lead1}
• The P, QRS, ST and T vector circle between two
different ECG were compared and the resultant
vector was magnified, focussed and shown in same
figure for better appreciation of the changes.
Table 1: Voltages from Fig 1 & 2
Vector Net Voltages in mm in each lead Angle
LI LII LIII aVR aVL aVF
QRS 6.5 2.0 - 4.5 - 4.25 5.5 - 1.25 - 12.5°
T 2.0 2.25 0.25 -2.125 0.875 1.25 35.80°
QRS/T QRS/ T angle are directed within normal ( 60°) 48.30°
QRS 9.0 - 4.0 -13.0 -2.5 11.0 - 8.5 - 47.46°
T -0.66 2.66 3.32 -1.0 -2.0 3.0 100.8°
QRS/T T vector moving away from QRS: Wide QRS/T 148.26°
P wave of Normal axis or angle & Retrograde P wave
P 0.833 1.667 0.830 -1.25 0 1.25 60°
P 0 -2.5 -2.5 1.25 1.25 -2.5 270°
Table 2: Voltages from fig 3,4 &5
Vector Net Voltages in mm in each lead Angle
LI LII LIII aVR aVL aVF
QRS Abnormal QRS (Left Anterior Fascicular block) - 49.0°
2.0 - 1.0 - 3.0 - 0.5 2.5 - 2.0
Pathological Q wave (Lateral Wall Old Infarct) 103.91°
-1.0 3.0 4.0 -1.0 -2.5 3.5
ST ST Elevation in aVR (Subendocardial Injury) -160.91°
-1.25 -1.0 0.25 1.125 - 0.75 - 0.375
ST Elevation in II, III & aVF (Inferior Wall Injury) 107.50°
- 0.8 1.8 2.6 - 0.5 - 1.7 2.2
T T wave Inversion in I, aVL (Lateral Wall Ischemia) 164°
- 2.0 - 0.5 1.5 1.25 - 1.75 0.5
Inverted in III, aVF (Inferior Wall Ischemia) - 10.15°
4.83 1.67 - 3.16 - 3.25 4.0 - 0.75
Fig 1: Abnormal QRS/T angle
Fig 2: Comparison of P Vector
Fig 3:Comparison of QRS Vector
Fig 4: Comparison of ST Vector
Fig 5: Comparison of T Vector
 Conclusion
• Cardiac Vector Theory and Einthoven’s
Equilateral Triangle Model forms the basic
foundation in the teaching of ECG.
• Cardiac vector theory helps to clearly analyse
the ECG wave changes that helps to overcome
the arduous task of pattern memorization.
• The combination of the 12-lead ECG with this
resultant cardiac vector represented by circle
provide the optimum approach to ECG
interpretation resulting in saving countless lives
of patients.
THANK YOU EVERYONE

FOR YOUR PATIENCE