Med

Learn
Level III

Dr. Tarek Abdelhamid M.D.

‫‪Med‬‬
‫‪Learn‬‬ ‫تحذير هام‬

‫هذا الكتاب اإللكترونى و جميع الرسوم التوضيحية المتاحة فى هذا الموقع هم‬
‫تحت حماية قانون الملكية الفكرية و ال يحق ألحد إستخدامه أو إستنساخه أو‬
‫تحميله على أى كمبيوتر أو إعادة طبعه أو طبع أجزاء منه بدون إذن مسبق من‬
‫الدكتور طارق عبد الحميد ( أو من ينوب عنه قانونيا ً )‪ .‬و من يتعدى على‬
‫الملكية الفكرية المذكورة فسوف يتعرض للمسائلة القضائية عن جريمة إنتهاك‬
‫حقوق الملكية الفكرية‪ .‬و إستخدام الفيديوهات و المادة العلمية المذكورة مكفول‬
‫فقط لشخص واحد فقط و ألخذ تصريح إستخدام ألكثر من شخص برجاء‬
‫اإلتصال بالدكتور طارق عبد الحميد‬

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© by Dr. Tarek Abdelhamid M.D. 2014
Step 1
Inspect the Limb Leads and identify one where the QRS
complex has a net magnitude near Zero.

© by Dr. Tarek Abdelhamid M.D. 2014

Step 1
Inspect the Limb Leads and identify one where the QRS
complex has a net magnitude near Zero.
LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

Step 1
Inspect the Limb Leads and identify one where the QRS
complex has a net magnitude near Zero.
LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

 LI LII LIII aVR aVL aVF

Step 2
Try to imagine the position of this lead on the hexaxial
reference system

© by Dr. Tarek Abdelhamid M.D. 2014

 LI LII LIII aVR aVL aVF

Step 2
Try to imagine the position of this lead on the hexaxial
reference system

© by Dr. Tarek Abdelhamid M.D. 2014

 LI LII LIII aVR aVL aVF

Step 2
Try to imagine the position of this lead on the hexaxial
reference system
AVR

© by Dr. Tarek Abdelhamid M.D. 2014

Step 3
Imagine the positon of the identified lead on the circle
below

© by Dr. Tarek Abdelhamid M.D. 2014

Step 3
Imagine the positon of the identified lead on the circle
below

© by Dr. Tarek Abdelhamid M.D. 2014

Step 3
Imagine the positon of the identified lead on the circle
below
aVR

-150

© by Dr. Tarek Abdelhamid M.D. 2014

Step 4
The electrical axis of the heart will be perpendicular to the
identified angle

aVR -60

-150

+ 120
© by Dr. Tarek Abdelhamid M.D. 2014
Step 4
The electrical axis of the heart will be perpendicular to the
identified angle

aVR -60

-150

+ 120
© by Dr. Tarek Abdelhamid M.D. 2014
Step 4
The electrical axis of the heart will be perpendicular to the
identified angle

aVR -60

-150

+ 120
© by Dr. Tarek Abdelhamid M.D. 2014
Step 5
Next inspect the inferior leads (i.e. II, III, aVF) and apply the
golden rule of the ECG

III aVF II
If they show predominantly
positive deflections then the
axis of the heart must be
directed toward them
If they show
predominantly negative
deflections then the axis
of the heart must be
directed away from them
© by Dr. Tarek Abdelhamid M.D. 2014
Step 5
Next inspect the inferior leads (i.e. II, III, aVF) and apply the
golden rule of the ECG

III aVF II If they show predominantly

negative deflections then
the axis of the heart must
be directed away from
them

© by Dr. Tarek Abdelhamid M.D. 2014

Step 6
aVR -60 In this example the
inferior leads show
predominantly positive
deflections.
-150

+ 120
LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

Step 6
aVR -60 In this example the
inferior leads show
predominantly positive
-150 deflections. This means
that the axis is directed
toward them i.e. +120
degree rather tan -60

+ 120
LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

Step 6
If the inferior leads of
aVR -60 the same ECG were
predominantly
negative (as shown
-150 below), the axis would
be directed away from
them (i.e. -60 degrees
rather than + 120…)

+ 120
LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

 LI LII LIII aVR aVL aVF

Step 7
Note: For even more accurate calculation of the cardiac axis
If the positive deflection

aVR -60 of aVR in this case is

bigger than the negative
one, then, the axis is
slightly directed (more)
toward aVR e.g. +135
-150 rather than + 120.

+ 120
© by Dr. Tarek Abdelhamid M.D. 2014
Step 7
Note: For even more accurate calculation of the cardiac axis
If the negative deflection of
aVR
-60 aVR was bigger than the
positive one, then, the axis
is slightly directed away
from aVR e.g. +105 rather
than + 120.
-150

+ 120
© by Dr. Tarek Abdelhamid M.D. 2014
Remember

© by Dr. Tarek Abdelhamid M.D. 2014

Let us Revise
how to
calculate the
Cardiac Axis
❶ Inspect the Limb Leads and identify
one where the QRS complex has a net
magnitude near Zero.

LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system

LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net
AVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system

LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net -60⁰
aVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system

❸ Imagine the position of the identified

lead on the circle that represents different
angles of the cardiac axis

+ 120⁰

LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net -60⁰
aVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system -150

❸ Imagine the position of the identified

lead on the circle that represents different
angles of the cardiac axis

+ 120⁰

LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net -60⁰
aVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system -150

❸ Imagine the positon of the identified

lead on the circle that represents different
angles of the cardiac axis

❹ The electrical axis of the heart will be

perpendicular to the identified angle + 120⁰

LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net -60⁰
aVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system -150

❸ Imagine the positon of the identified

lead on the circle that represents different
angles of the cardiac axis

❹ The electrical axis of the heart will be

perpendicular to the identified angle + 120⁰

LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net -60⁰
aVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system -150

❸ Imagine the positon of the identified

lead on the circle that represents different
angles of the cardiac axis

❹ The electrical axis of the heart will be

perpendicular to the identified angle + 120⁰

LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net -60⁰
aVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system -150

❸ Imagine the positon of the identified

lead on the circle that represents different
angles of the cardiac axis

❹ The electrical axis of the heart will be

perpendicular to the identified angle + 120⁰

❺ Next inspect the Inferior leads (i.e. II, III, aVF) and
apply the golden rule of the ECG
LI LII LIII aVR aVL aVF

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net -60⁰
aVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system -150

❸ Imagine the positon of the identified

lead on the circle that represents different
angles of the cardiac axis

❹ The electrical axis of the heart will be

perpendicular to the identified angle

❺ Next inspect the Inferior leads (i.e. II, III, aVF) and
apply the golden rule of the ECG
LI LII LIII aVR aVL aVF

If they show predominantly positive deflections then the

axis of the heart must be directed toward them

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net -60⁰
aVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system -150

❸ Imagine the positon of the identified

lead on the circle that represents different
angles of the cardiac axis

❹ The electrical axis of the heart will be

perpendicular to the identified angle + 120⁰

❺ Next inspect the Inferior leads (i.e. II, III, aVF) and
apply the golden rule of the ECG
LI LII LIII aVR aVL aVF

If they show predominantly positive deflections then the

axis of the heart must be directed toward them

© by Dr. Tarek Abdelhamid M.D. 2014

❶ Inspect the Limb Leads and identify
one where the QRS complex has a net -60⁰
aVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system -150

❸ Imagine the positon of the identified

lead on the circle that represents different
angles of the cardiac axis

❹ The electrical axis of the heart will be

perpendicular to the identified angle + 120⁰

❺ Next inspect the Inferior leads (i.e. II, III, aVF) and
apply the golden rule of the ECG
LI LII LIII aVR aVL aVF

If they show predominantly positive deflections then the

axis of the heart must be directed toward them
If they show predominantly negative deflections then the
axis of the heart must be directed away from them © by Dr. Tarek Abdelhamid M.D. 2014
❶ Inspect the Limb Leads and identify
one where the QRS complex has a net
-60⁰
aVR
magnitude near Zero.

❷ Try to imagine the position of this

lead on the hexaxial reference system -150

❸ Imagine the positon of the identified

lead on the circle that represents different
angles of the cardiac axis

❹ The electrical axis of the heart will be

perpendicular to the identified angle + 120⁰

❺ Next inspect the Inferior leads (i.e. II, III, aVF) and
apply the golden rule of the ECG
LI LII LIII aVR aVL aVF

If they show predominantly positive deflections then the

axis of the heart must be directed toward them
If they show predominantly negative deflections then the
axis of the heart must be directed away from them © by Dr. Tarek Abdelhamid M.D. 2014
IMPORTANCE

© by Dr. Tarek Abdelhamid M.D. 2014

IMPORTANCE

?! CHB

© by Dr. Tarek Abdelhamid M.D. 2014

IMPORTANCE

?! Normal finding

© by Dr. Tarek Abdelhamid M.D. 2014

IMPORTANCE

Acute Chest
Pain +
Tachypnea

?! Pulmonary
Embolism

© by Dr. Tarek Abdelhamid M.D. 2014

IMPORTANCE

Acute Chest
Pain +
Tachypnea

?! Pulmonary
Embolism

© by Dr. Tarek Abdelhamid M.D. 2014

Try now to calculate the cardiac axis in the
following ECG strips:
A
LI LII LIII aVR aVL aVF

B
LI LII LIII aVR aVL aVF

C
LI LII LIII aVR aVL aVF

D
LI LII LIII aVR aVL aVF

See answers in the next page © by Dr. Tarek Abdelhamid M.D. 2014
Answers

A -30⁰

B -135⁰

C + 60⁰

D -70⁰
© by Dr. Tarek Abdelhamid M.D. 2014