Pemicu 1 aja udah bikin susah

- -”
Andreas Stevan
081908643754
 Electrode Placement
• Einthovens Triangle represents the leads that
we all use with our monitors on a regular
basis
• 1) Standard Limb Leads
• Lead I: The positive lead is above the left breast or on the left arm and the
negative lead is on the right arm.
Records the difference of potential between the Left arm and Right arm. 

• Lead II: The positive lead is on the left abdomen or left thigh and the
negative lead is also on the right arm.
Records the difference of potential between the left leg and the right arm.

• Lead III: The positive lead is also on the left abdomen or left lower lateral
leg but the negative lead is on the left arm.
Records the difference of potential between the left leg and the right arm.
 The hexaxial view

Leads I, II & III & AVR, AVL, and AVF.

•I: Left Chest
•II: Left Upper Quadrant
•III: Right Upper Quadrant
•AVR: Right lateral arm
•AVL: Left lateral arm
•AVF: Right lateral lower leg
• 2) Augmented Leads
• The four limb leads go on the four extremities as follows:
-The upper extremities need placement of the electrodes on the area of
the lateral humoral aspect of the arms.
-The lower extremities need placement of the electrodes on the lateral
lower legs near the lateral mallelous.

• Lead aVR faces the heart from the right shoulder and is oriented to the
CAVITY OF THE HEART.
• Lead aVL faces the heart from the left shoulder and is oriented to the
LEFT VENTRICLE.
• Lead aVF face the heart from the left hip and is oriented to the INFERIOR
SURFACE OF LEFT VENTRICLE.
• 3) Precordial Leads
• Six Precordial Electrode Placement:

Records potential in the horizontal plane. Each lead is positive. The

major forces of depolarization move from right to left.V1 and V2 are
negative deflections.V3, V4, V5 and V6 become more positive ( peak
positive is V3 or V4 ).
• V1 - fourth intercostal, right strernal border.
• V2 - fourth intercostal, left sternal border.
• V3 - equal distance between V2 and V4.
• V4 - fifth intercostal, left mid clavicular line.
• V5 - anterior axillary line, same level with V4.
• V6 - mid axillary line, same level with V4 and V5.
• The precordial views make up a cross section view of the heart in a transverse
horizontal plane projecting a view across the AV Node.
• Einthovens Triangle and the four limb leads make up the "HEXAXIAL VIEW!" This
view is a vertical/frontal-posterior - ventral/dorsal plane making a star with 6 points
intersecting through the heart in a flat frontal plane across the patients chest.

The PRECORDIAL views are used to make up the other six views of the heart for a
total of twelve views.
• So, adding this up: lead I, II and III, lead AVR, AVL, AVF, and the 6 precordial leads
equals 12 leads... RIGHT?????

Correct, however, we only need 10 electrodes placed.

( 4 on the limbs and 6 on the chest )
The cardiac monitor uses the four Limb Leads to make up Lead I, II, III & AVR, AVL,
AVF; six views...
 12 lead Quick Triage
• The following situation constitutes activation of the cardiac response team
at the hospital by reporting the field diagnosis of AMI!
• Category one: AMI that clearly meets the criteria.Example:1 mm or more of
ST elevation in the inferior leads (II, III, AVF) with reciprocal changes in the
lateral leads (I, AVL, V5, V6)Reciprocal changes not necessary to make the
diagnosis.
• Category two: The following will result in your reporting the specific findings
of concern that may or may not result in the Cardiac Response
team.Example:1 mm of ST elevation in the anterior leads. (V1-V4)Example :
Injury/Infarct pattern in the presence of LBBB with cardiogenic clinical
presentation.
• The following situation will result in the 12 Lead ECG being reported as
"normal". No subsequent activation of the cardiac response team.
• Category Three: No patterns of ischemia or infarction.
 Other Signals to use as a diagnostic tool:
• Tackycardia: (heart rate above 100) indicates damge to
the left Ventricle and an "anterior" or "lateral" infarct.
The Left Circumflex and or Left Decending Coronary
Artery is occluded.
Visable elevation in the CHEST LEADS: V-3, 4, 5, & 6.

• Bradycardia: (heart rate below 60) indiactes damage to

the Right Ventricle and an "inferior" or "posterior"
infarct. The Right Coronary Artery is occluded.
Elevation in the LIMB LEADS: II, III, & AFV.
 Systematic Infarct Recognition Approach

INFARCT LOCATION ST ELEVATION FOUND IN

Anterior – Septal V1, V2, V3, and V4 -- 0.2mV or more in leads
Posterior V1, and V2 -- 0.2mV or more in leads
Inferior II, III, and aVF -- 0.1mV or more in 2 leads
High Lateral I, and aVL -- 0.1mV or more in 2 leads
Low Lateral V5, and V6 -- 0.1mV or more in 2 leads

“ST Depression indicates Angina”

Region of ST Elevation Region of ST Depression
Anterior (leads V1-V4) Inferior (true posterior)
Inferior (leads II, III, aVF) Anterior (leads V1-V3 or lateral lead
1. aVL)
Lateral ( leads I, aVF, V5, V6) Inferior ( leads II, III, aVF)
True Posterior Anterior (leads V1-V3)
 12 lead rapid assessment
• Verify aVR is negative
• Assess rate and rhythm
• Axis determination - Leads I and aVF
• Conduction abnormalities:LBBB - seen in V1
Hypertrophy
Aneurysm
Pericarditis
Drugs or Electrolytes
Early repolarization
• Ischemia, Injury, Infarct signs:T-wave inversionsST segment elevationSignificant Q waves
• Acute MI pattern:Anterior:ST elevation in V1, V2, V3, V4ST depression in II, III, aVFInferior: ST
elevation in II, III, aVFST depression in V1, V2, V3, or I, aVLLateral: ST elevation in I, aVL, V5, V6ST
depression in II, II, aVFSeptal wall: ST elevation in I, aVL, V1, V2
Posterior: tall and wide R waves and ST depression in V1, V2
Right Ventricular: ST elevations in V4R, V5R, V6R(5 additional right chest wall electrodes placed on
the chest in the same positions as the precordial leads)
• Clinical pressentaion
• Treatment plan
Common ECG Formation

•Iscehmia=Inverted T wavesInverted T wave is

symmetrical
•T waves are usually upright in leads I, II, and V2-V6

•Injury=Elevated ST segmentSignifies an acute process;

ST returns to baseline with time
•If ST elevation is diffuse and unassociated with Q
wavesor reciprocal ST depression, consider pericarditis
•Location of injury can be determined in same manner
as infarct location
•Usually associated with reciprocal ST depression in
other leads

•Infarction=Q waveSmall Qs may be normal in V5, V6, I

and aVL
•Abnormal Q must be one small square (0.04 sec) wide
•Also abnormal if Q-wave depth is greater than one-
third of QRS height in lead III
 Anterior Infarction

•ST elevation without abnormal Q wave

•Usually associated with occlusion of the left anterior decending branch of the left
coronary artery (LCA)
 Lateral Infarction

•ST elevation with/without abnormal Q wave

•May be a component of a mutiple-site infarction
•Usually associated with abstruction of the left circumflex artery
 Inferior Infarction
•ST elevation with/without abnormal Q wave
•Usally associated with right coronary artery (RCA) occlusion
 Right Ventricular Infarction
•Usually accompanies inferior MI due to proximal acclusion of the RCA
•Best diagnosed by 1 - 2 mm ST elevation in lead V4R
•An important cause of hypotension in inferior MI recognized by jugular venous
distension with clear lung fields
•Aggressive therapy is indicated, including: reprofussion, adequate IV fluids for right
heart filling, and pacingf to maintain A-V synchrony if necessary
 Poterior Infarction
•Tall, broad (>0.04 sec) R wavr and ST depression in V1 and V2 (reciprocal changes)
•Frequestly associated with inferior MI
•Usually associated with obstruction of RCA and or left circumflex coronary artery