Axis Deviation Chapter 5.

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Presentation transcript:

Axis Deviation Chapter 5

Definition Electrical axis... The general direction in the frontal plane or toward which lead the QRS complex is predominately oriented ...the mean direction of depolarization through the frontal plane of the heart

Mean QRS Axis Calculation Lead II

Mean QRS Axis Calculation General rules the mean QRS axis points midway between any two leads that show tall R waves of equal height the mean QRS axis is oriented at right angles (90°) to any lead showing a bi-phasic complex

Mean QRS Axis Calculation

Mean QRS Axis Calculation

Mean QRS Axis Calculation

Mean QRS Axis Calculation

Mean QRS Axis Calculation

Normal versus Deviation Left 3 ? 1 ? 2 ? Right + 90∘

Axis Deviation Left Right

Axis Deviation Criteria LEAD I LEAD II (or Lead aVF or III) Normal Positive LAD Negative RAD Intermediate axis

Axis Deviation RAD = If R wave in III > R wave in II LAD = If R wave in aVL > I; and deep S wave in III

Axis deviation ? ?

Axis deviation ?

Axis deviation ?

What is the axis? Right

What is the axis? Left

What is the axis? Normal

What is the axis? Left

What is the axis? Normal

What is the axis? Right

Causes of Left Axis Deviation FYI • left anterior hemiblock • Q waves of inferior myocardial infarction • artificial cardiac pacing • emphysema • hyperkalaemia • Wolff-Parkinson-White syndrome - right sided accessory pathway • tricuspid atresia • ostium primum ASD • injection of contrast into left coronary artery note: left ventricular hypertrophy is not a cause left axis deviation

Causes of Right Axis Deviation FYI • normal finding in children and tall thin adults • right ventricular hypertrophy • chronic lung disease even without pulmonary hypertension • anterolateral myocardial infarction • left posterior hemiblock • pulmonary embolus • Wolff-Parkinson-White syndrome - left sided accessory pathway • atrial septal defect • ventricular septal defect