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These have been added to, creating the 15 rules for 12-lead (and 15- or 18-lead) interpretation. [85] Rule 1: All waves in aVR are negative. Rule 2: The ST segment (J point) starts on the isoelectric line (except in V1 & V2 where it may be elevated by not greater than 1 mm). Rule 3: The PR interval should be 0.12–0.2 seconds long.
The hexaxial reference system is a diagram that is used to determine the heart's electrical axis in the frontal plane. The hexaxial reference system, better known as the Cabrera system, is a convention to present the extremity leads of the 12 lead electrocardiogram, [1] that provides an illustrative logical sequence that helps interpretation of the ECG, especially to determine the heart's ...
Lead II — This axis goes from the right arm to the left leg, with the negative electrode on the shoulder and the positive one on the leg. This results in a +60 degree angle of orientation. [4] = Lead III — This axis goes from the left shoulder (negative electrode) to the right or left leg (positive electrode). This results in a +120 degree ...
Every 3 min the speed & incline of the treadmill are increased. [2] There are 7 such stages and only very fit athletes can complete all 7 stages. The modified Bruce Protocol is an alteration in the protocol so that the treadmill is initially horizontal rather than uphill, with the 1st few intervals increasing the treadmill slope only. [3]
Progressive degeneration of the electrical conduction system of the heart can lead to third-degree heart block. This may be preceded by first-degree AV block, second-degree AV block, bundle branch block, or bifascicular block. In addition, acute myocardial infarction may present with third-degree AV block. [3]
If lead b is positive, the electrical heart axis can be estimated to lie within the quadrant between axis of lead a and lead b. A simple tool to quickly identify axis deviation (Figure 3) is the popular mnemonic; Reaching for Right Axis Deviation and Leaving for Left Axis Deviation. This refers to the appearance of leads I and II.
Recordings from these 12-lead monitors are of a significantly lower resolution than those from a standard 12-lead ECG, and in some cases have been shown to provide misleading ST segment representation, even though some devices allow setting the sampling frequency up to 1000 Hz for special-purpose examinations such as detection of "late potential".
The use of additional ECG leads like right-sided leads V3R and V4R and posterior leads V7, V8, and V9 may improve sensitivity for right ventricular and posterior myocardial infarction. In spite of these limitations, the 12 lead ECG stands at the center of risk stratification for the patient with suspected acute myocardial infarction.