Indicates the direction of the average electrical depolarization with an arrow (vector). This is the heart axis.
A change of the heart axis or an extreme deviation can be an indication of pathology.
To determine the heart axis you look at the LIMB leads only (not chest leads V1-V6).
On leads I, II, and AVF you can make a good estimate of the heart axis.
An important concept in determining the heart axis is the fact
-electricity flow towards a lead yields a positive deflection in the electric recording of that lead.
YOU remember the the EINTHOVENS TRIANGLE -
- Positive QRS deflection in lead I: the electrical activity is directed to the left (of the patient)
- Positive QRS deflection in lead AVF: the electrical activity is directed down. Clinical application
- A left heart axis is present when the QRS in lead I is positive and negative in II and AVF. (between -30 and -90 degrees)
- A right heart axis is present when lead I is negative and AVF /II positive. (between +90 and +180)
- An extreme heart axis is present when both I and AVF/II are negative. (axis between +180 and -90 degrees)
Left axis deviation
Left heart axis
Left anterior hemiblock
Causes of left axis deviation include:
- Normal variation (physiologic, often with age)
- Mechanical shifts, such as expiration, high diaphragm (pregnancy, ascites, abdominal tumor)
- Left ventricular hypertrophy
- Left bundle branch block
- left anterior fascicular block
- Congenital heart disease (e.g. atrial septal defect)
- Emphysema
- Hyperkalemia
- Ventricular ectopic rhythms
- Preexcitation syndromes
- Inferior myocardial infarction
- Pacemaker rhythm
Right axis deviation
Right heart axis deviationCauses of right axis deviation include:
- Normal variation (vertical heart with an axis of 90ยบ)
- Mechanical shifts, such as inspiration and emphysema
- Right ventricular hypertrophy
- Right bundle branch block
- Left posterior fascicular block
- Dextrocardia- heart in the right position
- Ventricular ectopic rhythms
- Preexcitation syndromes
- Lateral wall myocardial infarction
- Right ventricular load, for example Pulmonary Embolism or Cor Pulmonale (as in COPD)
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