5 precordial axis
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12-Lead Electrocardiography
a comprehensive course
Adam Thompson, EMT-P, A.S.
The
Precordial
Axis
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Frontal Axis
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Precordial Axis
• Sometimes called Z axis• Clockwise or Counterclockwise rotation
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Precordial AxisFrontal Plane Axis Precordial Axis
ERAD-90 to 180
Right Axis Deviation90 to 180
Pathological Left Axis Deviation
-30 to -90
Early TransitionCounterclockwise
Rotation
Late TransitionClockwise Rotation
• Ventricular Rhythm• Paced Rhythm• Dextrocardia• Electrolyte derangement
• May be normal• LPFB• Pulmonary disease• RVH• RBBB• WPW• Dextrocardia•Venrticular Rhythm
• Pregnancy• LAFB• WPW• Pulmonary disease• LBBB• Hyperkalemia• Q-waves, MI
• Posterior wall infarction• RVH• RBBB• WPW
• Sometimes Normal, especially in women• Anterior MI• LVH• LAFB• LBBB• Lung Disease
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Precordial Axis
Precordial Leads = V Leads
Sometimes called Chest Leads
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Precordial Axis
• The main impulse travels down then to the left.
1
3
22
3
4
Mean vector
Cardiac vector
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Precordial Axis
1
3
22
3
4
Mean vector
Cardiac vector
V1 V2
V3V4 V5
V6
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Precordial Axis
• The normal transition zone is between V3 and V4.
• V1 should be predominately negative.• V6 should be mostly positive.
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Precordial Axis
Lets take a look at a 12-lead
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Precordial Axis
Is V1 mostly negative?
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Precordial Axis
Is V6 mostly positive?
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Precordial Axis
Where is the transition?
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Precordial Axis
The Precordial Axis is Normal
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Precordial Axis
Now picture the precordial leads in this pattern.
V1
V2
V3
V4
V5V6
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Precordial Axis
V1
V2
V3
V4
V5V6
Normal transition
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Precordial Axis
V1
V2
V3
V4
V5V6
Early transition = Counterclockwise Rotation
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Precordial Axis
V1
V2
V3
V4
V5V6
Late transition = Clockwise Rotation
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Precordial Axis
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Precordial Axis
Early Transition - Counterclockwise Rotation
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Precordial Axis
Early Transition - Counterclockwise Rotation
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Precordial Axis
Another Example
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Precordial Axis
Late Transition - Clockwise Rotation
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Precordial AxisFrontal Plane Axis Precordial Axis
ERAD-90 to 180
Right Axis Deviation90 to 180
Pathological Left Axis Deviation
-30 to -90
Early TransitionCounterclockwise
Rotation
Late TransitionClockwise Rotation
• Ventricular Rhythm• Paced Rhythm• Dextrocardia• Electrolyte derangement
• May be normal• LPFB• Pulmonary disease• RVH• RBBB• WPW• Dextrocardia•Venrticular Rhythm
• Pregnancy• LAFB• WPW• Pulmonary disease• LBBB• Hyperkalemia• Q-waves, MI
• Posterior wall infarction• RVH• RBBB• WPW
• Sometimes Normal, especially in women• Anterior MI• LVH• LAFB• LBBB• Lung Disease
![Page 24: 5 precordial axis](https://reader034.fdocuments.in/reader034/viewer/2022042521/55655111d8b42a9b4c8b51a9/html5/thumbnails/24.jpg)
Precordial AxisNormal R-wave progression
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Precordial AxisEarly R-wave progression
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Precordial AxisLate R-wave progression
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Bundle Branch Blocks
1
2
3
Left Bundle Branch Block
V1
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Bundle Branch Blocks
1
2
3
Right Bundle Branch Block
V1
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Bundle Branch Blocks
V1
V1
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Bundle Branch Blocks
= RBBB
= LBBB
V1
V1
GT
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RBBB Morphologies
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LBBB Morphologies
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Bundle Branch BlocksFrontal Plane Axis Precordial Axis
ERAD-90 to 180
Right Axis Deviation90 to 180
Pathological Left Axis Deviation
-30 to -90
Early TransitionCounterclockwise
Rotation
Late TransitionClockwise Rotation
• Ventricular Rhythm• Paced Rhythm• Dextrocardia• Electrolyte derangement
• May be normal• LPFB• Pulmonary disease• RVH• RBBB• WPW• Dextrocardia•Venrticular Rhythm
• Pregnancy• LAFB• WPW• Pulmonary disease• LBBB• Hyperkalemia• Q-waves, MI
• Posterior wall infarction• RVH• RBBB• WPW
• Sometimes Normal, especially in women• Anterior MI• LVH• LAFB• LBBB• Lung Disease
![Page 34: 5 precordial axis](https://reader034.fdocuments.in/reader034/viewer/2022042521/55655111d8b42a9b4c8b51a9/html5/thumbnails/34.jpg)
Bundle Branch Blocks
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Bundle Branch Blocks
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The End
“Its finally over”
…Well almost.
More to come in lesson three.