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Simplifying Axis Determination on an EKG

Understand the basics of determining cardiac axis abnormalities on an EKG. Learn about left and right deviations, indications, and implications. Essential for initial patient evaluation.

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Simplifying Axis Determination on an EKG

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  1. Axis Determination on an EKG by Don Hudson, D.O., FACEP/ACOEP

  2. I prefer to keep it real simple !! • There are lot of nuances that will not be picked up this way but that is in the area for the Cardiologist. • First do the EKG • Lay it down and put your thumbs over leads I and aVf. • Point them in the same direction as the QRS.

  3. Place your thumb over leads I &aVf pointingin the direction of the QRS NORMAL LAD RAD NO MANS LAND

  4. Why do you care about the Axis • Normal is simply obvious • Left Axis Deviation indicated that ½ of the two left Bundles of HIS is not working either the anterior or posterior branch. In this simple format we don’t care which one, anterior or posterior. • Right Axis Deviation indicates a probable Rt. Ventricle Hypertrophy

  5. No Man’s Land Axis • This problem with this lead is it may represent either an extreme RAD or an extreme LAD. • The point is in the simplified version you recognize it as abnormal and it may be an indication of either a left hemiblock or right ventricular hypertrophy. • Either finding requires further testing and evaluation of the patient.

  6. Right Axis Deviation • We have already considered that this finding indicates right ventricle hypertrophy • Since this side of the pump normally pumps to the lung the consideration of a disease process causing the vessels in the lung to be non-complient and therefore more difficult for the heart to pump blood into.

  7. What is most important • These are all important factors. • You will most often see LAD in the general ER patient. • The other abnormality you will need to add to the axis determination is Bundle Branch Blocks • These will be gone over in another section

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