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- I, aVL (Top)
- V5, V6 (Middle)
What is the steps to the systematic approach to reading a 12-Lead?
- Baseline ECG (Normally Lead II)
- Axis Determination
- Bundle Branch Blocks
- V-Tach determination
- Assess for Infarct (I See All Leads)
- Final Diagnosis
Normal Axis Determination in I, II, III
Left Physiological Axis Determination
Left Pathological Axis Determination
Extreme Right Axis Determination
What is the "Turn Signal Rule"?
- J Point, points up - Right BBB
- J Point, Points down - Left BBB
3- MI Pitfalls in 12-Lead Interpretation
- Left Ventricular Hypertrophy
How do you determine Left Ventricular Hypertorphy (LVH)
- The R wave in lead aVL is taller than 12mm or
- Rule of 35
- Rule of 53
What is the Rule of 35/53?
- Look at the tallest R wave in V4, V5, or V6
- Add the total mm of R wave to Deepest S wave in V1, V2, or V3
- If the total is >35 and the Pt is >35 it is LVH
- If <35 yo, use rule of 53
How do you determine Pericarditis?
- ST Elevation in most leads
- Pt. will feel better when leaning forward
- No ST Depression
What factors determine true V-Tach on a 12-Lead?
- Fast Rate
- Leads I, II, and III all Down? Yes V-Tach
- Is V1 Up? Yes V-Tach
- Is V6 Down? Yes V-Tach
What does "I See All Leads" the acronym for?
- S- Septal
- A- Anterior
- L- Lateral
Deviations in leads II, III and aVF
Deviations in leads V1 and V2
Deviations in leads V3 and V4
Deviations in leads V5, V6, I, aVL
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