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Basics: Difference between revisions
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→Special Leads
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==Special Leads== | ==Special Leads== | ||
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| image2 = Brugada_lead_placement.png | | image2 = Brugada_lead_placement.png | ||
| caption2 = Changed lead positions of leads V3 and V5 to increase the sensitiviy to 'catch' a [[Brugada]] pattern on the ECG. | | caption2 = Changed lead positions of leads V3 and V5 to increase the sensitiviy to 'catch' a [[Brugada]] pattern on the ECG. | ||
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| | | image1 = E000559.jpg | ||
| | | caption1 = A patient with atrial fibrillation with a 'Lewis Lead' poling of the leads. Compared with the normal lead configuration, the atrial signal is enlarged. | ||
| image2 = E000557.jpg | |||
| caption2 = The same patient with a normal lead configuration | |||
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Throughout history extra lead positions have been tried. Most are rarely used in practice, but they can deliver very valuable diagnostic clues in specific cases. | Throughout history extra lead positions have been tried. Most are rarely used in practice, but they can deliver very valuable diagnostic clues in specific cases. | ||
*Leads to improve diagnosis in '''right ventricular en posterior infarction''': | *Leads to improve diagnosis in '''right ventricular en posterior infarction''': | ||
In case of an inferior wall infarct, extra leads may be used: | In case of an inferior wall infarct, extra leads may be used: | ||
#On a right-sided ECG, V1 and V2 remain on the same place. V3 to V6 are placed on the same place but mirrored on the chest. So V4 is in the middle of the right clavicle. The ECG should be marked as a ''Right-sided ECG''. V4R (V4 but right sided) is a sensitive lead for diagnosing right ventricular infarctions. | :#On a right-sided ECG, V1 and V2 remain on the same place. V3 to V6 are placed on the same place but mirrored on the chest. So V4 is in the middle of the right clavicle. The ECG should be marked as a ''Right-sided ECG''. V4R (V4 but right sided) is a sensitive lead for diagnosing right ventricular infarctions. | ||
#Leads V7-V8-V9 can be used to diagnose a posterior infarct. After V6, leads are placed towards the back. See the chapter[[Ischemia]] for other ways of diagnosing posterior infarction. | :#Leads V7-V8-V9 can be used to diagnose a posterior infarct. After V6, leads are placed towards the back. See the chapter[[Ischemia]] for other ways of diagnosing posterior infarction. | ||
*Leads to improve detection of '''atrial rhyhtm''': | *Leads to improve detection of '''atrial rhyhtm''': | ||
In wide complex tachycardia, good detection of atrial rhythm and atrio-ventricular dissociation can be very helpful in the diagnosis process. An esophagal ECG electrode placed close to the atria can be helpful. Another, less invasive, method is the '''Lewis Lead'''. This is recorded by changing the limb electrodes, placing the right arm electrode in the second intercostal space and the left arm electrode in the fourth intercostal space, both to the right of the sternum. Furthermore gain is increased to 20mm/mV and paper speed to 50mm/sec.<cite>Lewis1</cite>ß | In wide complex tachycardia, good detection of atrial rhythm and atrio-ventricular dissociation can be very helpful in the diagnosis process. An esophagal ECG electrode placed close to the atria can be helpful. Another, less invasive, method is the '''Lewis Lead'''. This is recorded by changing the limb electrodes, placing the right arm electrode in the second intercostal space and the left arm electrode in the fourth intercostal space, both to the right of the sternum. Furthermore gain is increased to 20mm/mV and paper speed to 50mm/sec.<cite>Lewis1</cite>ß | ||