![]() ![]() For example, imagine that the camera below is Lead V1.So, depending on the mean QRS vector axis, each lead will see a “negative”, "biphasic", or “positive” QRS complex. Every heart has its own variation in QRS vector axis.What causes a QRS complex to be “negative”, biphasic, or “positive”? Right Ventricular Hypertrophy (RVH) or Left Ventricular Hypertrophy (LVH).Several causes of poor R-wave progression:.*** Any deviation from this natural progression is considered abnormal, or poor R-wave progression *** R-wave progression is observed in leads V1-V6.A steady progression of the QRS complex from “mostly negative” to “biphasic” to “mostly positive is considered normal.We need to examine what normal looks like to identify “poor R-wave progression”.The QRS vector can be pointing in or out. ![]() Find the most “biphasic” lead (perpendicular to the axis).Find the most “negative” lead (furthest from the axis).Find the most “positive” lead (closest to the axis).*** Side note: There are P-wave and T-wave axis’ but we don’t care about those! *** Dead muscle = no longer conducts electricity (fewer vectors).HYPERTROPHY = added muscle = more vectors = more electricity Once you have figured out the mean QRS vector, you can apply it to the figure below in order to determine which sector the heart’s axis is in: Mean QRS Vector: all electrical impulses of the ventricles added together ![]()
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