Einthoven's triangle

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Graphical representation of Einthoven's triangle Limb leads of EKG.png
Graphical representation of Einthoven's triangle

Einthoven's triangle is an imaginary formation of three limb leads in a triangle used in electrocardiography, formed by the two shoulders and the pubis. [1] The shape forms an inverted equilateral triangle with the heart at the center. It is named after Willem Einthoven, who theorized its existence. [2]

Contents

Einthoven used these measuring points, by immersing the hands and foot in pails of salt water, as the contacts for his string galvanometer, the first practical ECG machine. [3]

Lead placements

Electrodes may be placed distally or proximally on the limb without affecting the recording. [5] The right leg electrode acts to reduce interference, and can be placed anywhere without an effect on the ECG results. [6]

Each lead measures the electric field created by the heart during the depolarization and repolarization of myocytes. The electric field can be represented as a vector that changes continuously and can be measured by recording the voltage difference between electrodes. [7]

Using Einthoven's triangle to identify lead misplacements

Einthoven's triangle can be helpful in the identification in incorrect placement of leads. Incorrect placement of leads can lead to error in the recording, which can ultimately lead to misdiagnosis.

If the arm electrodes are reversed, lead I changes polarity, causing lead II and lead III to switch. If the right arm electrode is reversed with the leg's electrode, lead II changes polarity, causing lead I to become lead III, and vice versa. Reversal of the left arm and leg causes a change in polarity of lead III and switching of leads I and II. [6]

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Electrocardiography Examination of the hearts electrical activity

Electrocardiography is the process of producing an electrocardiogram, a recording of the heart's electrical activity. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the heart using electrodes placed on the skin. These electrodes detect the small electrical changes that are a consequence of cardiac muscle depolarization followed by repolarization during each cardiac cycle (heartbeat). Changes in the normal ECG pattern occur in numerous cardiac abnormalities, including cardiac rhythm disturbances, inadequate coronary artery blood flow, and electrolyte disturbances.

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String galvanometer

A string galvanometer is a sensitive fast-responding measuring instrument that uses a single fine filament of wire suspended in a strong magnetic field to measure small currents. In use, a strong light source is used to illuminate the fine filament, and the optical system magnifies the movement of the filament allowing it to be observed or recorded by photography. The principle of the string galvanometer remained in use for electrocardiograms until the advent of electronic vacuum-tube amplifiers in the 1920s.

Hexaxial reference system

The hexaxial reference system, better known as the Cabrera system, is a convention to present the extremity leads of the 12 lead electrocardiogram, that provides an illustrative logical sequence that helps interpretation of the ECG, especially to determine the heart's electrical axis in the frontal plane. The most practical way of using this is by arranging extremity leads according to the Cabrera system, reversing polarity of lead aVR and presenting ECG complexes in the order. Then determine the direction the maximal ECG vector is "pointing", i.e. in which lead there are most positive amplitude - this direction is the electrical axis - see diagram. Example: If lead I has the highest amplitude, the axis is approximately 0°. Conversely, if lead III has the most negative amplitude it means the vector is pointing away from this lead, i.e. towards -60°.

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Left axis deviation

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References

  1. Lippincott Williams & Wilkins (1 August 2009). ECG Facts Made Incredibly Quick!. Lippincott Williams & Wilkins. p. 5. ISBN   978-1-60547-476-2.
  2. Understanding Electrocardiography. Elsevier Health Sciences. 2003. p. 4. ISBN   0-323-01905-6.
  3. Silverman, M. E. (1992-10-01). "Willem Einthoven--the father of electrocardiography". Clinical Cardiology. 15 (10): 785–787. doi: 10.1002/clc.4960151020 . ISSN   0160-9289. PMID   1395193.
  4. 1 2 3 The Only EKG Book You'll Ever Need. Lippincott Williams & Wilkins. 2003. p. 40. ISBN   0-7817-4176-9.
  5. Klabunde, Richard E (2005-01-01). Cardiovascular Physiology Concepts . Lippincott Williams & Wilkins. pp.  34–35. ISBN   9780781750301.
  6. 1 2 Abi-Saleh, Bernard; Omar, Bassam (2010-01-01). "Einthoven's triangle transparency: a practical method to explain limb lead configuration following single lead misplacements". Reviews in Cardiovascular Medicine. 11 (1): 33–38. doi:10.3909/ricm0506. ISSN   1530-6550. PMID   20495514. S2CID   36229417.
  7. Richardson, Daniel R.; Randall, David Clark; Speck, Dexter F. (1998-03-13). Cardiopulmonary System Structure and Function. Hayes Barton Press. pp. 99–101. ISBN   9781889325309.