cardiac axis - mastery of paramedicine | mastery of paramedicine

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Cardiac axis

Cardiac axis in Paramedicine is, I feel, undervalued as a re-

sult of being poorly taught. In order to keep the spookiness

out of this topic, I am going to keep this concept very basic.

The purpose of this blog is to demonstrate that determining

a cardiac axis is simple and also useful.

Understanding cardiac axis, will allow you to see more and

comprehend each patient encounter more deeply. It is my

hope that in learning and applying this will both increase

your clinical ability and rekindle some interest in the typical

chest pain cases.

Cardiac axis

Simply, is the general direction of depolarisation occurring

through the heart. All you are attempting to do is determinewhich one of four ways the major electrical activity is travel-

ing. Nothing scary about that right? It is important to under-

stand though, as an axis deviation, is suggestive of an under-

lying clinical problem; for example pulmonary hypertension

or a pulmonary embolus. For our purposes in paramedicine

an axis deviation highlights a need for further investigation.

So just in case youre getting scared, here are a couple of

general principles to show you how straight forward this is.

When a ventricular muscle has hypertrophy, the car-

diac axis will deviate toward the larger muscle mass,

as thats where the greater electrical activity will be.

Infarcted tissue is electrically inert, hence no electri-

cal activity will pass or register, this effectively turns

the axis away from the infarcted tissue.

If you have ST elevation in the presence of a normal

axis, (i.e. current flowing normally), it is highly sug-

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gestive of infarct.

The cardiac axis with either be normal, or deviate to the right

or left. In extreme circumstances it may deviate so far that it

is termed (extreme or indeterminate).

Right Axis Deviation (RAD) occurs in:

Right Ventricular Hypertrophy (RVH)Acute Right Heart Strain, e.g. a pulmonary embolus

Anterior Lateral MI (widow maker)

Left Axis Deviation (LAD) occurs in:

Left ventricular hypertrophy (LVH)

Inferior MI

Paced beats

Extreme Axis Deviation (rare) occurs in:

Apical MI

VT

So how do we determine which axis a heart has? There are

many rule of thumb (tacky pun intended, see my video ),

methods out there. My video below will show you the first

and easiest method I learnt. Its dead easy, needs nothing

more than two thumbs and an ECG with limb leads. This

method is very basic, but should serve as a start point.

If you found that easy and are looking for the next level, I


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suggest you drop by:

http://cardiorhythmsonline.blogspot.com.au/2014/01/car-

diac-axis.html

This will introduce you to a three-step method which will in-

corporate degrees into your practice. If you like that and find

you want to go further then:

http://www.heartaxis.com

This will take you deeper again and is a very good interactive

site.

Thank you so much for your time and I hope you got some-

thing out of this blog. As always, if you have any useful tips,

please leave a comment or email me with anything you want

to discuss. I enjoy getting emails from you, so please keepthem coming.

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