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Axis Determination on an EKG by Don Hudson, D.O., FACEP/ACOEP I prefer to keep it real simple !! • There are lot of nuances that will not be picked up this way but that is in the area for the Cardiologist. • First do the EKG • Lay it down and put your thumbs over leads I and aVf. • Point them in the same direction as the QRS. Place your thumb over leads I & aVf pointing in the direction of the QRS NORMAL LAD RAD NO MANS LAND Why do you care about the Axis • Normal is simply obvious • Left Axis Deviation indicated that ½ of the two left Bundles of HIS is not working either the anterior or posterior branch. In this simple format we don’t care which one, anterior or posterior. • Right Axis Deviation indicates a probable Rt. Ventricle Hypertrophy No Man’s Land Axis • This problem with this lead is it may represent either an extreme RAD or an extreme LAD. • The point is in the simplified version you recognize it as abnormal and it may be an indication of either a left hemiblock or right ventricular hypertrophy. • Either finding requires further testing and evaluation of the patient. Right Axis Deviation • We have already considered that this finding indicates right ventricle hypertrophy • Since this side of the pump normally pumps to the lung the consideration of a disease process causing the vessels in the lung to be non-complient and therefore more difficult for the heart to pump blood into. What is most important • These are all important factors. • You will most often see LAD in the general ER patient. • The other abnormality you will need to add to the axis determination is Bundle Branch Blocks • These will be gone over in another section