Electrocardiographic Interpretation of Cardiac Muscle and Coronary Blood Flow Abnormalities: Vectorial Analysis

Principles of Vectorial Analysis of Electrocardiograms

• Use of Vectors to Represent Electrical Potentials
o Heart current flows in a particular direction in the heart at a given instant during the cardiac cycle. A vector
is an arrow that points in the direction of the electrical potential generated by the current flow, with the
arrowhead in the positive direction. (length of arrow is proportional to the voltage of the potential)
o Resultant Vector in the Heart at Any Given Instant
• Direction of a Vector is Denoted in Terms of Degrees
o In a normal heart, the average direction of the vector during spread of the depolarization wave through the
ventricles (mean QRS vector) is about +59 degrees.
o During most of the depolarization wave, the apex of the heart remains positive with respect to the base of the
heart.
• Axis for Each Standard Bipolar Lead and Each Unipolar Limb Lead
• Vectorial Analysis of Potentials Recorded in Different Leads
o When the vector in the heart is in a direction almost perpendicular to the axis of the lead, the voltage
recorded in the electrocardiogram of this lead is very low. When the heart vector has almost entirely the
same axis as the lead axis, essentially the entire voltage of the vector will be recorded.
o Vectorial Analysis of Potentials in the Three Standard Bipolar Limb Leads
Vectorial Analysis of the Normal Electrocardiogram
• Vectors that Occur at Successive Intervals During Depolarization of the Ventricles—The QRS complex
• Electrocardiogram During Repolarization—The T Wave
o Because the septum and endocardial areas of the ventricular muscle depolarize first, it seems logical that
these areas should repolarize first as well. However, this is not the case because the septum and other
endocardial areas have a longer period of contraction than most of the external surfaces of the heart.
o The greatest portion of ventricular muscle mass to repolarize first is the entire outer surface of the ventricles.
o The positive end of the overall ventricular vector during repolarization is toward the apex of the heart  the
normal T wave in all three bipolar limb leads is POSITIVE
• Depolarization of the Atria—The P Wave
o Repolarization of the Atria—The Atrial T wave
 Spread of depolarization through the atrial muscle is much slower than in the ventricles because the
atria have no Purkinje system for fast conduction of the depolarization signal.
 The area in the atria that also becomes repolarized first is the sinus nodal region (originally
depolarized first)  atrial repolarization vector is backward to the vector of depolarization.
• Vectorcardiogram
o The vector increases and decreases in length because of increasing and decreasing voltage of the vector.
o The vector changes direction because of changes in the average direction of the electrical potential from the
heart.
Mean Electrical Axis of the Ventricular QRS—And its Significance
• Determining the Electrical Axis from Standard Lead Electrocardiograms
• Abnormal Ventricular Conditions that Cause Axis Deviation
o Change in the position of the heart in the chest
 If the heart itself is angulated to the left/right, the mean electrical axis of the heart also shifts to the
left/right
o Hypertrophy of one ventricle
 When one ventricle greatly hypertrophies, the axis of the heart shifts toward the hypertrophied
ventricle
• A far greater quantity of muscle exists on the hypertrophied side of the heart (excess
generation of electrical potential on that side)
• More time required for the depolarization wave to travel through the hypertrophied
ventricle (normal ventricle depolarized in advance of the hypertrophied ventricle)
o Vectorial analysis of left axis deviation resulting from hypertrophy of the left ventricle
o Vectorial analysis of right axis deviation resulting from hypertrophy of the right ventricle
o Bundle branch block causes axis deviation
o Vectorial analysis of left axis deviation in left bundle branch block
o Vectorial analysis of right axis deviation in right bundle branch block