‫دورة مهارات رسم القلب الكهربائى‬
‫‪ECG Teacher‬‬
‫محاضرة رقم ‪4‬‬
‫وضع الرسوم البيانية المختلفة للرسم الكهربى وعالقتها بالقلب‬
‫أوال‪ :‬الملخص العربى‬
‫سننرسرف ننى اننحا ال مالننرة مالةمننات اامننق اننةل ولننة ارسمنناق الكهربجننق لرسننم القلننب لننى ننم ا ننا‬
‫والراتج ‪ 21‬رسم بجا ى كل مرهم يابر ن زء منن القلنب ولنال د لنق اامنق نى ارمنرار وسنراارل اي نا لنى‬
‫الشرايجن ال غحيق لكل زء‪.‬‬
‫ت ر ارسالك من هاز رسم كهربائجق القلنب للنى طسمناق كهربائجنق ‪ ،)electrodes‬وان رنرائف لزينق مة نلق‬
‫للكهرباء‪ .‬وتةلة ارسماق لى كل ذراع وساق و رس ّ‬
‫ست قاط لى الصسر‪ ،‬ةق مرمقق القلب‪.‬‬
‫وتقةم ارسماق بالاقاط الاجارات الا يراجها القلب رس كل خفقق من خفقاتال‪ ،‬وترقلها للى مكبر داخل هناز رسنم‬
‫القلب‪ .‬تر اق الاجارات ال كبرة باس ذلك خالل ملف من سنلك ر جنة نسما مالنخ داخنل مجنال مغراطج ن ‪ ،‬ويامنرك‬
‫ال لك ب بب تفا ل احا الاجارات مة ال جال ال غراطج ‪ .‬وتقةم را اق ا اسق با ججل اركق ال لك لى ورق‬
‫‪.leads‬‬
‫رسم بجا مامرك جراج ن ذلك رسم كهربائجق القلب ل اجئق ةر ت‬
‫تراج كنل ب نق سلنب سل نلق منن ال ة نات ويامن الرنبا المبجان للقلنب ةذ منا مة جمنا ممنسدما‪ .‬وتغجنر ط نةاع‬
‫ماجرق من طمرار القلب احا الر ةذج ال ارول لى مة ي كن الاارل لجال‬
‫ل الصسر ا كا ت ‪:‬‬
‫طماكن ارسماق الا‬
‫‪:V1‬‬
‫ال‬
‫ا ق رسم ‪ 4‬الا بجن ال لةع ل الج جن ‪Right 4th intercostal space‬‬
‫‪:V2‬‬
‫ال‬
‫ا ق رسم ‪ 4‬الا بجن ال لةع ل الج ار ‪Left 5th intercostal space‬‬
‫‪:V3‬‬
‫صف ال‬
‫ا ق بجن ‪V4 & V2‬‬
‫ارسماق القادمق ساكة‬
‫ى ال‬
‫ا ق رسم ‪ 5‬بجن ال لةع ‪5th left intercostal / rib‬‬
‫‪space‬‬
‫‪ : V4‬رنننننننننننننننننننننننننننننننننننننننننننننننننننننس س نننننننننننننننننننننننننننننننننننننننننننننننننننننق القلنننننننننننننننننننننننننننننننننننننننننننننننننننننب ‪APEX‬‬
‫‪ :V5‬ن‬
‫فننم م نناةة س ننق القلننب رننس خننف ا بننف ا مننام‬
‫‪ :V6‬ن‬
‫فننم م نناةف س ننق القلننب رننس خننف ا بننف ننى ال راصننف‬
‫اما ارسماق الا‬
‫ل ا طرال كل وااسة تراج لرا‬
‫قف للاة جل ا رل‬
‫تاسخل‬
‫الرسم)‬
‫‪anterior axillary line‬‬
‫ةرة ما سا الا‬
‫‪mid-axillary line‬‬
‫رس ال اق الج نرة هن‬
‫رننس الجننس الج رن ت ن‬
‫الج ر ‪aVF :‬‬
‫و الان‬
‫‪aVR :‬‬
‫رننس الجننس الج ننرة‪ aVL :‬و الان‬
‫رننس القننسم‬
‫طما الثالثق رسةم بجا جق ال ابقجق ه ا بارة نن ا نسماج كنل نةرتجن منن الصنةر الراتجنق نن‬
‫ا سمننننننننننننننننننننننننننننننننننننننناق ال ة نننننننننننننننننننننننننننننننننننننننةدة رنننننننننننننننننننننننننننننننننننننننس ا طنننننننننننننننننننننننننننننننننننننننرال‬
‫ثال‪ :‬ا سماج الصةرة الراتجق من القمب ال ة ةد رس الجس الج ر مة ا خر ال ة نةد رنس الجنس‬
‫الج ننننننننننننننننننرة ترنننننننننننننننننناج لرننننننننننننننننننا رسنننننننننننننننننن ا بجا جننننننننننننننننننا كهربجننننننننننننننننننا ي نننننننننننننننننن ‪:‬‬
‫‪.)lead I‬‬
‫‪)lead II :‬‬
‫و طي ا الرسم البجا ى الكهربى من الجس الج ر مة القسم ت‬
‫‪)lead III :‬‬
‫و طي ا الرسم البجا ى الكهربى من الجس الج رة مة القسم ت‬
‫و احا الرسةم الكهربجق ادماج ركثر من رسم ه بالاال تكة مكبرة )‪ (augmented‬ولكن‬
‫تكة الصةر الراتجق كلها ما اويق يقةم الجهاز باكبجنر الصنةر ا خنرة الصنادرة منن ا طنرال‬
‫‪. )aVR , aVL, aVF‬‬
‫اجث المرل )‪ (V‬يار كل ق )‪ (Vector‬طة ال اجال الجال القمب )‪.)electrode‬‬
‫و مار كل ق ‪ )a‬ا ‪ )augmented‬طة مكبرة‬
‫و مار كل ق ‪ )R‬ا ‪)Right arm‬‬
‫و مار كل ق ‪ )L‬ا ‪)Left arm‬‬
‫و مر كل ق ‪ )F‬ا )‪.)Foot‬‬
‫و الرسةم الكهربجق تكة سداا ‪ 21‬مرتبق من الش ال للج جن ك ا يلى‪:‬‬
‫‪Lead I , lead II , lead III , aVR , aVL , aVF , V1 , V2 ,V3 ,V4 , V5 , V6‬‬
‫لق القلب‪:‬‬
‫والجسول الاالى يبجن كجفجق تابجر كل رسم بجا ى ‪ ) Lead‬ن زء من‬
‫سار القلب‬
‫‪Heart Wall‬‬
‫الرسم الكهربى ‪) lead‬‬
‫الجزء ارمامى والما ز البمجرى‬
‫‪V1, V2, V3, and V4‬‬
‫‪Anterior - Septal‬‬
‫الشريا ال غحى‬
‫‪left anterior descending‬‬
‫‪(LAD) branch of the left‬‬
‫‪coronary artery‬‬
‫الفرع ارمامى اري ر الهابف من الشريا‬
‫الاا ى اري ر‬
‫فم الشريا ط الا‬
‫‪Posterior‬‬
‫الجزء الخلفى‬
‫‪V1, and V2‬‬
‫‪Inferior‬‬
‫الجزء ال فلى‬
‫‪II, III, and aVF‬‬
‫)‪right coronary artery (RCA‬‬
‫الشريا الاا ى اري ن‬
‫‪High Lateral‬‬
‫الجزء الجا بى ار لى من الج ار‬
‫‪I, and aVL‬‬
‫‪Low Lateral‬‬
‫الجزء الجا بى ار لى من الج ار‬
‫‪V5, and V6‬‬
‫)‪left circumflex branch (LCA‬‬
‫‪of the left coronary artery‬‬
‫الفرع اري ر ال رامف من الشريا‬
‫الاا ى اري ر‬
‫ثانيا‪ :‬شاهد الفيديو‬
‫‪http://www.youtube.com/embed/NVwF8xdr_po‬‬
‫ النص اإلنجليزى للمحاضرة كامال‬:‫ثالثا‬
1.4 POSITION OF THE 12 ECG LEADS RELATIVE TO THE
HEART (VIDEO 4)
The different leads of the ECG examine cardiac electrical activity from
different perspectives. Learning the position of the leads of a standard
ECG relative to the heart is not as difficult as it seems and as we’ll see
later pays dividends in clinical practice. Consider the 12 leads in two
groups of six, with the six chest (also referred to as the precordial leads)
examining the flow of cardiac depolarisation and repolarisation in the
horizontal plan and a second group of six leads which examine these
events in the vertical plane. We will first deal with the horizontal groupthe precordial or chest leads. These 6 leads, V1 to V6 are placed on the
surface of the chest wall in an arc, from V1 in the 4th right intercostal
space to the right of the sternum to lead V2 in the fourth left intercostal
space to the left of the sternum and then at roughly equal intervals to lead
V6 in the fifth left intercostal space in the mid-axillary line*. These 6
chest leads examine the heart in the horizontal plane. In order to
understand their view of cardiac electrical activity we need to remind you
of the position of the heart in the chest cavity. The heart is positioned
such that the right and left atria sit behind and somewhat to the right of
the ventricles at the back of the chest. Furthermore, the organ is rotated
towards the left, so that the right ventricle lies anterior to the left
immediately behind the sternum. Therefore, V1 and V2 face the anterior
surface of the right ventricle, V3 and V4 look at the anterior surface of
the left ventricle while V5 and V6 look at the lateral surface of the left
ventricle. Modern machines present the printed ECG readout landscaped
on an A4 piece of paper and the signal from each of the chest leads is
recorded on the left hand side (anatomical left!) of this A4 ECG readout
in
numerical
order.
The remaining 6 ECG leads we can consider in two groups, the standard
leads; leads I, II and III, and the augmented leads; aVR, aVL and aVF.
These 6 leads look at the heart in a vertical plane known in anatomical
terms as the frontal plane. To remember the position of all 6 of the
vertical leads relative to the heart use lead I as your reference point. Lead
I looks directly at the heart from the patients left hand side and defines 00
in all further discussions of the frontal leads, lead II looks at the heart at
an angle 600 further clockwise while lead III is positioned a further 600
clockwise from II. These angles will become important in the next section
of this course. The readout from the standard leads, Leads I, II and III are
recorded down the right hand side of the ECG paper. We are now left
with three further leads to remember, the augmented leads aVR, aVL and
aVF, aVL looks at the heart from the left (L is for left) but at 30o
anticlockwise (or more to the left if you like) from lead I, aVR looks at
the right side of the heart (R is for right), and, just like aVL, it is 300
above the horizontal relative to lead I. aVF looks straight up at the
inferior surface of the heart and is therefore at 90o clockwise from lead I,
think of aVF as looking straight up at the heart from the feet (F is for
feet). On the ECG readout, recordings from the augmented leads are
positioned between the standard leads and the chest leads from aVR to
aVL
and
down
to
aVF
at
the
foot
of
the
page.
For the experienced practitioner, looking at different areas on the ECG
readout is like looking at different anatomical regions of the heart. Three
of the vertical leads II, III and aVF form a group examining the inferior
or diaphragmatic surface of the ventricles, a region supplied by the right
coronary artery (RCA), you will (eventually) get into the habit of seeing
these so-called inferior leads as a single entity in the bottom right hand
corner of the ECG. The chest leads V1 to V4 examine the anterior surface
of the ventricles and the septum, a region supplied by the left anterior
descending (LAD) artery. While leads I, aVL, V5 and V6 examine the
left lateral aspect of the left ventricle, a region supplied by the left
circumflex artery (LCA). In a subsequent section of this course, we’ll see
the key role that these groupings of leads play in diagnosing myocardial
infarction and in identifying the vessel obstructed in this condition.
KEYPOINTS: All of the above really
1. The chest leads examine the heart in the horizontal plane.
2. The frontal leads examine the heart in the vertical plane.
3. Leads II, III and aVF examine the region of the heart supplied by
the right coronary artery (RCA).
4. Leads V1-V4 examine the region of the heart supplied by the left
anterior descending (LAD) branch of the left coronary artery.
5. Leads I, aVL, V5 and V6 examine the region of the heart supplied
by the left circumflex branch (LCA) of the left coronary artery.
:‫لك را ة مار م ة ل لى الرابف الاالى‬
‫ى اال ا ااجاج رى تر ق من‬
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