The interpretation of gross left axis deviation in the electrocardiogram.

European journal of cardiology Pub Date : 1979-10-01
H B Burchell, N Tuna
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Abstract

In 94 patients with prominent left axis deviation, there was a marked disparity in the mean angles determined by the maximum magnitude of the deflections and that determined by areas. There was also considerable variation in the angle of the maximum vector in the frontal plane (frontal plane angle) and the angle of 50 msec vector in the frontal plane. Similar results were observed in 17 cases of ostium primum atrial septal defect. These differences contrasted with the findings in a normal group of 50 subjects where a close correlation was found. The initial vector was directed to the right in approximately 80% of normals and 60% of the patients with LAD indicative of conduction defects in the left anterior fascicular or its distal ramifications. We conclude that a rightward orientation of the 5--10 msec vector (i.e. causing a Q wave in lead 1) should not be required for diagnosis of left anterior fascicular block. The spatial orientation of the initial vector was always anterior in the control subjects. In these 'normals', as well as in the patients with left axis deviation, the initial vector varied markedly in its azimuth direction (right or left) when superiorly directed; but when inferiorly directed in the normal subjects it was virtually always directed rightward. From these data we were unable to construct rigid criteria which would reliably distinguish aberrant excitation patterns manifested by gross left axis deviation in the electrocardiograms of patients with established heart disease from subjects without defined heart disease. Old infarction patterns, anterior, inferior, and lateral were not obscured by the associated anterior fascicular block.

心电图左轴总偏差的解释。
在94例左轴偏离明显的患者中,由最大偏移量决定的平均角度与由面积决定的平均角度存在明显差异。最大矢量在锋面的夹角(锋面角)和50msec矢量在锋面的夹角也有较大的变化。对17例原发性房间隔缺损患者进行了类似的治疗。这些差异与50名正常受试者的研究结果形成鲜明对比,后者发现了密切的相关性。大约80%的正常人和60%的LAD患者的初始矢量指向右侧,这表明左前肌束或其远端分支存在传导缺陷。我们的结论是,5- 10毫秒矢量的向右方向(即在导联1中引起Q波)不应该被诊断为左前束传导阻滞。在对照组中,初始向量的空间方向始终是前向的。在这些“法线”中,以及在左轴偏离的患者中,当向上定向时,初始矢量在其方位角方向(右或左)上明显变化;但在正常受试者中,当向下引导时,它实际上总是向右引导。从这些数据中,我们无法建立严格的标准来可靠地区分异常兴奋模式,这些异常兴奋模式表现为确定的心脏病患者的心电图左轴偏离与未确定的心脏病受试者。前、下、外侧的旧梗死模式未被相关的前束阻滞所掩盖。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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