The Chest Lead Electrocardiogram in Health

Abstract

In this investigation 100 healthy adults were personally examined clinically, radiologically, and electrocardiographically. The leads in each subject included standard limb leads and unipolar limb leads (not analysed in this paper), and chest leads in positions 1 to 6 (American Heart Association, 1938) and in position 7 in the posterior axillary line (Evans and Hunter, 1943) The CR and V leads were taken in all subjects, but the CF leads were discontinued after the first 50 (aged 40 to 71 years) because of their variability. The voltage at the chest electrode was usually much higher than at the indifferent electrode, whether CR, V, or even CF was used, so that the pattern of the chest lead electrocardiogram depended more on the position of the chest electrode than on the choice of the indifferent electrode (Wilson, 1937). When the findings were common to CR, V, and CF, the chest leads were referred to as Cl or C2 or C3, etc. Of the 100 healthy adults the majority were males; 50 were between the ages of 18 and 40 years (average 27), and 50 were between 40 and 71 years (average 53). They were without symptoms or abnormal physical signs and the blood pressure was always normal. Fluoroscopy of the heart and chest was normal. The records were always taken on a couch in the semi-recumbent position. The majority of the younger subjects were either medical students, medical officers, or hospital porters. Many of the older group had indigestion, but the pain of coronary artery disease was not simulated; if there was doubt they were excluded. It happened that the subjects were seldom stout, but six women with cyesis were deliberately included. 213 p

Appropriate leads in electrocardiography.

“…in V7, confirming that the CR leads almost invariably gave more positive deflections. The same finding was reported by Leatham (1950). The CR lead is of particular value in position one (just to the right of the sternum in the fourth interspace), where the T wave was upright in CR1 but inverted in V1 in 42 among 200 (21 %) of the cases examined from this particular aspect (Table Ifl and Fig.…”

Electrocardiography in Mitral Valvular Disease

“…In normal adults Leatham (1950) found R/S in VI was always<1 and the maximum ratio recorded by Sokolow and Friedlander (1949) was 1. In our consecutive series of 2000 cardiograms R/S>1 was not found in any patient without some pathological condition likely to give rise to R.V.H.…”

“…Reynolds (1953) suggests that the first peak of the bifid P wave derives from the right atrium and the second peak from the left atrium. Broad and slightly notched P waves may be seen in hypertensive heart disease and Leatham (1950) reported slight notching in 17 per cent of his 100 normal cases although it was never pronounced. These observations make it impossible to be certain that such minor changes are pathological in a case of mitral valvular disease.…”

“…in patients in this series was primarily based on the criteria suggested by Wilson (1947), by Myers et al (1948), by Sokolow and Lyon (1949 a and b), and by Carouso et al (1951) and subsequently modified in the light of the analysis of our own clinical and post-mortem material. We have also taken into account analyses of normal unipolar cardiograms by Sokolow and Friedlander (1949), by Leatham (1950), and the authors quoted in Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Blood Vessels (1953), and in our own department. Justification for the criteria accepted rests on presumptive evidence for R.V.H.…”

Electrocardiogram of pure left ventricular hypertrophy and its differentiation from lateral ischaemia.

“…The limitations of this criterion, however, are not always appreciated. There is a wide range of RS voltage in healthy subjects2 6 and hence considerable overlap between the voltage in left ventricular hypertrophy and that in normal individuals. If the dividing line is set low enough to include all patients with left ventricular hypertrophy it inevitably includes a considerable proportion of those who do not have left ventricular hypertrophy.…”