Jorge Uzquiano MD

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Just like we use letters to read words, we can use cardiac vectors to read and interpret heartbeats, with the same precision every time. The task of interpreting heartbeats is very easy; there are only two types of cardiac vectors, narrow and wide. And to make things much easier yet, we only look for narrow vectors.

Narrow vectors are fast, and they are always at the onset of all normal supraventricular heartbeats. The other heartbeats, with a wide deflection at the onset of QRS complexes, are ventricular heartbeat.

The dreaded WIDE QRS TACHYCARDIAS diagnosis now becomes a simple task to resolve; the tachycardia is supraventricular if a narrow vector is at the QRS onset. It is a ventricular tacycardia, if a wide vector is at the onset of the QRS complex.

A narrow vector (narrow deflection) is contained witin the confines of the little square of the ECG paper. All narrow deflections are of supraventricular origin, where all myocardial cells beat simultaneously, via Purkinje's fibers.

Vector +1 moves to the right; it is recorded as a tiny, upright deflection in lead V1; this vector +1 represents the normal septal contraction, which initiates the normal ventricular heartbeat; this vector is the 'fingerprint' which identifies all supraventricular heartbeats.

Wide QRS Tachycardias with an initial narrow deflections are Supraventricular Tachycardias. Ventricular Tachycardias have wide vectors only.

Opposite recording electrodes register 'upside down' 'mirror images;' therefor, ST segment depressions of an acute 'non ST' or 'Subendocardial infarcts' over the precordial leads, are actually acute ST posterior wall infarcts, on posterior cardiac leads.

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