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With the positive electrode on the left arm and the negative electrode on the right arm Lead
I provides a view of the left side of the heart looking toward the right.
With the positive electrode on the left leg and the negative electrode on the right arm Lead
II provides a view of the bottom (inferior aspect) of the heart looking toward the right arm.
With the positive electrode on the left leg and the negative electrode on the left arm Lead
III provides another inferior aspect of the heart looking toward the left arm.
Unipolar Limb Leads
The unipolar limb leads are identified by three letters. The first two are aV (augmented
voltage). The third letterR (right arm) L (left arm) or F (left leg)refers to the lead
placement of the positive electrode.
Unipolar, no aV needed
V1 and V2 are placed in the fourth intercostal space (ICS) just to the right and
left respectively of the sternum. Between ribs 4 and 5 is the fourth intercostal space.
V3 is placed between V2 and V4, either on the fifth rib or in the fifth interspace.
V4 is usually next. It is in the fifth intercostal space in the midclavicular line. About halfway
down the clavicle between the sternum and the shoulder just below the nipple.
V5 is positioned in the fifth intercostal space at the anterior axillary line. This line can be
found by placing the patients arm by his side and following the crease line from the armpit
down the front of the patients chest. Lead V5 is positioned where this line intersects the
fifth interspace.
V6 is placed at the fifth interspace mid-axillary line.
Leads V3 and V4 are commonly referred to as the anterior leads.
Leads V5 and V6 look at the heart from the lower aspect of the left side and so are known as
lateral leads.
Leads V4 V5 and V6 are all in a straight line in the fifth intercostal space
CHAPTER 2:
UNDERSTANDING THE 12-LEAD ECG PRINTOUT