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Why complicate an important task? An orderly display of the limb leads in the 12-lead electrocardiogram and its implications for recognition of acute coronary syndrome

Lindow, T. LU ; Birnbaum, Y. ; Nikus, K. ; Maan, A. ; Ekelund, U. LU orcid and Pahlm, O. LU (2019) In BMC Cardiovascular Disorders 19(1).
Abstract

Background: In the standard ECG display, limb leads are presented in a non-anatomical sequence: I, II, III, aVR, aVL, aVF. The Cabrera system is a display format which instead presents the limb leads in a cranial/left-to-caudal/right sequence, i.e. in an anatomically sequential order. Lead aVR is replaced in the Cabrera display by its inverted version, -aVR, which is presented in its logical place between lead I and lead II. Main text: In this debate article possible implications of using the Cabrera display, instead of the standard, non-contiguous lead display, are presented, focusing on its use in patients with possible acute coronary syndrome. The importance of appreciating reciprocal limb-lead ECG changes and the diagnostic and... (More)

Background: In the standard ECG display, limb leads are presented in a non-anatomical sequence: I, II, III, aVR, aVL, aVF. The Cabrera system is a display format which instead presents the limb leads in a cranial/left-to-caudal/right sequence, i.e. in an anatomically sequential order. Lead aVR is replaced in the Cabrera display by its inverted version, -aVR, which is presented in its logical place between lead I and lead II. Main text: In this debate article possible implications of using the Cabrera display, instead of the standard, non-contiguous lead display, are presented, focusing on its use in patients with possible acute coronary syndrome. The importance of appreciating reciprocal limb-lead ECG changes and the diagnostic and prognostic value of including aVR or lead -aVR in ECG interpretation in acute coronary syndrome is covered. Illustrative cases and ECGs are presented with both the standard and contiguous limb lead display for each ECG. A contiguous lead display is useful when diagnosing acute coronary syndrome in at least 3 ways: 1) when contiguous leads are present adjacent to each other, identification of ST elevation in two contiguous leads is simple; 2) a contiguous lead display facilitates understanding of lead relationships as well as reciprocal changes; 3) it makes the common neglect of lead aVR unlikely. Conlusions: It is logical to display the limb leads in their sequential anatomical order and it may have advantages both in diagnostics and ECG learning.

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Please use this url to cite or link to this publication:
author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BMC Cardiovascular Disorders
volume
19
issue
1
article number
13
publisher
BioMed Central (BMC)
external identifiers
  • pmid:30630413
  • scopus:85059829160
ISSN
1471-2261
DOI
10.1186/s12872-018-0979-x
language
English
LU publication?
yes
id
375e7eaf-67c4-422a-b9f0-5b6b5c7d5668
date added to LUP
2019-01-23 12:29:45
date last changed
2024-10-30 17:49:44
@article{375e7eaf-67c4-422a-b9f0-5b6b5c7d5668,
  abstract     = {{<p>Background: In the standard ECG display, limb leads are presented in a non-anatomical sequence: I, II, III, aVR, aVL, aVF. The Cabrera system is a display format which instead presents the limb leads in a cranial/left-to-caudal/right sequence, i.e. in an anatomically sequential order. Lead aVR is replaced in the Cabrera display by its inverted version, -aVR, which is presented in its logical place between lead I and lead II. Main text: In this debate article possible implications of using the Cabrera display, instead of the standard, non-contiguous lead display, are presented, focusing on its use in patients with possible acute coronary syndrome. The importance of appreciating reciprocal limb-lead ECG changes and the diagnostic and prognostic value of including aVR or lead -aVR in ECG interpretation in acute coronary syndrome is covered. Illustrative cases and ECGs are presented with both the standard and contiguous limb lead display for each ECG. A contiguous lead display is useful when diagnosing acute coronary syndrome in at least 3 ways: 1) when contiguous leads are present adjacent to each other, identification of ST elevation in two contiguous leads is simple; 2) a contiguous lead display facilitates understanding of lead relationships as well as reciprocal changes; 3) it makes the common neglect of lead aVR unlikely. Conlusions: It is logical to display the limb leads in their sequential anatomical order and it may have advantages both in diagnostics and ECG learning.</p>}},
  author       = {{Lindow, T. and Birnbaum, Y. and Nikus, K. and Maan, A. and Ekelund, U. and Pahlm, O.}},
  issn         = {{1471-2261}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Cardiovascular Disorders}},
  title        = {{Why complicate an important task? An orderly display of the limb leads in the 12-lead electrocardiogram and its implications for recognition of acute coronary syndrome}},
  url          = {{http://dx.doi.org/10.1186/s12872-018-0979-x}},
  doi          = {{10.1186/s12872-018-0979-x}},
  volume       = {{19}},
  year         = {{2019}},
}