two three yeah hey Katie what's going on 二三耶嘿凯蒂是怎么回事
oh hey dr. camka just taking a look at 哦，嘿博士。 camka只是看看
my patients EKGs trying to understand 我的病人EKG试图了解
what's going on in each of these leads I 这些导致我发生了什么
don't even have 12 leads you know that's 甚至没有12个线索你知道那个
a great question so we're looking at a 一个很好的问题，所以我们正在看一个
three-dimensional structure in 2d and so 二维立体结构等
the EKG represents a single snapshot of EKG代表了一个单一的快照
the heart's electrical rhythm from 12 心脏的电子节奏从12点开始
different angles oh so it's like a chest 不同的角度哦，所以它就像一个胸部
x-ray when we look at the lateral and 当我们看侧面和侧面时的 X射线
the frontal plane if we look at one view 如果我们看一个视图，那么正面
we might miss something you got it 我们可能会错过你得到的东西
exactly right and those 12 leads tell us 完全正确，那12个线索告诉我们
different portions of the heart the 心脏的不同部分
anterior the posterior and so forth and 前后等等
this actually leads us to our next 这实际上引导我们走向下一个
discussion so let's take a look at this 讨论所以让我们来看看这个
diagram here so we're taking a look at 这里有图表，所以我们来看看
the heart from 12 different angles right 从12个不同角度的心脏对
and so we have two sets of leads we have 所以我们有两套，我们有引线
the precordial leads right here which 心前导就在这里
are the chest leads the purple ones that 是胸部引导紫色的那个
are looking at the heart from the 正在研究从心脏的
horizontal axis and then we have the 水平轴然后我们有
green leads which are looking at the 绿色的线索正在看着
heart from the frontal axis and we can 从正面轴心脏，我们可以
take this to take a look at certain 拿这个来看一下
portions of the heart so we have two 心脏的一部分， 所以我们有两个
three and Avia that are looking at the 三个和Avia正在看着
inferior portion we have v1 through v4 下部我们有v1 到v4
that's looking at the anterior portion 那是在看前面的部分
of the heart and then on this side of me 心脏然后在 我的 这一边
we have v5 v6 and one an AVL they're 我们有v5 v6 和一个AVL他们
looking at the lateral portion of the 看着侧面部分
heart now let's take a look at how we 现在让我们来看看我们如何
can use the leads to tell us about the 可以使用线索告诉我们
axis or the flow of electricity for the 轴或电流为
heart so we hear a lot about axis what 心脏所以我们听到了很多关于轴线什么
is axis it simply represents the average 是轴，它只代表平均值
flow of electricity through the heart 通过心脏的电流
your normal heart leans down and to the 你的正常心脏向下倾斜
left so it makes sense that the average 离开所以平均值是有道理的
flow of electricity is also going to be 电流也将是
down into the left and we can take a 下到左侧，我们可以采取一个
look at the EKG to kind of tell us which 看心电图来样告诉我们哪些
direction the flow of electricity is 方向的电流是
through the heart normal hearts are 通过心脏正常的心脏
going to be somewhere between 0 degrees 将介于0度之间
and minus 90 right axis deviation is 和负90度的右轴偏差是
going to have the flow of the heart 要有心灵的流动
between 105 to positive 180 degrees left 在105到正180度之间
axis deviation is going to be minus 105 轴偏差将为负105
degrees to minus 度数减去
180 degrees but it can get a little bit 180度， 但它可以得到一点点
complicated so my friend mark here is a 复杂，所以我的朋友在这里标记是一个
very simple method that can help explain 非常简单的方法可以帮助解释
things yeah so I really like to use the 事情是的所以我真的很喜欢使用
quadrant method I've heard about that I 象限方法我听说过，我
like it yeah so the quadrant method we 喜欢它是的象限方法我们
mainly look at the QRS complex in two 主要看两个QRS复合体
leads please one in a Viet but what 请一个人在一个越南，但是什么
about all the other leaves mark well 关于所有其他叶子标记得很好
they're important too but we like to 他们是重要太多，但我们喜欢
keep it simple simple is always positive 保持简单简单总是积极的
so remember that lead one runs 所以请记住，一个人跑
horizontally and to the patient's left 水平和 患者的左
and lead AVF runs vertically and towards 并导致AVF垂直向前运行
the patient's feet so if we have a 病人的脚如果我们有一个
positive QRS complex and leads one and a 积极的QRS复合体并导致一个和一个
BF then we know our vector is somewhere BF然后我们知道我们的向量是某个地方
in between those two leads or normal 在这两个领导之间或正常
access that's pretty good mark let me 访问这个非常好的标记让我
make it a little bit more challenging 让它更具挑战性
for you so what if the lead is negative 对你而言如果领先是否定的话会怎样
in lead one and positive in AVF that 在AVF中处于领先地位且正面
would mean that our axis is somewhere in 意味着我们的轴在某个地方
this quadrant we would call that right 这象限我们称之为正确
axis deviation that's pretty good what 轴偏差是非常好的
about if it's positive and lead one and 关于它是否是积极的并且领导一个和
negative in AVF well though it means 虽然这意味着AVF很好
that our axis is somewhere in this 我们的轴就在这里
quadrant and we would call that left 象限，我们称之为左
that axis deviation exactly right so now 那个轴偏差现在完全正确
that we have a better understanding of 我们对此有了更好的了解
how to determine axis let's practice on 如何确定轴让我们练习
a couple 12 lead EKG z' all right now 一对夫妇12导联心电图Z”现在好了
let's practice determining axis here we 让我们在这里练习确定轴
have a complete 12 lead EKG which leads 有一个完整的12导联EKG领先
do we want to look at when we determine 我们确定的时候想看看吗？
axis remember that when we talk about 轴记住，当我们谈论
axis we're talking about the frontal 轴我们正在谈论正面
plane so we want to look at the limb 飞机所以我们要看看肢体
leads so let's take a closer look at 导致所以让我们仔细看看
those are which two leads were we 那些是我们的两个主角
looking at when we were using the 看着我们何时使用
quadrant method to determine access we 象限方法确定访问我们
were looking at lead one and AVF we can 我们正在寻找领先者和AVF
see in this EKG that lead one is 在这个EKG中看到的是领先者
positive meaning we have at all our wave 我们所有的浪潮都具有积极的意义
predominance and AVF is negative meaning 优势和AVF是负面意义
there's a predominant s-wave positive 有一个主要的s波正面
and one negative and AVF means left axis 一个负数，AVF表示左轴
deviation left axis deviation is 偏差左轴偏差是
commonly seen in conditions like left 常见于左翼等情况
ventricular hypertrophy which we can see 我们可以看到心室肥大
in patients that have long 在长期患者中
standing hypertension let's take a look 站立高血压让我们来看看
at another EKG now that you've got the 在另一个EKG，你已经得到了
skills let's take a look at another EKG 技巧让我们来看看另一个心电图
this one has a different axis deviation 这个轴偏差不同
so just like Mark taught us we're going 所以就像马克教我们一样
to focus in on those limb leads so let's 把注意力集中在那些肢体导联上，让我们来吧
zoom in on one and AVF so in one we have 放大一个和AVF所以我们有一个
mostly a downward deflection that 大多是向下偏转
predominant s-wave and then in AVF 主要是s波，然后是AVF
we see that it's mostly upright with a 我们看到它大部分是直立的
tall R wave this is a right axis 高R波这是一个右轴
deviation we see this most commonly and 我们最常见的偏见和偏见
someone with right ventricular 有右心室的人
hypertrophy where the right ventricles 右心室肥大
become bigger because it's pushing 变得更大，因为它正在推动
against elevated pulmonary artery 对抗肺动脉升高
pressure this is often an EKG that 压力这通常是心电图
you'll see in our pulmonary hypertension 你会看到我们的肺动脉高压症
patients you may have noticed that we've 患者你可能已经注意到我们已经
mentioned hypertrophy twice now as a 现在提到两次肥大作为一个
cause of axis deviation but in fact 事实上，轴偏差的原因
there are multiple things that can 有很多事情可以
affect our axis another important one is 影响我们的轴另一个重要的是
ischemia the mean vector will deviate 缺血时平均载体会偏离
away from the infarct right hypertrophy 远离梗塞右侧肥大
ischemia and many other things can 缺血和许多其他事情都可以
affect our axis it's important to 影响我们的轴是非常重要的
determine the axis on every EKG that you 确定每个EKG上的轴
see so remember determine rate rhythm 看到这样记得确定率节奏
axis on every EKG every time 每次EKG上的轴
you 您