1
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two three yeah hey Katie what's going on
 二三耶嘿凯蒂是怎么回事

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oh hey dr. camka just taking a look at
 哦，嘿博士。 camka只是看看

3
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my patients EKGs trying to understand
 我的病人EKG试图了解

4
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what's going on in each of these leads I
 这些导致我发生了什么

5
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don't even have 12 leads you know that's
甚至没有12个线索你知道那个

6
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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

7
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three-dimensional structure in 2d and so
二维立体结构等

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the EKG represents a single snapshot of
 EKG代表了一个单一的快照

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the heart's electrical rhythm from 12
 心脏的电子节奏从12点开始

10
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different angles oh so it's like a chest
不同的角度哦，所以它就像一个胸部

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x-ray when we look at the lateral and
 当我们看侧面和侧面时的 X射线

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the frontal plane if we look at one view
 如果我们看一个视图，那么正面

13
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we might miss something you got it
我们可能会错过你得到的东西

14
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exactly right and those 12 leads tell us
 完全正确，那12个线索告诉我们

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different portions of the heart the
 心脏的不同部分

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anterior the posterior and so forth and
 前后等等

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this actually leads us to our next
这实际上引导我们走向下一个

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discussion so let's take a look at this
 讨论所以让我们来看看这个

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diagram here so we're taking a look at
 这里有图表，所以我们来看看

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the heart from 12 different angles right
 从12个不同角度的心脏对

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and so we have two sets of leads we have
所以我们有两套，我们有引线

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the precordial leads right here which
心前导就在这里

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are the chest leads the purple ones that
是胸部引导紫色的那个

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are looking at the heart from the
 正在研究从心脏的

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horizontal axis and then we have the
 水平轴然后我们有

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green leads which are looking at the
绿色的线索正在看着

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heart from the frontal axis and we can
从正面轴心脏，我们可以

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take this to take a look at certain
拿这个来看一下

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portions of the heart so we have two
 心脏的一部分， 所以我们有两个

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three and Avia that are looking at the
 三个和Avia正在看着

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inferior portion we have v1 through v4
下部我们有v1 到v4

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that's looking at the anterior portion
 那是在看前面的部分

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of the heart and then on this side of me
 心脏然后在 我的 这一边

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we have v5 v6 and one an AVL they're
我们有v5 v6 和一个AVL他们

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looking at the lateral portion of the
看着侧面部分

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heart now let's take a look at how we
 现在让我们来看看我们如何

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can use the leads to tell us about the
可以使用线索告诉我们

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axis or the flow of electricity for the
轴或电流为

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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

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is axis it simply represents the average
是轴，它只代表平均值

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flow of electricity through the heart
 通过心脏的电流

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your normal heart leans down and to the
 你的正常心脏向下倾斜

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left so it makes sense that the average
 离开所以平均值是有道理的

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flow of electricity is also going to be
电流也将是

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down into the left and we can take a
 下到左侧，我们可以采取一个

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look at the EKG to kind of tell us which
看心电图来样告诉我们哪些

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direction the flow of electricity is
方向的电流是

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through the heart normal hearts are
通过心脏正常的心脏

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going to be somewhere between 0 degrees
将介于0度之间

50
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and minus 90 right axis deviation is
和负90度的右轴偏差是

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going to have the flow of the heart
要有心灵的流动

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between 105 to positive 180 degrees left
 在105到正180度之间

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axis deviation is going to be minus 105
轴偏差将为负105 

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degrees to minus
度数减去

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180 degrees but it can get a little bit
 180度， 但它可以得到一点点

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complicated so my friend mark here is a
 复杂，所以我的朋友在这里标记是一个

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very simple method that can help explain
非常简单的方法可以帮助解释

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things yeah so I really like to use the
 事情是的所以我真的很喜欢使用

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quadrant method I've heard about that I
象限方法我听说过，我

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like it yeah so the quadrant method we
喜欢它是的象限方法我们

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mainly look at the QRS complex in two
主要看两个QRS复合体

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leads please one in a Viet but what
 请一个人在一个越南，但是什么

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about all the other leaves mark well
关于所有其他叶子标记得很好

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they're important too but we like to
他们是重要太多，但我们喜欢

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keep it simple simple is always positive
保持简单简单总是积极的

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so remember that lead one runs
 所以请记住，一个人跑

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horizontally and to the patient's left
水平和 患者的左

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and lead AVF runs vertically and towards
并导致AVF垂直向前运行

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the patient's feet so if we have a
病人的脚如果我们有一个

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positive QRS complex and leads one and a
积极的QRS复合体并导致一个和一个

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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

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in between those two leads or normal
在这两个领导之间或正常

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access that's pretty good mark let me
 访问这个非常好的标记让我

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make it a little bit more challenging
让它更具挑战性

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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

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in lead one and positive in AVF that
 在AVF中处于领先地位且正面

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would mean that our axis is somewhere in
意味着我们的轴在某个地方

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this quadrant we would call that right
 这象限我们称之为正确

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axis deviation that's pretty good what
轴偏差是非常好的

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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

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negative in AVF well though it means
 虽然这意味着AVF很好

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that our axis is somewhere in this
 我们的轴就在这里

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quadrant and we would call that left
 象限，我们称之为左

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that axis deviation exactly right so now
那个轴偏差现在完全正确

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that we have a better understanding of
 我们对此有了更好的了解

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how to determine axis let's practice on
如何确定轴让我们练习

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a couple 12 lead EKG z' all right now
一对夫妇12导联心电图Z”现在好了

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let's practice determining axis here we
让我们在这里练习确定轴

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have a complete 12 lead EKG which leads
 有一个完整的12导联EKG领先

90
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do we want to look at when we determine
 我们确定的时候想看看吗？

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axis remember that when we talk about
轴记住，当我们谈论

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axis we're talking about the frontal
轴我们正在谈论正面

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plane so we want to look at the limb
飞机所以我们要看看肢体

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leads so let's take a closer look at
导致所以让我们仔细看看

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those are which two leads were we
那些是我们的两个主角

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looking at when we were using the
看着我们何时使用

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quadrant method to determine access we
象限方法确定访问我们

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were looking at lead one and AVF we can
我们正在寻找领先者和AVF

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see in this EKG that lead one is
在这个EKG中看到的是领先者

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positive meaning we have at all our wave
 我们所有的浪潮都具有积极的意义

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predominance and AVF is negative meaning
优势和AVF是负面意义

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there's a predominant s-wave positive
有一个主要的s波正面

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and one negative and AVF means left axis
一个负数，AVF表示左轴

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deviation left axis deviation is
偏差左轴偏差是

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commonly seen in conditions like left
常见于左翼等情况

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ventricular hypertrophy which we can see
 我们可以看到心室肥大

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in patients that have long
在长期患者中

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standing hypertension let's take a look
站立高血压让我们来看看

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at another EKG now that you've got the
在另一个EKG，你已经得到了

110
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skills let's take a look at another EKG
技巧让我们来看看另一个心电图

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this one has a different axis deviation
 这个轴偏差不同

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so just like Mark taught us we're going
 所以就像马克教我们一样

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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

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zoom in on one and AVF so in one we have
 放大一个和AVF所以我们有一个

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mostly a downward deflection that
大多是向下偏转

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predominant s-wave and then in AVF
主要是s波，然后是AVF

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we see that it's mostly upright with a
 我们看到它大部分是直立的

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tall R wave this is a right axis
 高R波这是一个右轴

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deviation we see this most commonly and
 我们最常见的偏见和偏见

120
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someone with right ventricular
有右心室的人

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hypertrophy where the right ventricles
 右心室肥大

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become bigger because it's pushing
变得更大，因为它正在推动

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against elevated pulmonary artery
对抗肺动脉升高

124
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pressure this is often an EKG that
压力这通常是心电图

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you'll see in our pulmonary hypertension
 你会看到我们的肺动脉高压症

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patients you may have noticed that we've
患者你可能已经注意到我们已经

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mentioned hypertrophy twice now as a
现在提到两次肥大作为一个

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cause of axis deviation but in fact
 事实上，轴偏差的原因

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there are multiple things that can
 有很多事情可以

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affect our axis another important one is
 影响我们的轴另一个重要的是

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ischemia the mean vector will deviate
缺血时平均载体会偏离

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away from the infarct right hypertrophy
远离梗塞右侧肥大

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ischemia and many other things can
 缺血和许多其他事情都可以

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affect our axis it's important to
 影响我们的轴是非常重要的

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determine the axis on every EKG that you
确定每个EKG上的轴

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see so remember determine rate rhythm
看到这样记得确定率节奏

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axis on every EKG every time
每次EKG上的轴

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you
您