Abstract
Recent investigations in the field of electrocardiography have been directed towards methods for the more accurate detection and localization of myocardial lesions. The 3 conventional leads frequently fail to detect alterations consequent to a lesion and they have recently been supplemented by chest and precordial leads introduced by Wolferth and Wood, 1 , 2 , 3 , 4 , 5 Hoffman and Delong, 6 Wilson and his co-workers 7 , 8 , 9 , 10 and others. However cases of acute coronary occlusion which fail to produce electrocardiographic alterations even in these leads are not an uncommon occurrence. In this communication I will discuss a method of chest lead application which I previously reported with the study of a series of normal cases. 11 My method entails the use of long linear electrodes placed parallel to and beyond the borders of the heart anteriorly and posteriorly. Various combinations of these electrodes are used in the hope of utilizing other recording planes.
The right and left arm electrode wires of the conventional leads are connected to the chest electrodes in such a manner that the current take-off is kept in the same relationship to the current direction within the heart as in lead I of the 3 standard leads. The right arm electrode wire is therefore always'connected to the chest electrode which lies in closest relation to the tail of the arrow while the left arm electrode wire is connected to the chest electrode which lies in closest relation to the head of the arrow representing the heart action current direction. The size of the heart and the position of the cardiac borders are determined. The chest electrodes are placed about 2 or 3 cm. beyond the estimated position of the borders of the heart.
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