To Which Lead View Should We Set The ECG Monitor?:
Lead II (initially, normally for most patients)
The 12 Lead ECG provides an excellent view of the electrical activity within the heart from 12 different perspectives; but, if only one choice for one view from one perspective, we normally choose, or begin with Lead II.
Lead II is the most common, most popular, and generally the best view because the placement of the positive electrode in Lead II views the wavefront of the impulse from the inferior aspect of the heart, as it travels from the right shoulder (RA) towards the left leg (LL). This view is in line with the mean electrical vector of the impulse that originates in the SA node, moving toward the Purkinje fibers.
By setting the ECG monitor to Lead II, we are essentially viewing the impulse as it travels from the right atria toward the left ventricle; hence, Lead II is the “best seat in the house” for viewing the wavefront. On a telemetry unit, you will see most, if not all monitors are set to Lead II for this reason.
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