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Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Cardiologists are becoming increasingly challenged to use the standard 12-lead electrocardiogram (ECG) for diagnosis of the precise location and relative size of myocardial infarcts. The cardiac electrical signal recorded on the body surface represents the summation vector of the individual vectors emerging from all of the segments at a particular point in time. In Figure 3 the initial 55 msec of the vector loops from the normal heart and from the heart with the medium sized anterior MI presented in Figure 1 are shown for comparison.
This is shown for the vector loops in 3 dimensional space, and their projection onto the horizontal plane (below) and frontal plane (behind). With this clear understanding of how the electrical activation of the ventricles of the heart as seen in the vector loop is altered by the MI induced abnormality (Heart to Loop), we can interpret the 12 lead signals of the electrocardiogram (ECG) more effectively (Loop to Leads). The Loop to Leads relationship is shown for the complete ventricular activation period in Figure 4. The same color code and timing used for the projected vector loops is repeated in the recordings of the ECG leads.

Simulations relating to other cardiac abnormalities, such as bundle branch block and left ventricular hypertrophy, will be added in the near future.
A sample of 3D illustrations of some of the other locations of MI and how this Heart to Loop to Leads method of illustration helps to identify the abnormality. This figure shows a Large Anterior MI and in the top diagram the point of obstruction by coronary thrombosis in the proximal LAD (red circle) and the arteries with obstructed flow in blue.
A new method of visual training is proposed to make these diagnoses more obvious and accurate. Figure 2 (on the left) illustrates the summation vector at 20 msec after the onset of ventricular activation in the normal heart as presented in Figure 1. These projected vector loops are color coded: 0-25 msec (red), 25-50 msec (blue), and 50-75 msec (green). In the case of the Anterior MI the major effect is seen in the precordial leads, principally leads V1 to V4.
The effect on the body surface electrical signals of the elimination of the anterior vectors by the MI appears as a distortion of the initial 40 msec of the vector loop.

The view is from above the heart and the vector loop; and the projection of the loop onto the horizontal plane.
The black lines represent the 6 horizontal plane leads, with their names (V1 to V6) indicated on their positive poles.
The recordings of the body surface electrical signals on each of these 6 leads are presented. There is an upward waveform when the summation of these signals is toward the lead’s positive pole, and a downward waveform when it is in the opposite direction. The projection of the vector loop onto these leads establishes the direction and magnitude of the summated electrical signals at each point in time.

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