Einthoven's triangle is an imaginary formation of three limb leads in a triangle used in electrocardiography, formed by the two shoulders and the pubis.[1] The shape forms an inverted equilateral triangle with the heart at the center that produces zero potential when the voltages are summed. It is named after Willem Einthoven, who theorized its existence.[2]
Einthoven used these measuring points, by immersing the hands and foot in pails of salt water, as the contacts for his string galvanometer, the first practical ECG machine.[3]
Lead placements
Lead I — This axis goes from shoulder to shoulder, with the negative electrode placed on the right shoulder and the positive electrode placed on the left shoulder. This results in a 0 degree angle of orientation.[4]
Lead II — This axis goes from the right arm to the left leg, with the negative electrode on the shoulder and the positive one on the leg. This results in a +60 degree angle of orientation.[4]
Lead III — This axis goes from the left shoulder (negative electrode) to the right or left leg (positive electrode). This results in a +120 degree angle of orientation.[4]
Electrodes may be placed distally or proximally on the limb without affecting the recording.[5] The right leg electrode acts to reduce interference, and can be placed anywhere without an effect on the ECG results.[6]
Each lead measures the electric field created by the heart during the depolarization and repolarization of myocytes. The electric field can be represented as a vector that changes continuously and can be measured by recording the voltage difference between electrodes.[7]
Using Einthoven's triangle to identify lead misplacements
Though Einthoven's triangle is no longer used in contemporary ECGs, Einthoven's triangle can be helpful in the identification in incorrect placement of leads. (Incorrect placement of leads can lead to error in the recording, which can ultimately lead to misdiagnosis.)
If the arm electrodes are reversed, lead I changes polarity, causing lead II and lead III to switch. If the right arm electrode is reversed with the leg's electrode, lead II changes polarity, causing lead I to become lead III, and vice versa. Reversal of the left arm and leg causes a change in polarity of lead III and switching of leads I and II.[6]
References
^Lippincott Williams & Wilkins (1 August 2009). ECG Facts Made Incredibly Quick!. Lippincott Williams & Wilkins. p. 5. ISBN 978-1-60547-476-2.
^Understanding Electrocardiography. Elsevier Health Sciences. 2003. p. 4. ISBN 0-323-01905-6.
^Silverman, M. E. (1992-10-01). "Willem Einthoven--the father of electrocardiography". Clinical Cardiology. 15 (10): 785–787. doi:10.1002/clc.4960151020. ISSN 0160-9289. PMID 1395193.
^ abcThe Only EKG Book You'll Ever Need. Lippincott Williams & Wilkins. 2003. p. 40. ISBN 0-7817-4176-9.
^Klabunde, Richard E (2005-01-01). Cardiovascular Physiology Concepts. Lippincott Williams & Wilkins. pp. 34–35. ISBN 9780781750301.
^ abAbi-Saleh, Bernard; Omar, Bassam (2010-01-01). "Einthoven's triangle transparency: a practical method to explain limb lead configuration following single lead misplacements". Reviews in Cardiovascular Medicine. 11 (1): 33–38. ISSN 1530-6550. PMID 20495514.
^Richardson, Daniel R.; Randall, David Clark; Speck, Dexter F. (1998-03-13). Cardiopulmonary System Structure and Function. Hayes Barton Press. pp. 99–101. ISBN 9781889325309.
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…voltage of the limb leads. This idealized site is meant to represent a reference at the center of Einthoven triangle where total current is zero. The central terminal is referred to as the reference or indifferent…
…right arm, left arm, and left leg (the right leg has a ground electrode) to form a triangle (Einthoven triangle). In addition to the original three bipolar leads, the standard 12-lead ECG now records three …
English Journal
Minimization of the Wilson's Central Terminal voltage potential via a genetic algorithm.
Moeinzadeh H, Bifulco P, Cesarelli M, McEwan AL, O'Loughlin A, Shugman IM, Tapson JC, Thiagalingam A, Gargiulo GD.
BMC research notes. 2018 Dec;11(1)915.
The Wilson Central Terminal (WCT) is an artificially constructed reference for surface electrocardiography, which is assumed to be near zero and steady during the cardiac cycle; namely it is the simple average of the three recorded limbs (right arm, left arm and left leg) composing the Einthoven tri
On the Einthoven Triangle: A Critical Analysis of the Single Rotating Dipole Hypothesis.
Gargiulo GD, Bifulco P, Cesarelli M, McEwan AL, Moeinzadeh H, O'Loughlin A, Shugman IM, Tapson JC, Thiagalingam A.
Sensors (Basel, Switzerland). 2018 Jul;18(7).
Since its inception, electrocardiography has been based on the simplifying hypothesis that cardinal limb leads form an equilateral triangle of which, at the center/centroid, the electrical equivalent of the cardiac activity rotates during the cardiac cycle. Therefore, it is thought that the three li
Professor Herman Burger (1893-1965), eminent teacher and scientist, who laid the theoretical foundations of vectorcardiography--and electrocardiography.
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Journal of electrocardiology. ;47(2)168-74.
Einthoven not only designed a high quality instrument, the string galvanometer, for recording the ECG, he also shaped the conceptual framework to understand it. He reduced the body to an equilateral triangle and the cardiac electric activity to a dipole, represented by an arrow (i.e. a vector) in th
… From the theoretical point of view, the concept of the ventricular gradient (VG) is thought to be interesting in the interpretation of the clinical electrocardiogram, but there has been few studies on the relationships between the ventricular gradient and the histologic findings of the ventricular myocardium.The author determined the frontal plane VG from the Einthoven's triangle with Leads 1 and 2 and the horizontal plane VG with Leads V<SUB>1</SUB> …
There are three lead systems that make up the standard ECG: Standard Limb Leads (Bipolar): I, IlI & III Augmented Limb Leads (Unipolar): aVR, aVL & aVF Precordial Leads: V1- V6 The Standard Limb Leads are used to display a ...
324: Einthoven's TriangleEinthoven's Triangle lessons and EKG practice strips ... Introduction By use of three sensors, one each placed on the right arm, left arm and left leg, we are able to obtain six different views. The first three ...
The Einthoven triangle is central to the field of electrocardiography, but the concept of cardiac vectors is often a difficult notion for students to grasp. To illustrate this principle, we constructed a device that recreates the ...