[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-571866-105":3,"detail-sidebar-cat-1-en-105":74,"doc-detail-571866-en":120},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":67,"head_meta":69,"extra_data":71,"updated_unix":73},105,"en","the-ten-rules-of-the-12-lead-ecg-in-adults","The TEN Rules of the 12 Lead ECG in Adults","","Quick reference sheet summarizing key interpretation rules for a 12-lead ECG in adults. Lists ten specific criteria for wave polarity, ST segment behavior, PR interval, and QRS duration, plus localization guidance for ischemia or injury based on R-wave progression, QRS orientation, P-wave positivity, Q-wave presence, and T-wave polarity across lead groups. Includes quick initial assessment tips such as ruling out nonischemic ST elevation causes, additional recordings for inferior STEMI and posterior involvement, and pattern recognition for left main or multivessel disease and LBBB STEMI using the Sgarbossa criterion.",{"@graph":14,"@context":66},[15,34,49],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/the-ten-rules-of-the-12-lead-ecg-in-adults/571866/",4,{"url":32,"name":10,"@type":35,"author":36,"headline":10,"publisher":39,"fileFormat":42,"inLanguage":8,"description":12,"dateModified":43,"datePublished":43,"encodingFormat":42,"isAccessibleForFree":44,"interactionStatistic":45},"DigitalDocument",{"name":37,"@type":38},"Ophelia","Person",{"url":19,"name":40,"@type":41},"DocShare","Organization","application/pdf","2026-10-13",true,{"@type":46,"interactionType":47,"userInteractionCount":4},"InteractionCounter",{"@type":48},"ViewAction",{"@type":50,"mainEntity":51},"FAQPage",[52,58,62],{"name":53,"@type":54,"acceptedAnswer":55},"What are the TEN core interpretation rules for a 12-lead ECG in adults?","Question",{"text":56,"@type":57},"The sheet states ten rules covering aVR wave polarity, ST segment isoelectric behavior except in V1–V3, PR interval range, QRS duration limit, and directional relationships between QRS and T in limb leads. It also provides localization criteria tied to lead patterns for ischemia or injury.","Answer",{"name":59,"@type":54,"acceptedAnswer":60},"How does the sheet localize ischemia or injury from lead patterns?",{"text":61,"@type":57},"It uses precordial and limb-lead findings, including R-wave growth from V1 to at least V4, upright QRS in I and II, positive P waves in I, II, and V2–V6, absence or small Q waves in specified leads, and positive T waves in I, II, and V2–V6.",{"name":63,"@type":54,"acceptedAnswer":64},"What additional recordings does the sheet recommend during initial assessment?",{"text":65,"@type":57},"For inferior STEMI, it advises recording V4r to check for ST elevation suggesting RV involvement. For isolated ST depression in two of V1–V4, it recommends recording V7–V9 to assess possible posterior wall involvement.","https://schema.org",{"og:url":32,"og:type":68,"og:title":10,"og:site_name":40,"og:description":12},"article",{"robots":70,"canonical":32},"index,follow",{"doc_id":72,"site_id":7},571866,1791924130,{"code":4,"msg":75,"data":76},"success",[77,82,87,92,97,102,106,111,116],{"id":78,"doc_module":22,"doc_module_name":25,"category_name":79,"show_sort_weight":80,"slug":81},11,"Presentations",90,"presentations",{"id":83,"doc_module":22,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},12,"Resumes",80,"resumes",{"id":88,"doc_module":22,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},14,"Invoices",70,"invoices",{"id":93,"doc_module":22,"doc_module_name":25,"category_name":94,"show_sort_weight":95,"slug":96},15,"Posters",60,"posters",{"id":98,"doc_module":22,"doc_module_name":25,"category_name":99,"show_sort_weight":100,"slug":101},16,"Social Media",50,"social-media",{"id":103,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":104,"slug":105},17,40,"forms",{"id":107,"doc_module":22,"doc_module_name":25,"category_name":108,"show_sort_weight":109,"slug":110},18,"Letters",30,"letters",{"id":112,"doc_module":22,"doc_module_name":25,"category_name":113,"show_sort_weight":114,"slug":115},21,"Paper Templates",5,"papers-templates",{"id":117,"doc_module":22,"doc_module_name":25,"category_name":118,"show_sort_weight":4,"slug":119},158,"General","general-158",{"code":4,"msg":75,"data":121},{"doc_id":72,"user_id":122,"nickname":37,"user_avatar":123,"doc_module":22,"category_id":103,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":124,"file_id":125,"file_url":126,"file_type":127,"file_size":128,"view_count":4,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":129,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":130,"faqs":131,"seo_title":132,"seo_description":12,"update_tm":73,"read_time":22},7971461741311,"https://ap-avatar.wpscdn.com/avatar/74000253aff267980c6?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779345379180704826","The TEN Rules of the 12 Lead ECG in Adults  \n1. All waves are negative in lead aVR.  \n2. The ST starts isoelectric except in V1-V3  \n3. The PR interval should be 0.12-0.20sec.  \n4. The QRS complex should not exceed 0.12sec.  \n5. The QRS and T waves tend to have the same general direction in the limb leads.  \nLOCALISING Ischaemia or Injury ›  \n6. The R wave in the precordial leads grows V1 to at least V4.  \n7. The QRS is mainly upright (Positive) in I & II.  \n8. The P wave in upright (Positive) in I, II, V2-V6.  \n9. There is no Q wave or only a small q \u003C0.04 (1 small square) in width in I, II, V2-V6.  \n10. The T wave is upright (Positive) in I, II, V2-V6.  \nI Lateral  \nII  \nInferior  \nIII  \nInferior  \naVL Lateral  \naVF Inferior  \nV1 Anterior  \nV2 Anterior  \nV3 Anterior  \nV4 Anterior  \nV5 Lateral  \nV6 Lateral  \nLIMB LEADS ›  \nAXIS DEVIATION  \nQuick Initial Assessment ›  \nPOSITIONING  \nTIPS ›  \n• Rule out nonischaemic causes of ST elevation such as LVH, RBBB, LBBB, Early repolarisation, electrolyte abnormalities, ventricular pacing.  \n• For Inferior STEMI, record V4r to check for ST Elevation > 0. 5mm which suggests RV involvement.  \n• If there is isolated ST depression in two ofV1-V4 record V7 V8 V9 to check for ST elevation > 0.5mm which suggests posterior wall involvement / STEMI.  \n• ST Depression in 6 limb leads and ST Elevation in aVR and V1 may suggest left main obstruction or multivessel disease (NOTE: extreme tachycardia and other causes of ischaemia can produce this pattern) .  \n• LBBB with ST Elevation in a lead with upright QRS suggests STEMI (Sgarbossa criterion) .  \n12-Lead ECG Electrodes ›  \n© Designed in association with Mark Whitbread. Produced by Ortus Technology Ltd.  \nThe ECG card is used with the exclusion of any liability. The verification (of the values) is the responsibility of the individual.  \n• Broadened diagnostics with 22 leads  \n• Posterior leads V7–V9  \n• Right cardiac leads V3r–V6r  \n• Orthogonal leads X, Y, Z and Vectorloops  \n• Only 10 electrodes, extremities and chest leads  \nCalculate the CEB®  \nCardiac Electrical Biomarker from the same electrodes.  \nbout  \nScan the QR code to learn more about ECGmax. The corpuls revolution  \nof the ECG.  \n[hello@ortus.co.uk](hello@ortus.co.uk)[ ](hello@ortus.co.uk)[www.theortusgroup.com](www.theortusgroup.com)","cbCaic85Kjvjpr51","https://ap.wps.com/l/cbCaic85Kjvjpr51","pdf",2143129,"English","# The TEN Rules of the 12 Lead ECG in Adults\n## Localising Ischaemia or Injury\n## Quick Initial Assessment Tips\n## 12-Lead ECG Electrodes","[{\"question\":\"What are the TEN core interpretation rules for a 12-lead ECG in adults?\",\"answer\":\"The sheet states ten rules covering aVR wave polarity, ST segment isoelectric behavior except in V1–V3, PR interval range, QRS duration limit, and directional relationships between QRS and T in limb leads. It also provides localization criteria tied to lead patterns for ischemia or injury.\"},{\"question\":\"How does the sheet localize ischemia or injury from lead patterns?\",\"answer\":\"It uses precordial and limb-lead findings, including R-wave growth from V1 to at least V4, upright QRS in I and II, positive P waves in I, II, and V2–V6, absence or small Q waves in specified leads, and positive T waves in I, II, and V2–V6.\"},{\"question\":\"What additional recordings does the sheet recommend during initial assessment?\",\"answer\":\"For inferior STEMI, it advises recording V4r to check for ST elevation suggesting RV involvement. For isolated ST depression in two of V1–V4, it recommends recording V7–V9 to assess possible posterior wall involvement.\"}]","The TEN Rules of the 12 Lead ECG in Adults | PDF"]