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ECG Lead positioning

The ECG is one of the most useful investigations in medicine. Electrodes attached to the chest and/or limbs record small voltage changes as potential difference, which is transposed into a visual tracing

3-electrode system

Uses 3 electrodes (RA, LA and LL)
Monitor displays the bipolar leads (I, II and III)
To get best results – Place electrodes on the chest wall equidistant from the heart (rather than the specific limbs)

5-electrode system

Uses 5 electrodes (RA, RL, LA, LL and Chest)
Monitor displays the bipolar leads (I, II and III)
AND a single unipolar lead (depending on position of the brown chest lead (positions V1–6))

12-lead ECG

10 electrodes required to produce 12-lead ECG
- 4 Electrodes on all 4 limbs (RA, LL, LA, RL)6 Electrodes on precordium (V1–6)
Monitors 12 leads (V1–6), (I, II, III) and (aVR, aVF, aVL)
Allows interpretation of specific areas of the heart
- Inferior (II, III, aVF)Lateral (I, aVL, V5, V6)Anterior (V1–4)

12-lead Precordial lead placement

V1: 4th intercostal space (ICS), RIGHT margin of the sternum
V2: 4th ICS along the LEFT margin of the sternum
V4: 5th ICS, mid-clavicular line
V3: midway between V2 and V4
V5: 5th ICS, anterior axillary line (same level as V4)
V6: 5th ICS, mid-axillary line (same level as V4)

Additional Lead placements

Right sided ECG electrode placement

There are several approaches to recording a right-sided ECG:

A complete set of right-sided leads is obtained by placing leads V1-6 in a mirror-image position on the right side of the chest (see diagram, below).
It can be simpler to leave V1 and V2 in their usual positions and just transfer leads V3-6 to the right side of the chest (i.e. V3R to V6R).
The most useful lead is V4R, which is obtained by placing the V4 electrode in the 5th right intercostal space in the mid-clavicular line.
ST elevation in V4R has a sensitivity of 88%, specificity of 78% and diagnostic accuracy of 83% in the diagnosis of RV MI.

V4R ECG lead placement

Erhardt et al first described the use of a right sided precordial lead (CR4R or V4R) in the diagnosis of right ventricular infarction which had previously been thought to be electrocardiographically silent. [Single right-sided precordial lead in the diagnosis of right ventricular involvement in inferior myocardial infarction.

Posterior leads

Leads V7-9 are placed on the posterior chest wall in the following positions:

V7 – Left posterior axillary line, in the same horizontal plane as V6.
V8 – Tip of the left scapula, in the same horizontal plane as V6.
V9 – Left paraspinal region, in the same horizontal plane as V6.

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Biochemistry

Biochemistry is the study of chemical and biochemical components in the body for preventing, diagnosing and managing the disease. Diseases like diabetes, heart attacks, infertility, thyroid problems, cystic fibrosis and meningitis can be diagnosed by the examination of body fluids including blood, urine and CSF.

The Clinical Biochemistry division at Apollo Diagnostics is a new generation laboratory featuring state-of-the-art equipment and technology. It provides comprehensive clinical laboratory services in the extensive domain of clinical chemistry, therapeutic drug monitoring, endocrinology and clinical toxicology. The department carries out a range of esoteric testing such as identification of hemoglobin variants and HbA1c quantification.

The experienced team of professionals – medical scientists, clinicians, laboratory technicians, technical assistants and phlebotomists – are capable of providing the medical and scientific expertise needed to deliver hi-precision results.

Clinical Pathology

The Department of Clinical Pathology at Vibhuti HealthCare supports the diagnosis of disease using laboratory testing of blood and other bodily fluids, tissues, and microscopic evaluation of individual cells.

The department employs advanced computer technology and automated equipment. A wide range of point-of-care equipment is also available to get specimen testing straight to the intensive care units and the operating rooms.

The laboratory scientists and pathologists work in close association with the clinical biochemistry team and the division of Hematology to deliver high quality, timely and affordable services.

Histocytopathology

The Vibhuti HealthCare’ Histopathology laboratory is a state-of-the-art facility specialising in the analysis of biopsies of all sorts and also comprises of the cytopathology and immunohistochemistry divisions. It facilitates to provide diagnostic examinations for specimens consisting of both gynaecologic and non-gynaecologic samples and all other organ systems of the human body. These include analysis of pap tests, body fluid evaluations and diagnostic examination of fine needle aspirations.

The Histopathology department is strengthened by a highly experienced and skilled team of senior consultants. A committed and honest team of exceptionally trained technical staff also supports the division. The histopathology reports at Vibhuti HealthCare are of high international standards, and come at an affordable price tag. The department also accepts samples from sources outside Vibhuti group.

The laboratory ensures a short turnaround time. Quick processing and reporting is done for critical cases like transplants and other life threatening conditions.

In combination with molecular biology and cytogenetics, we aim to provide the highest quality of diagnostics in line with national and international standards with the concept of holistic reporting for our patients. Constant interactions with referring partners and clinicians ensures most accurate and seamless reporting. Samples including slides, tissue, paraffin wax blocks are retained as per regulatory policy for additional testing and re-evaluation as applicable.

Specialized tests such immunohistochemistry for cancer markers including estrogen , progesterone and her 2 neu receptors, reflex to FISH testing, cluster differentiation markers for lymphomas are some of the department’s specialities.

Hematology

The Hematology department at Apollo Diagnostics features an excellent equipment base including automated cell counters, coagulometers and flowcytometers. It provides a wide range of services for the diagnosis and treatment of blood disorders and bone marrow.

The lab has powerful systems to diagnose several blood deficiencies, genetic defects, anaemia, leukaemia and clotting abnormalities. Comprehensive tests for the identification of bleeding disorders and all types of hypercoagulability disorders are also offered.

The laboratory integrates highly skilled doctors, specialised technicians and strong automation to provide accurate,dependable results within a short period of time while maintaining a high degree of quality control.

Immunology

The Immunology laboratory tests at Apollo Diagnostics provide a huge range of assays that help in the diagnosis, management and analysis of medical problems connected with several immunological and infectious diseases. The lab engages in diagnostic testing for allergen sensitivity, autoimmune diseases, infectious disease and HIV serological testing.

The department carries out multiple immunoassays, including radio-immunoassays, specialised endocrine testing and others.

Tests are performed using highly automated systems. Introduction of cutting edge technologies is an ongoing process in this department, to deliver on the promise of quality results,quick turnaround time and reduced costs.

Microbiology

The Microbiology Laboratory of Apollo Diagnostics provides complete clinical services for the diagnosis, prevention and treatment of infectious diseases. Several techniques like microscopy, isolation on culture media, detection of antibodies, etc. are employed to identify the presence of potentially pathogenic microorganisms such as bacteria, fungi, viruses and parasites. Antimicrobial susceptibility tests are executed on isolates to identify the most appropriate antibiotic for treating an infection.

The laboratory is equipped with automated systems to address blood culture and mycobacterium culture, bacterial determination and antimicrobial susceptibility thus shortening the turnaround time for reporting.

Quality control and quality assurance are held in highest regard in the lab.

Molecular Biology

As a leader in healthcare, Apollo Diagnostics simplifies the way to better health through patient-definite diagnostic data.

Molecular Biology provides an understanding of a patient’s biological composition on structure and function of macromolecules such as proteins and nucleic acids essential to life. Discovering the genetic variants of a patient can help determine his/her tendency to disease and potential responses to a beneficial treatment alternative.

While the experienced team at Apollo Diagnostics stays abreast of latest advancements in molecular biology testing, the physicians continually incorporate the latest upgrades in medical science and technology into their current programs of expertise in pathology, disease diagnosis and management. The focus on personalised medicine guarantees detailed, patient-specific, diagnostic information that promotes effective decision making and improved patient care at reduced costs.

Cytogenetics

Improved public awareness about the relationship between genetics and personal health has raised the demand for cytogenetic testing. The advantage of this is clear in many contexts, like risk assessment for familial cancer, prenatal and pre-implantation diagnosis, and the diagnosis of abnormalities in chromosomes in health and disease.

Cancer genetics deals with diagnosis and prognosis of cancers at a cellular level helping Physicians make crucial decisions in treatments.

Cytogenetic tests are used to detect neonatal and paediatric disorders related to mental retardation, congenital diseases of the heart and other organs, deafness, blindness and gene deletions and duplications. Chromosomal anomalies in prenatal diagnostics also forms a key activity in this department.

Our expert geneticists also offer genetic counselling services.

Technical capabilities include G banding, FISH and interphase/metaphase identification of cells. Newer capabilities are explored and added with constant clinical inputs received. Tissues used for analysis – blood, bone marrow, DNA, Products of conception/abortus material , amniotic fluid, chorionic villus and cord blood. Risk assessment and prognosis in cancers, hematological disorders, prenatal and cytogenetic anomalies in infertilities, pediatric disorders, developmental sexual disorders and prenatal diagnosis are the key activities of this department.

Data and sample storage in accordance with national and international are strictly ensured maintaining privacy and confidentiality with Apollo Diagnostics AAA+ assurance.

Serology

When people are exposed to virus or bacteria their body’s immune system generates particular antibodies against the organism. Antibody levels help physicians decide if an infection appeared recently or some time ago. Viral infections, bacterial infections and others can be diagnosed with the help of serological studies.

Apollo Diagnostics has the capability to test for blood-borne pathogens and examine blood specimens for vaccine preventable diseases, mosquito-borne diseases and diseases transmitted from animals to humans. Quality control with perfect results is the central goal. Towards this, the department employs the latest technologies that hugely increase the accuracy of the tests and diminish the chances of human error.

The advanced methods in use produce a high level of sensitivity and accuracy while yielding great quality results.

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