The electrocardiogram (ECG) has been reinvigorated by the identification of
electrical alterations that were not definitely clarified before. In this
context, and mainly regarding the definition of arrhythmogenic substrates, the
association of the ECG with the vectorcardiogram (VCG) has gathered much more
information about the cardiac electrical phenomena, thus allowing us to
differentiate potentially fatal cases from benign ones. Obtaining a VCG
concomitantly with the performance of an ECG has led to a significant gain in
the definition of extremely sophisticated pathologies, which function suffer
some type of structural or dynamic alterations, involving either the reduction
or enhancement of ionic channels and currents.
The classic aspects of the ECG/VCG association in the differential diagnosis of
myocardial infarctions, conduction disorders, atrial and ventricular
hypertrophies, and the correlations between these electrical disorders are still
valid and assertive. The association of these pathologies is further clarified
when they are seen through the ECG/VCG dyad.
The three-dimensional spatial orientation of both the atrial and the ventricular
activity provides a far more complete observation tool than the ECG linear form.
The modern analysis of the ECG and its respective VCG, simultaneously obtained
by the recent technique called electro-vectorcardiogram (ECG/VCG), brought a
significant gain for the differential diagnosis of some pathologies. Therefore,
we illustrate how this type of analysis can elucidate some of the most important
diagnoses found in our daily clinical practice as cardiologists.