When is the vectorcardiogram superior to the scalar electrocardiogram?

The clinical usefulness of the vectorcardiogram is well documented by the numerous reports published in the last 3 decades. It has been found more reliable than the electrocardiogram for the diagnosis of atrial enlargement and right ventricular hypertrophy. It is more sensitive than the electrocardiogram in the recognition of myocardial infarction, especially if the infarction is inferior or if it occurs in the presence of left bundle branch block or left anterior hemiblock. It is helpful in the diagnosis of ventricular pre-excitation and in the localization of the bypass tract. Some repolarization abnormalities are more clearly demonstrated by the vector display. However, some information, such as that on cardiac chamber size and myocardial damage, can also be obtained by other noninvasive tests that are often performed on the same patients. With the increasing awareness of cost-effectiveness of various laboratory procedures in medicine, the vectorcardiogram should no longer be considered a routine cardiac test and should be requested only for a specific clinical purpose. When properly utilized, vectorcardiography should remain a valuable diagnostic as well as teaching tool.