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The outer surface of the heart changes from positive to negative during what?

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depolarization

Figure 20.33 The outer surface of the heart changes from positive to negative during depolarization. This wave of depolarization is spreading from the top of the heart and is represented by a vector pointing in the direction of the wave. This vector is a voltage  potential difference  vector. Three electrodes, labeled RA, LA, and LL, are placed on the patient. Each pair  called leads I, II, and III  measures a component of the depolarization vector and is graphed in an ECG.

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