Extreme Axis

An extreme axis deviation means that the overall direction of ventricular depolarisation is so abnormal that we can’t work out whether to call it left or right deviation! This direction can be between -90 degrees (straight upwards) to 180 degrees (to the right). If the axis is extreme, Lead I and lead aVF will both be negative.

Extreme axis deviation is usually due to a ventricular rhythm, but can also be due to hyperkalemia or very severe right ventricular hypertrophy.

See also: Axis

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References

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Extreme Axis LA/RA electrode reversal Sinus arrhythmia 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 15th October 2018 – Interpretation

This ECG is from a woman in her 40s who presented after an episode of chest pain.

In the ECGquest archives, this ECG has been tagged with: - Electrode misplacement Extreme Axis Normal rate Regular Inverted P waves Inverted T waves 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 24th September 2018 – Interpretation

This ECG is from a male in his teens who presented with episodes of his hands turning cold and blue for several hours at a time.

In the ECGquest archives, this ECG has been tagged with: - Bradycardia Extreme Axis LA/RA electrode reversal Regular Pacemaker spikes Wide QRS Ventricular pacemaker 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 27th August 2018 – Interpretation
In the ECGquest archives, this ECG has been tagged with: - Weakness Extreme Axis LA/RA electrode reversal Flat T waves Wide P waves 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 9th July 2018 – Interpretation

This ECG is from a woman in her 80s who presented with lethargy and weakness, on a background of schistosomiasis-related liver disease, portal hypertension and ascites.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Extreme Axis Regular Concordant ST depression in V1-V3 Excessive discordant ST elevation Wide QRS Ventricular pacemaker Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
Chest pain, Ventricular Paced Rhythm, and a Completely Normal Angiogram 3 Months Prior.

This ECG is from an elderly woman who presented with chest pain on a background of a normal angiogram 3 months prior.

This ECG shows ventricular paced rhythm (likely biventricular) with concordant ST depression in III, aVF and V3. There is excessive discordant ST elevation in I and aVL. The cause was an acute left main occlusion due to suspected embolism.