Chronic Obstructive Pulmonary Disease (COPD) often causes right axis deviation (and right P wave axis), short QRS complexes, clockwise rotation and exaggerated atrial repolarisation.

See also: Pulmonary and Pericardial

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The QRS complex usually has a gradual change from negative to positive across the chest leads. The lead that is in the middle of this transition will have isoelectric QRS complexes (equal amounts above and below the baseline). This lead can be known as the transition point. It is usually V3-V4

An abnormal transition point can indicate that the interventricular septum is displaced. If the transition point has been pushed across to V4-V5 or even V5-V6, it may be due to right ventricular hypertrophy. This is otherwise known as Clockwise rotation as it resembles the heart having rotated clockwise in the chest. This ECG pattern frequently occurs with chronic lung disease.