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: QRS axis

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ECG Library (22)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead LA/RA electrode reversal Extreme Axis Sinus arrhythmia 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: - 12-Lead Electrode misplacement Extreme Axis Inverted P waves Inverted T waves Normal rate Regular 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: - 12-Lead LA/RA electrode reversal Bradycardia Extreme Axis Pacemaker spikes Regular Wide QRS Ventricular pacemaker ECG of the Week CC-BY-NC-SA
ECG of the Week – 27th August 2018 – Interpretation
In the ECGquest archives, this ECG has been tagged with: - Weakness 12-Lead LA/RA electrode reversal Extreme Axis Flat T waves Wide P waves ECG of the Week 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 12-Lead Concordant ST depression in V1-V3 Excessive discordant ST elevation Extreme Axis Regular Wide QRS Ventricular pacemaker Positive Sgarbossa criteria 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.