Right Axis Deviation

right axis deviation means that the overall direction of ventricular depolarisation is abormal and too far around to the right. This direction can be between +90 degrees (straight downwards) to +180 degrees (to the right). If the axis is rightward, Lead I will be negative and aVF positive. Right Axis Deviation is often caused by Right ventricular hypertrophy, acute right heart strain (e.g. pulmonary embolism), COPD or other lung disease. It can also be caused by a lateral STEMI, hyperkalemia, dextrocardia, or just a tall thin patient. The diagnosis of exclusion is a left posterior fascicular block.

See also: QRS axis

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References

ECG Library (63)

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In the ECGquest archives, this ECG has been tagged with: - 12-Lead Nonspecific baseline artefact Anterior ST depression Inferior ST depression Inverted T waves R in V1 Regular Right Axis Deviation Tall P waves Normal Sinus Rhythm Right atrial enlargement ECG Interpretation CC-BY-NC-SA
ECG Blog #156 (LVH – RVH – LAA – RAA – Strain – Ischemia)
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Normal T waves Right Axis Deviation Dr Smith's ECG Blog CC BY-NC
A completely healthy 30-something woman with acute chest pain — repeat at 80min

This ECG is from a woman in her 30s who presented with 1 hour of severe right sided chest pain, radiating down her right arm. This was the repeat ECG after aspirin and nitroglycerin.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Inverted T waves Right Axis Deviation Dr Smith's ECG Blog CC BY-NC
A completely healthy 30-something woman with acute chest pain — repeat the next morning

This ECG is from a woman in her 30s who presented with 1 hour of severe right sided chest pain, radiating down her right arm. This was the repeat ECG the next day after stenting.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Hyperacute T waves Right Axis Deviation Dr Smith's ECG Blog CC BY-NC
A completely healthy 30-something woman with acute chest pain — this post is loaded with info !!!

This ECG is from a woman in her 30s who presented with 1 hour of severe right sided chest pain, radiating down her right arm. This was the initial ECG.

In the ECGquest archives, this ECG has been tagged with: - Dizziness Dyspnoea Syncope 12-Lead Right Axis Deviation RSR' Tachycardia Wide QRS Wide complex tachycardia RBBB Pulmonary embolism Dr Smith's ECG Blog CC BY-NC
RBBB. Is there ST Elevation in III and aVR, with reciprocal ST depression in I and aVL?

This ECG is from a man of unknown age who presented with dizziness and dyspnoea on a background of stage 4 lymphoma. He was tachycardic, tachypnoeic (31) and hypoxic (SpO2 79%). The lungs were clear on auscultation.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Flutter P waves Regular Right Axis Deviation Tachycardia Tall QRS Atrial flutter ECG of the Week CC-BY-NC-SA
ECG of the Week – 2nd July 2018 – Interpretation

This ECG is from a woman in her 50s who presented with chest pain on a background of mitral stenosis secondary to rheumatic fever.

In the ECGquest archives, this ECG has been tagged with: - Cardiac arrest Loss of consciousness 12-Lead Inverted T waves R in V1 Right Axis Deviation RVH Dr Smith's ECG Blog CC BY-NC
ST Depression and T-wave Inversions after ROSC from Resp and Cardiac Arrest after Head Trauma
In the ECGquest archives, this ECG has been tagged with: - Loss of consciousness 12-Lead Anterior ST depression Inferior ST depression Peaked T waves Right Axis Deviation ST elevation in aVL ST elevation in V1 Wide QRS Hyperkalemia Dr Smith's ECG Blog CC BY-NC
ST elevation in aVL with reciprocal ST depression in the inferior leads

This ECG is from a man in his 50s with a history of thyroid cancer was brought to the Emergency Department after being found minimally unresponsive with sonorous respirations on his couch at home. Blood glucose level was 76 mg/dL. EMS administered naloxone, which was followed quickly by hyperventilation but no improvement in mental status. EMS performed RSI at that time using etomidate and succinylcholine, but intubation was unsuccessful. Luckily, BVM ventilation was easy in this patient, and he was bagged on the way to the ED, with oxygen saturation maintained in the mid-90s. He was intubated immediately on arrival to the ED using ketamine and rocuronium. This was the initial ED ECG.

In the ECGquest archives, this ECG has been tagged with: - Loss of consciousness 12-Lead Serial 12-lead Anterior ST depression Inferior ST depression Peaked T waves Right Axis Deviation ST elevation in aVL ST elevation in V1 Wide QRS Hyperkalemia Dr Smith's ECG Blog CC BY-NC
ST elevation in aVL with reciprocal ST depression in the inferior leads – repeat after calcium

This ECG is from a man in his 50s with a history of thyroid cancer was brought to the Emergency Department after being found minimally unresponsive with sonorous respirations on his couch at home. Blood glucose level was 76 mg/dL. EMS administered naloxone, which was followed quickly by hyperventilation but no improvement in mental status. EMS performed RSI at that time using etomidate and succinylcholine, but intubation was unsuccessful. Luckily, BVM ventilation was easy in this patient, and he was bagged on the way to the ED, with oxygen saturation maintained in the mid-90s. He was intubated immediately on arrival to the ED using ketamine and rocuronium. This was the repeat ECG after calcium had been administered.

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