Electrocardiographic Features

  • Right axis deviation
  • Positive QRS complexes (with upright P and T waves) in aVR
  • Lead I: inversion of all complexes, aka ‘global negativity’ (inverted P wave, negative QRS, inverted T wave)
  • Absent R-wave progression in the chest leads (dominant S waves throughout)

These changes can be reversed by placing the precordial leads in a mirror-image position on the right side of the chest and reversing the left and right arm leads.

Differential Diagnosis

Accidental reversal of the left and right arm electrodes may produce a similar picture to dextrocardia in the limb leads (but with normal appearances in the precordial leads).

Further Reading


  • Surawicz B, Knilans TK. Chou’s Electrocardiography in Clinical Practice. 6th Edition. Saunders Elsevier 2008.
  • Wagner, GS. Marriott’s Practical Electrocardiography (11th edition), Lippincott Williams & Wilkins 2007.

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  1. Joe says

    In a patient with dextrocardia presenting with chest pain, I presume one should reverse the precordial leads in order to pick up ST changes. Should I reverse the limb leads as well? Is the interpretation e.g. LAD, RCA all the same?