Right Axis Deviation
Definition
- QRS axis between + 90 and + 180 degrees
Right axis deviation: +90 to +180 degrees
How to recognise right axis deviation
- QRS is positive (dominant R wave) in leads III and aVF
- QRS is negative (dominant S wave) in leads I and aVL
Right axis deviation: leads III and aVF are positive; leads I and aVL are negative
Causes
- Left posterior fascicular block
- Lateral myocardial infarction
- Right ventricular hypertrophy
- Acute lung disease (e.g. PE)
- Chronic lung disease (e.g. COPD)
- Ventricular ectopy
- Hyperkalaemia
- Sodium-channel blocker toxicity
- WPW syndrome
- Normal in children or thin adults with a horizontally positioned heart
Acknowledgements
- Axis diagram reproduced from David C Chung’s ‘ECG: A Pictorial Primer’.
Related Topics
Further Reading
- ECG BASICS – Waves, Intervals, Segments and Clinical Interpretation
- ECG CLINICAL CASES – Your favourite ECG’s placed in clinical context with a challenging Q&A approach
- ECG and Cardiology Eponymous Syndromes – Cheats guide to eponymous emancipation
- ECG Reference Sites on the WEB – the best of the rest
Author Credits
References
- Harrigan RA, Jones K. ABC of clinical electrocardiography. Conditions affecting the right side of the heart. BMJ. 2002 May 18;324(7347):1201-4. Review. [PMID: 12016190]
- Mattu A, Brady W. ECGs for the Emergency Physician 2, BMJ Books 2008.
- Wagner, GS. Marriott’s Practical Electrocardiography (11th edition), Lippincott Williams & Wilkins 2007.
About Edward Burns
