Right Axis Deviation

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

• Left axis deviation

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.