Right Axis Deviation

Aka: Right Axis Deviation, Extreme Right Axis Deviation, Right Superior QRS Axis

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II. Definitions

  1. Extreme Right Axis Deviation (right superior axis, -90 to 180)
    1. Negative net QRS voltage in lead I
    2. Negative net QRS voltage in lead avF
    3. On clock face, represents the 9:00 to 12:00 position
  2. Right Axis Deviation
    1. Deviation into lead III axis (+90 to -90 degrees)
    2. Negative net QRS voltage in lead I
    3. Positive net QRS voltage in lead avF
    4. On clock face, represents the 6:00 to 9:00 position

III. Interpretation: Based on most isoelectric lead

  1. Images
    1. EKG-Axes.png
  2. Approach
    1. See QRS Axis
    2. Lead with most symmetric voltage (as much positive QRS voltage as negative QRS voltage)
    3. Choose lead that is perpendicular to isoelectric lead and that leads axis is the same as the QRS Axis
  3. Extreme Right Axis Deviation (-90 to -180, negative in lead I and negative in lead avF)
    1. Most Isoelectric I (avF is perpendicular): -90 (12:00)
    2. Most Isoelectric avL (II is perpendicular): -120 (11:00)
    3. Most Isoelectric III (avR is perpendicular): -150 (10:00)
    4. Most Isoelectric avF (I is perpendicular): -180 (9:00)
  4. Right Axis Deviation (+180 to +90, negative in lead I and positive in lead avF)
    1. Most Isoelectric avF (I is perpendicular): +180 (9:00)
    2. Most Isoelectric II (avL is perpendicular): +150 (8:00)
    3. Most Isoelectric avR (III is perpendicular): +120 (7:00)
    4. Most Isoelectric I (avF is perpendicular): +90 (6:00)

IV. Causes

  1. Normal variation
  2. Chronic Obstructive Pulmonary Disease (COPD)
  3. Acute Pulmonary Embolism
  4. Right Ventricular Hypertrophy
  5. Right Bundle Branch Block
  6. Left Posterior Fascicular Block (Left Posterior Hemiblock)
  7. Dextrocardia
  8. Left ventricular ectopic rhythm
  9. Wolf-Parkinson-White Syndrome (WPW Syndrome)
  10. Prior lateral Myocardial Infarction
  11. Hyperkalemia
  12. Misplaced Limb Leads
  13. Sodium-channel Blocker (Class I Antiarrhythmic) Overdose

V. References

  1. Mattu (2020) Crit Dec Emerg Med 34(4): 18

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Related Studies

Ontology: Right axis deviation (C0232296)

Concepts Laboratory or Test Result (T034)
SnomedCT 47665007, 164953007, 142125000
English Ekg Right Axis Deviation, Right axis deviation by EKG, axis deviation right, right axis deviation, Right heart axis deviation, Right axis deviation, RAD - Right axis deviation, Right axis deviation (finding)
Spanish signos electrocardiográficos de desviación del eje hacia la derecha (hallazgo), signos electrocardiográficos de desviación del eje hacia la derecha
Derived from the NIH UMLS (Unified Medical Language System)

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