Right Axis Deviation

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

advertisement

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

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Right Axis Deviation." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Related Topics in Examination

advertisement