Asymptomatic adult patient. Routine ECG. Describe the ECG.

Describe and interpret this ECG


Main Abnormalities

This ECG demonstrates the typical features of dextrocardia:

  • Marked right axis deviation (+180 degrees)
  • Lead aVR: Positive QRS complex (upright P and T waves)
  • Lead I: inversion of all complexes, aka ‘global negativity’ (inverted P-QRS-T)
  • Absent R-wave progression in the chest leads (dominant S waves throughout)

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.

TOP 100 ECG Series

Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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