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.


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) 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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