Right Axis Deviation (RAD)

Right Axis Deviation RAD Overview

Right Axis Deviation = QRS axis greater than +90°

  • Normal Axis = QRS axis between -30° and +90°
  • Left Axis Deviation = QRS axis less than -30°
  • Extreme Axis Deviation = QRS axis between -90° and 180° (AKA “Northwest Axis”)

Hexaxial Reference System

Haxaxial ECG AXIS Reference 2021
Hexaxial Reference System – relationship between QRS axis and frontal leads of the ECG.

How to recognise right axis deviation

Three Lead analysis

  • QRS is POSITIVE (dominant R wave) in Lead II, Lead III and aVF
  • QRS is NEGATIVE (dominant S wave) in Lead I
Lead-I-II-aVF-Hexaxial-Evaluation-RAD-2021 2

Example ECG of RAD

Left Posterior Fascicular Block (LPFB) Right axis deviation

RAD: leads II, III and aVF are POSITIVE; Leads I and aVL are NEGATIVE


Causes

Related Topics


References


Advanced Reading

Online

Textbooks


LITFL Further Reading

ECG LIBRARY 700

ECG LIBRARY

Electrocardiogram

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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