Right Axis Deviation: Lateral Infarction

Report:

Sinus tachycardia 110/min

Right axis deviation +150o

Postero-antero-lateral infarction, probably recent

Comment:

The Q waves in the (high) lateral leads 1 and aVL are responsible for the RAD. They are called “lateral” by convention and do not imply involvement of the LV free wall32,33; in most the infarction is, in fact, basal. The (true) posterior infarct is demonstrated by the dominant R wave and upright T in lead V1; the ST depression there, like the R and T wave changes, is reciprocal to the infarction pattern of the posterior wall (Q wave, inverted T and elevated ST segment). Most posterior MIs are associated with inferior MIs; this ECG is somewhat atypical.

Leads’ 1 and 3 QRS complexes are almost mirror images of each other: hence lead 2 (which is, arithmetically 1 + 3) is almost zero. Lead 2 is not a good lead for rhythm strips. The following day (below) only P waves are visible.

If you have any suggestions for or feedback on this report, please let us know.