ECG Basics and Fundamentals: right axis deviation differential and ST segment elevation in rightward leads
ECG Weekly Workout with Dr. Amal Mattu
HPI
A 48-year-old woman presents to the ED with chest pain and near syncope. The following ECG is obtained:
Before watching this week’s video, ask yourself these questions:
- What ECG abnormalities do you notice?
- What is the axis?
- What is the most likely diagnosis?
Video
Kudos
Big thanks to Dr. Doug Sward for sharing his case this week!
Key Teaching Points
Differential diagnoses for rightward axis
- Acute pulmonary HTN – Acute (PE) & chronic lung disease (COPD)
- Hyperkalemia
- Na+channel blocker toxicity
- Ventricular ectopy
- Right ventricular hypertrophy
- Left posterior fascicular block
- Old lateral MI (from Q-waves in lead I)
- Ventricular ectopy
- Lead misplacement / Dextrocardia
- Normal variant in young kids & thin adults with horizontally positioned hearts
Take-home Points:
- PE and hyperkalemia can cause ST segment elevation
- Especially in the rightward leads (V1, aVR, ± V2, III)