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Karuturi Cardiology Rounds 1 > What is your ECG Diagnosis?
Replies to This Discussion
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Permalink Reply by NIKHIL CHOUDHARY on -
hi subramaniam, ecg diagnosis is dextrocardia with the upright P wave in aVR and the negative P waves in I and aVL. also we can see tall R in V1 and dominant S wave in V6. nice images...
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Permalink Reply by Hisham M Selim on -
I think this could be Dextrocardia, and not a reversed arm leads.
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Permalink Reply by Bolognesi Massimo on -
Exactly ! ECG showing marked right-axis deviation of the P wave (negative in aVL and lead I) and of the QRS complex, and low voltage in the precordial leads, V4 through V6. Lead aVR is similar to the normal aVL in the normal ECG. With compliments.
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Permalink Reply by Subrahmanyam Karuturi on -
The correct answer is Dextrocardia.
Dextrocardia
In cases of dextrocardia (situs inversus), the ECG is a mirror image of the normal ECG. Persons with dextrocardia who develop cardiac abnormalities (e.g., ventricular hypertrophy, bundle branch block) have electrocardiographic abnormalities that are also the mirror images of those in persons whose heart is in the normal location. The physical examination and chest X-ray reveal placement of the heart in the right hemithorax.
Criteria for Diagnosis
Frontal Plane.
The ECG shows RAD. The axis of the T wave is within 60 degrees of the QRS wave and is usually separated in a clockwise direction (negative T in aVL) from the axis of the QRS.
Horizontal Plane.
The axis of the QRS wave is posterior and to the left (negative QRS in the V leads). The axis of the T wave is anterior and to the left (usually negative T in the V leads).
Reversed Leads
In some instances, the electrodes for the standard leads are misplaced. If the electrode of the left foot is placed on the right, or vice versa, there are no noticeable ECG changes because either electrode is in the lower vertex of Einthoven's triangle. On the other hand, if the electrodes of the right and left arm are reversed, then lead I is reversed from its normal disposition, and similar changes occur in leads II and III, aVR and aVL . Seldom, if ever, the precordial leads are simultaneously misplaced. Thus, the coordinate systems for the frontal and the horizontal planes are not compatible. The physical examination and chest X-ray show the normal location of the heart.
Criteria for Diagnosis
Frontal Plane.
There is right axis deviation in the frontal plane. The QRS wave in lead I is negative, and aVR looks like the normal aVL. The axis of the T wave is also deviated to the right and usually within 60 degrees of QRS.
Horizontal Plane.
The axis of the QRS wave is posterior and to the left in the horizontal plane, thus becoming incompatible with the measurements in the frontal plane. The QRS waves in the V leads follow the normal pattern. The axis of the T wave is to the left and to the front in the horizontal plane, thus becoming incompatible with measurements in the frontal plane. The T waves in the V leads follow the normal pattern.
Reference : Rakel: Textbook of Family Medicine, 7th ed.
