Slide 1: An 87 yo woman with COPD on home oxygen presents to the ED with shortness of breath. What is the axis? What do you notice about the precordial leads?
Slide 2: What is the axis? EKG shown with arrow for negative deflection in lead one plus negative deflection in aVF, which equals extreme axis deviation.
Slide 3: What about the precordial leads? Did you notice the…dominant R waves in V1, dominant S waves in V4-V6, and T-wave inversions in V1-V2.
Slide 4: What do these EKG findings suggestion? The extreme axis deviation and precordial lead abnormalities suggest RV hypertrophy and RV strain.
Slide 5: RV hypertrophy causes the mean electrical axis to deviate to the right, meaning the vector of ventricular depolarization is moving towards V1 and V2 (positive deflection) and away from V4-V6 (negative deflection).
Since the RV is in line with V1-V3, ST depressions or T-wave inversions in V1-V3 may be seen with RV strain. This patient has RV dysfunction. Stay tunes for Part 2…
Tags: Extreme axis deviation, RV dysfunction, RV hypertrophy, RV strain
3 comments on “RV Dysfunction (Part 1)”
Isn’t this ECG showing lead reversal?
Hello, thank you for your comment. One way to tell that there is no lead reversal in this EKG is by looking at the p-waves- if there were lead reversal, you would see a different p-wave vector with negative p-waves in lead I, II and positive p-waves in aVR
Oh wow, I’m so glad I’m not absolutely insane for thinking this. I remember learning, “aVR should be negative in all normal hearts”… Unless this 87 yo w/ COPD also has dextrocardia?? But seriously would love for someone to help clarify this point b/c I’m unsure and far from an expert on the topic.