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…

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