Epub 2012 Dec 17. This can be a normal variant EKG axis is determined by analyzing positive and negative patterns in the different limb leads. Introduction. The underlying cause determines the symptoms and treatment for left axis deviation. What might it mean for a patient to have extreme left axis deviation (-97 deg) but on a later ecg have extreme right axis deviation (188 deg)? Inferior wall myocardial infarction, left ventricular hypertrophy, The symptoms of left axis deviation are determined by the underlying reason. It is usually the result of a left anterior hemiblock rather than to the increased bulk of muscle of the left ventricle. The hallmark of fascicular blocks is deviation of the electrical axis. and transmitted securely. The most common cause of RAD is right ventricular hypertrophy. This results in the deflection of lead III becoming negative (this is only considered significant if the deflection of lead II also becomes negative). Accessibility 2011 Apr 15;10:30. doi: 10.1186/1475-2840-10-30. font-weight: normal; The abnormal left axis deviation is one of the most common abnormal ECG findings. www.heart.org. Performance indicators and validity of serum fructosamine assay as a diagnostic test in a screening program for diabetes mellitus. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Right axis deviation occurs when the QRS axis is shifted between 90 and 180 degrees. Necessary cookies are absolutely essential for the website to function properly. If you think you may have left axis deviation, it is important to see a doctor as soon as possible to receive . It can be normal, leftward (left axis deviation, or LAD), rightward (right axis deviation, or RAD) or indeterminate (northwest axis). As noted earlier, axis deviation is most commonly a result . #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . The clinical significance of the electrocardiographic aberration called abnormal left axis. Facebook: http://www.facebook.com/geekymedics Healthsoothe does not provide medical advice, diagnosis, or treatment. Left axis deviation by definition is a coronal QRS axis of more than -30 degrees. - Character 02:14 This causes the deflection inlead I to becomenegative and the deflection inlead aVF/III to bemore positive. Join the Geeky Medics community: Heart valve disease. Diabetes: Drinking More Water Can Help Reduce Blood Sugar; Follow These Tips To Increase Water Intake, Haircare: Biotin Can Boost Your Hair Growth; Try These Biotin Homemade Hair Masks, Experiencing Irregular Or Delayed Periods? Lack of vitality or anemia in the central muscular region of the heart causes coagulation of blood, which is verified by T-wave abnormality. Right ventricular hypertrophy is actually more common than LPFB and may cause ECG findings similar to LPFB. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Left axis deviation (LAD) discovered in children via electrocardiogram (ECG) is uncommon but can be associated with heart disease (HD). The quadrant technique, which looks at lead aVF, and Lead I is the simplest. The electrical activity of the heart starts at the sinoatrialnode then spreads to the atrioventricular (AV)node. Depolarization of the left ventricle will depend entirely on the posterior fascicle. It is mandatory to procure user consent prior to running these cookies on your website. The ECGs and clinical data were retrospectively analyzed for a period that varied from 3 to 42 years (mean, 15.310.2 years), and 115 men with LAH . MeSH I just had a ecg and it said left axis deviation and a t wave abnormality. Can my father undergo mitral valve replacement? DO NOT perform any examination or procedure on patients based purely on the content of these videos. ECG findings Comment; A (normal or normal variant ECG reading) Sinus bradycardia, arrhythmia, or tachycardia . In reality, this term is meaningless and . It may indicate the presence of various conditions, such as left ventricular hypertrophy, left anterior fascicular block, inferior wall myocardial infarction, emphysema, and mechanical shift due to elevated diaphragm because of obesity. Describe the issues of concern regarding the interpretation of the electrical axis on an ECG. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Ryoikibetsu Shokogun Shirizu. (EKG: left axis deviation) 765 results. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ The mean QRS axis during the first 4 weeks of life is +110 degrees or more.104 After 1 month the average axis is less than +90 degrees (although a significant number of children still have a QRS axis of up to +110 degrees). This site needs JavaScript to work properly. Unable to load your collection due to an error, Unable to load your delegates due to an error. The abnormal left axis deviation is one of the most common abnormal ECG findings. and transmitted securely. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Until recently, it was believed that the human heart didnt have this capacity. Depolarization of the left ventricle will depend entirely on impulses from the anterior fascicle if the posterior one is defect. if you have further questions to ask or if theres anything you want to contribute or correct to this article. Adult electrodes will overlap and potentially cause inaccurate . Alboni P, Longhini C, Malacarne C, Giovannini G. Cardin G, Nava A, Canciani B, Bottero M, Zevallos JC, Buja GF. By clicking Accept, you consent to the use of ALL the cookies. Left ventricular hypertrophy changes the structure and function of the heart. The site is secure. It occurs when a persons heart rate relates to their breathing cycle. It should not occur, likely technical error such as wrong lead location in one of 2 tests or both. It is part of the QRS complex and poor R wave progression can signal a problem. But no matter what your blood pressure is, developing left ventricular hypertrophy puts you at higher risk of congestive heart failure and irregular heart rhythms. Right axis often refers to the direction in which the current is traveling. It can be normal, leftward (left axis deviation, or LAD), rightward (right axis deviation, or RAD) or indeterminate (northwest axis). Myocardial infarction, coronary artery disease, left ventricular hypertrophy, dilated cardiomyopathy, hypertrophic cardiomyopathy, degenerative disease, hypertension, hyperkalemia, myocarditis, amyloidosis may all cause LAFB. Left axis deviation (LAD) is a condition in electrocardiography in which the average electrical axis of the ventricular contraction of the heart rests in a frontal plane direction between 30 and 90. If the electrical axis falls between the values of -30 to +90 this is considered normal. This is mirrored by a positive QRS complex in lead I and a negative complex in leads aVF & II. what does that mean? An abnormal ECG might indicate a variety of conditions. 12. I had a ekg and it said it was abnormal because of a left axis deviation. Fascicular blocks occurdue toanatomical or functional block in a fascicle. You also have the option to opt-out of these cookies. Normal variation, pre-excitation syndrome, conduction defects, inferior wall myocardial infarction, congenital heart disease, ventricular ectopic rhythms, emphysema, mechanical shift, high potassium levels, paced rhythm, and thickened left ventricle are just a few of the causes. Conclusions: Other causes include: inferior myocardial infarction; ventricular pre-excitation; hyperkalaemia; tricuspid atresia Being able to determine the electrical axis can give insight into underlying disease states and help steer the differential diagnosis towards or away from certain diagnoses. In electrocardiography, left axis deviation is a condition where the mean electrical axis of ventricular contraction of the heart lies in a frontal plane direction between 30 and 90. Introduction: This website uses cookies to improve your experience while you navigate through the website. #mc-embedded-subscribe-form .mc_fieldset { . And dont worry, Healthsoothe doesnt bite. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Instagram: https://instagram.com/geekymedics However, the P wave or T wave axis can also be measured. We planned a study of ambulatory adults with borderline (0 to -30) and moderate-to-marked (<-30 to -90) LAD looking into their possible . Left Axis Deviation LAD. Which can be benign or portend something more seriousConsult with your physician. Cardiac: Differential diagnosis: Other important EKG clues: Normal Variant: Left Ventricular Hypertrophy: Sum of S wave in V1 and R wave in V5 or V6 3.5 mV (35 mm) R wave in aVL 1.1 mV (11 . They don't necessarily imply any anatomical or fuctional abnormality. By signing up, you agree to the our terms and our Privacy Policy agreement. Do I need to change medicines after angioplasty? And dont worry, You can always check our FAQs section below to know more about left axis deviation. Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. (between +90 and +180) An extreme heart axis is present when both I and AVF are negative. For these, please consult a doctor (virtually or in person). and left axis deviation with a QRS duration of 180 ms (Figure 2). Left axis deviation is one of the most commonly encountered ECG abnormalities. Refer to Figure 1. This is mirrored by a positive QRS complex in lead I and a negative complex in leads aVF & II. Its presence should alert medical directors and underwriters to the possibility of underlying structural heart disease. Suppose there were an infarct in the left ventricle - the effective muscle mass on that side is decreased. We are sorry that this post was not useful for you! The thickened left ventricle becomes weak and stiff. is one of the best health sites out there that genuinely cares for you. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. It is not an abnormal finding and requires no treatment unless accompanied by any structural defect of the heart. I am 24 year old 4 days ago I have done an ECG which shows results as Sinus Rhythm Marked Right axis Deviation. The bottom EKG shows a reading of a person with left anterior fascicular block (LAFB), previously thought to be benign but found by a UCSF-led team to potentially signal a serious heart condition. QRS duration <0,12 seconds but slightly prolonged. . Left Anterior Fascicular Block in the Absence of Heart Disease. QRS is somewhere between -30 & +90 on a normal axis. The vector is initially directed upwards and to the left, which yields q-wave in lead aVF and R-wave in lead I. Type above and press Enter to search. Occasionally the T-wave in lead aVL will be inverted and in some cases lead I will display a monophasic R-wave instead of qR complex. There is also an increase in QRS duration (greater than 100 ms), especially an increase in intrinsicoid deflection (greater than 50 ms). Learn how your comment data is processed. it seemed a bit scary because i was looking it up, & it had many cau. Tests used to diagnose left ventricular hypertrophy may include: Lab tests. Doctors would place a diagnosis on 5 different axises. Can I undergo another hernioplasty with my heart disease? - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ "Left ventricular hypertrophy - Diagnosis and treatment - Mayo Clinic". For an optimized experience on mobile, add Left Axis Deviation (LAD)| Learn More About the Pathologies of the Heart by Determining the Left Deviations of its Electrical Axis shortcut to your mobile device's home screen, https://en.wikipedia.org/wiki/Left_axis_deviation. - Severity 05:32 So, anytime, you need trustworthy answers to any of your health-related questions, come straight to us, and we will solve your problem(s) for you. This is a rare finding. If the electrical axis is between -30 to -90 this is considered left axis deviation. The most common cause of RAD is right ventricular hypertrophy. Marked left-axis deviation is from -45 to -90 and is often associated with left anterior fascicular block 1. Left anterior fascicular block is due to anatomical or functional block in the anterior fascicle. This is reflected by a QRS complex positive in lead I and negative in leads aVF and II. of axis deviation in the prehospital setting (for the most part) will not guide management too much but it is important to know the differential diagnoses of axis . it can be very dangerous if not treated properly. , . Do Include Them In Your 2019 Workout Regime! Roughly 7% of cases progress to bifascicular block (which means that the LAFB is accompanied by a right bundle branch block), while 3% progress to third-degree AV block (complete heart block). This website follows the DNPA Code of Ethics, --------------------------------Advertisement---------------------------------- -. A careful history to elicit acute . Keep reading, even when you're on the train! The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Created for people with ongoing healthcare needs but benefits everyone. Non-specific Intraventricular Conduction Delay, Overview of Intraventricular Conduction Defects. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. DONT FORGET these 3 key components of the cardiovascular exam for your upcoming OSCEs Save this video to watch later and dont forget to follow Geeky Medics! - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Bethesda, MD 20894, Web Policies , Angiotensin II receptor blockers (ARBs). A number of things can result in right axis deviation which include lung disease, right sided heart strain, right bundle branch block, and right ventricular hypertrophy. Please enable it to take advantage of the complete set of features! RAD is commonly associated with conditions such as pulmonary hypertension, as they cause right ventricular hypertrophy. The bottom EKG shows a reading of a person with left anterior fascicular block (LAFB), previously thought to be benign but found by a UCSF-led team to potentially signal a serious heart condition. In borderline LAD group though mean BP and lipid values were normal, FPG was impaired. You might also be interested in our awesome bank of 700+ OSCE Stations. The .gov means its official. Left anterior fascicular block (LAFB), a pattern (formerly called left anterior hemiblock) seen on the surface electrocardiogram (ECG), results when normal electrical activity in the His-Purkinje system is delayed or interrupted ().The normal sequence of activation is altered in LAFB, with a resultant characteristic appearance on the ECG, associated with marked left axis . (left axis deviation, or LAD) - QRS is upright in lead I (positive) and downward in lead aVF . border: none; This can be a normal variant . So, anytime, you need trustworthy answers to any of your health-related questions, come straight to us, and we will solve your problem(s) for you. Review the role of an interprofessional team in improving care coordination in patients with electrical axis deviation. The electrical axis will be shifted to the left (left axis deviation), ranging between -45 and -90. This allows us to get in touch for more details if required. One of the key steps in interpreting an electrocardiogram (EKG) is determining the electrical axis of the heart. Join our newsletter and get our free ECG Pocket Guide! When the axis moves further and is more negative than 30 it is called marked left axis deviation (MLAD) and, on inspection of the tracing, can be diagnosed when in addition to the above features of LAD, the sum of QRS components is negative (ie S>R) in 2 and aVF as well as lead 3, while lead 1 is positive; (3) right . [Case Reports] Cureus. My work mantra is: "I can, and I will", Are you looking for a way to calculate how many calories youve burned during your, Get the latest creative news from Healthsoothe about health and dentalcare. Build A Successful Homecare Business With These Tips. It can be part of the criteria for LVH, but in isolation it has little significance. A1C cut points to define various glucose intolerance groups in Asian Indians. Multilead ST depression with coexistent ST elevation in lead aVR and V 1 has been described in patients with left main or . Since right axis deviation is a new finding since the last EKG, a doctor may be playing it on the safe side when telling . In case of a fascicular block, the wall/walls without fascicular supply will depend on impulses spreading from the other part of the ventricle (where the fascicle is intact). sharing sensitive information, make sure youre on a federal To understand the cardiac axis, one must first discover the connection between both the QRS axis and the ECG limb leads. - Exacerbating & relieving factors 05:12 This results in the deflection of lead III becoming negative (this is only considered significant if the deflection of lead II also becomes negative). A: Left axis deviation is usually a normal variation in the ECG in which the currents arising from the heart picked up by ECG have a leftward deviation. Is left axis deviation dangerous?what are possible treatments and heath tips. Right axis deviation (RAD) involves the direction of depolarisation being distorted to the right (between +90 and +180). Feel free to contact us at [emailprotected] if you have further questions to ask or if theres anything you want to contribute or correct to this article. Unauthorized use of these marks is strictly prohibited. This field is for validation purposes and should be left unchanged. Introduction: We are increasingly noticing isolated left axis deviation (LAD) in electrocardiogram in younger people with diabetes without obvious heart disease and association of LAD with glucose intolerance has not been explicitly raised before. Left Axis Deviation = QRS axis less than -30. Before The initial vector will be directed inferiorly (Figure 1, panel A), yielding a small r-wave in inferior leads (II, III and aVF) and small q-wave in lateral leads (aVL, I and -aVR). Is the left axis deviation dangerous? We consecutively enrolled adults aged 30 or more, with electrocardiogram normal duration QRS axis between 0 to -90, without cardiac symptoms, not on any medication, attending outdoor-clinics for health checkup. High blood pressure ( hypertension ). Got an ecg done on advice of a doctor. If your health care provider thinks you have left ventricular hypertrophy, imaging tests may be done to look at the heart. what is that? The cumulative 3-year incidence of the primary outcome measure was significantly higher in the left axis deviation group (26.4% in the left axis deviation, 22.7% in the right axis deviation, and . Undefined cookies are those that are being analyzed and have not been classified into a category as yet. A left heart axis is present when the QRS in lead I is positive and negative in II and AVF. This alters the ECG curve in a characteristic fashion which is rather easy to spot. Clinical electrocardiography and ECG interpretation, Cardiac electrophysiology: action potential, automaticity and vectors, The ECG leads: electrodes, limb leads, chest (precordial) leads, 12-Lead ECG (EKG), The Cabrera format of the 12-lead ECG & lead aVR instead of aVR, ECG interpretation: Characteristics of the normal ECG (P-wave, QRS complex, ST segment, T-wave), How to interpret the ECG / EKG: A systematic approach, Mechanisms of cardiac arrhythmias: from automaticity to re-entry (reentry), Aberrant ventricular conduction (aberrancy, aberration), Premature ventricular contractions (premature ventricular complex, premature ventricular beats), Premature atrial contraction(premature atrial beat / complex): ECG & clinical implications, Sinus rhythm: physiology, ECG criteria & clinical implications, Sinus arrhythmia (respiratory sinus arrhythmia), Sinus bradycardia: definitions, ECG, causes and management, Chronotropic incompetence (inability to increase heart rate), Sinoatrial arrest & sinoatrial pause (sinus pause / arrest), Sinoatrial block (SA block): ECG criteria, causes and clinical features, Sinus node dysfunction (SND) and sick sinus syndrome (SSS), Sinus tachycardia & Inappropriate sinus tachycardia, Atrial fibrillation: ECG, classification, causes, risk factors & management, Atrial flutter: classification, causes, ECG diagnosis & management, Ectopic atrial rhythm (EAT), atrial tachycardia (AT) & multifocal atrial tachycardia (MAT), Atrioventricular nodal reentry tachycardia (AVNRT): ECG features & management, Pre-excitation, Atrioventricular Reentrant (Reentry) Tachycardia (AVRT), Wolff-Parkinson-White (WPW) syndrome, Junctional rhythm (escape rhythm) and junctional tachycardia, Ventricular rhythm and accelerated ventricular rhythm (idioventricular rhythm), Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment, Long QT (QTc) interval, long QT syndrome (LQTS) & torsades de pointes, Ventricular fibrillation, pulseless electrical activity and sudden cardiac arrest, Pacemaker mediated tachycardia (PMT): ECG and management, Diagnosis and management of narrow and wide complex tachycardia, Introduction to Coronary Artery Disease (Ischemic Heart Disease) & Use of ECG, Classification of Acute Coronary Syndromes (ACS) & Acute Myocardial Infarction (AMI), Clinical application of ECG in chest pain & acute myocardial infarction, Diagnostic Criteria for Acute Myocardial Infarction: Cardiac troponins, ECG & Symptoms, Myocardial Ischemia & infarction: Reactions, ECG Changes & Symptoms, The left ventricle in myocardial ischemia and infarction, Factors that modify the natural course in acute myocardial infarction (AMI), ECG in myocardial ischemia: ischemic changes in the ST segment & T-wave, ST segment depression in myocardial ischemia and differential diagnoses, ST segment elevation in acute myocardial ischemia and differential diagnoses, ST elevation myocardial infarction (STEMI) without ST elevations on 12-lead ECG, T-waves in ischemia: hyperacute, inverted (negative), Wellen's sign & de Winter's sign, ECG signs of myocardial infarction: pathological Q-waves & pathological R-waves, Other ECG changes in ischemia and infarction, Supraventricular and intraventricular conduction defects in myocardial ischemia and infarction, ECG localization of myocardial infarction / ischemia and coronary artery occlusion (culprit), The ECG in assessment of myocardial reperfusion, Approach to patients with chest pain: differential diagnoses, management & ECG, Stable Coronary Artery Disease (Angina Pectoris): Diagnosis, Evaluation, Management, NSTEMI (Non ST Elevation Myocardial Infarction) & Unstable Angina: Diagnosis, Criteria, ECG, Management, STEMI (ST Elevation Myocardial Infarction): diagnosis, criteria, ECG & management, First-degree AV block (AV block I, AV block 1), Second-degree AV block: Mobitz type 1 (Wenckebach) & Mobitz type 2 block, Third-degree AV block (3rd degree AV block, AV block 3, AV block III), Management and treatment of AV block (atrioventricular blocks), Intraventricular conduction delay: bundle branch blocks & fascicular blocks, Right bundle branch block (RBBB): ECG, criteria, definitions, causes & treatment, Left bundle branch block (LBBB): ECG criteria, causes, management, Left bundle branch block (LBBB) in acute myocardial infarction: the Sgarbossa criteria, Fascicular block (hemiblock): left anterior & left posterior fascicular block on ECG, Nonspecific intraventricular conduction delay (defect), Atrial and ventricular enlargement: hypertrophy and dilatation on ECG, ECG in left ventricular hypertrophy (LVH): criteria and implications, Right ventricular hypertrophy (RVH): ECG criteria & clinical characteristics, Biventricular hypertrophy ECG and clinical characteristics, Left atrial enlargement (P mitrale) & right atrial enlargement (P pulmonale) on ECG, Digoxin - ECG changes, arrhythmias, conduction defects & treatment, ECG changes caused by antiarrhythmic drugs, beta blockers & calcium channel blockers, ECG changes due to electrolyte imbalance (disorder), ECG J wave syndromes: hypothermia, early repolarization, hypercalcemia & Brugada syndrome, Brugada syndrome: ECG, clinical features and management, Early repolarization pattern on ECG (early repolarization syndrome), Takotsubo cardiomyopathy (broken heart syndrome, stress induced cardiomyopathy), Pericarditis, myocarditis & perimyocarditis: ECG, criteria & treatment, Eletrical alternans: the ECG in pericardial effusion & cardiac tamponade, Exercise stress test (treadmill test, exercise ECG): Introduction, Indications, Contraindications, and Preparations for Exercise Stress Testing (exercise ECG), Exercise stress test (exercise ECG): protocols, evaluation & termination, Exercise stress testing in special patient populations, Exercise physiology: from normal response to myocardial ischemia & chest pain, Evaluation of exercise stress test: ECG, symptoms, blood pressure, heart rate, performance, ECG criteria for left anterior fascicular block (LAFB), Causes of left anterior fascicular block (LAFB), Prognosis of left anterior fascicular block (LAFB), Noteworthy about left anterior fascicular block (LAFB), ECG criteria for left posterior fascicular block (LPFB), Causes of left posterior fascicular block (LPFB), Causes ofleft anterior fascicular block (LAFB), Prognosis ofleft anterior fascicular block (LAFB), Noteworthy aboutleft anterior fascicular block (LAFB), Causes ofleft posterior fascicular block (LPFB). Electrocardiograms are used by doctors to diagnose a variety of cardiac problems. Before Here are the rules for interpreting a left anterior fascicular block (LAFB). Herein, we will discuss what makes up the electrical axis, ventricular (QRS) axis, axis classifications . International Journal of Molecular Sciences. Although not a dangerous finding in and of itself, axis deviation may be . Its probable relation to the so-called left anterior fascicular hemiblock]. Q: What is left axis deviation reported in the ECG? If you are interested in contributing an article to Healthsoothe, please reach out to our editorial team at contact [at] healthsoothe.com to request a media kit. In moderate-to-marked LAD group mean values of BP, FPG, and lipid profiles were higher (p<0.001) and abnormal. Wanted to please understand what this left axis deviation means and if it's normal. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. We also use third-party cookies that help us analyze and understand how you use this website. padding-bottom: 0px; National Library of Medicine The frequencies of glucose intolerance were 48.9% even in borderline LAD with 84.9% in moderate-to-marked LAD group. A research was carried out, and the results were that the development of left axis deviation in people of 40-59yr of age, independent of blood pressure is a significant predictor of ischemic heart disease events that are usually manifest 5-10yr after the onset of this electrocardiographic abnormality. Yazdanpanah MH, Sayyadipoor S, Hojati SR, Nikmanesh A, Farjam M, Homayounfar R. Diabetes Metab Syndr Obes. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. eCollection 2020. MeSH Approximately 510% of all individuals have a third fascicle the median or centroseptal fascicle whichgives off Purkinje fibers to the interventricular septum. Although not a dangerous finding in and of itself, axis deviation may be an indication of a serious underlying condition. A collection of surgery revision notes covering key surgical topics. Left anterior fascicular block is one of the commonest causes of left axis deviation and has specific ECG criteria for its diagnosis. It then spreads down the bundle of Hisand then Purkinje fibres to cause ventricular contraction. The electrical axis will be more positive than 90 (right axis deviation). [Right bundle branch block: electrocardiographic and prognostic features]. Simply so, is left axis deviation serious? The ECG showed a regular narrow QRS tachycardia at 108 bpm suggestive of a regularized atrial fibrillation, with ST-segment elevation in aVR and less marked in V 1, with ST-segment depression in V 2 through V 6 and the inferior and lateral leads. If, in contrast, the QRS complex in lead II is negative, this indicates a LAD.
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