Right Axis Deviation


Knowledge

RAD not present on prior ECGs: When right axis deviation is a new finding, it can be due to an exacerbation of lung disease, a pulmonary embolus, a new high lateral MI (Qr pattern) or simply a tachycardia.

RAD on prior ECGs: Chronic right axis deviation is normal in youngsters (less than 21 years of age) and in athletes. It can be a chronic finding in patients with lung disease and RVH or in patients with left posterior hemiblock. The latter is a diagnosis of exclusion.


Recommendations

RAD not present on prior ECGs: If right axis deviation is a change from previous ECGs, question the patient for symptoms consistent with an exacerbation of lung disease or a pulmonary embolus. If the patient has sharp, pleuritic chest pain a nuclear ventilation/perfusion (VQ) scan is usually indicated and if a ventilation/perfusion mismatch is noted anticoagulation is appropriate.

View an ECG Example