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ECG Findings

  • Rightward axis.

  • Positive QRS complex in aVR.

  • Inversion of the entire complex in lead I.

  • Loss of R wave progression.

  • QRS deflections in V4 to V6 are small and downgoing.


  1. The orientation of the heart in the chest cavity is reversed with the predominant electrical activity moving left to right (as opposed to right to left).

  2. Normally placed precordial leads in a patient with dextrocardia are actually placed over the thinner right ventricle instead of the left ventricle.

  3. Reversing all ECG leads should produce an essentially normal ECG.

  4. A “reversed” lead I (“downward” QRS) and “reversed” lead aVR (“upward” QRS) with normal-appearing V leads strongly suggests limb lead reversal.


Dextrocardia. (ECG contributor: James V. Ritchie, MD.)


The P wave, QRS, and T wave are downgoing in lead I. Differential diagnosis includes limb lead reversal and dextrocardia. The 12-lead ECG above represents dextrocardia as evidenced in the abnormal precordial leads.

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