Right axis deviation

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Right axis deviation
File:Hexaxial reference system.svg
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Often asymptomatic, may be associated with dyspnea, palpitations
Complications	Heart failure, arrhythmias
Onset	Can be congenital or acquired
Duration	Chronic
Types	N/A
Causes	Pulmonary hypertension, chronic obstructive pulmonary disease, right ventricular hypertrophy
Risks	Smoking, obesity, sedentary lifestyle
Diagnosis	Electrocardiogram (ECG)
Differential diagnosis	Left axis deviation, normal axis
Prevention	Managing risk factors, such as smoking cessation, weight loss
Treatment	Addressing underlying causes, such as medication for hypertension
Medication	N/A
Prognosis	Depends on underlying cause
Frequency	Common in certain populations, such as those with lung disease
Deaths	N/A

Right Axis Deviation

File:RBBB with first degree AV block.jpg

An electrocardiogram (ECG) illustrating various cardiac rhythms

Right axis deviation (RAD) refers to an electrocardiogram (ECG) finding wherein the electrical axis of the heart deviates to the right of what is considered the normal range. The electrical axis represents the general direction in which the electrical impulses travel across the heart during its rhythmic contraction.

Introduction

The electrical axis is determined by the net direction of electrical activity as it's represented on the ECG. Normally, this axis lies between -30° and +90°. In RAD, the axis shifts to a position greater than +90°, indicating a deviation in the direction of the heart's main electrical activity.

Causes

Right axis deviation can result from a variety of causes:

• Anatomical Changes: Enlargement or hypertrophy of the right ventricle can lead to RAD.
• Pulmonary Conditions: Conditions like chronic obstructive pulmonary disease (COPD) or pulmonary embolism can cause RAD due to increased strain on the right side of the heart.
• Cardiac Conditions: Certain congenital heart diseases or an acute myocardial infarction (heart attack) affecting the right ventricle can result in RAD.
• Electrical Abnormalities: Conditions such as Wolff-Parkinson-White syndrome may lead to RAD.

Diagnosis

The diagnosis of RAD is typically made by analyzing the QRS complex on a 12-lead ECG:

• Lead I: If the QRS complex is predominantly negative (or "downward"), it suggests RAD.
• Lead aVF: If the QRS complex is predominantly positive (or "upward"), it further supports the presence of RAD.

Clinical Implications

While RAD can be a normal variant in some individuals, especially younger patients or those with a tall, slender body habitus, its presence can also signify underlying cardiac or pulmonary pathology. Thus, it's crucial to interpret RAD in the context of the clinical scenario and, if needed, undertake further diagnostic evaluation.

Treatment

The treatment for right axis deviation primarily revolves around addressing its underlying cause. For instance:

• If it's due to hypertrophy of the right ventricle, therapies aimed at reducing the workload of the heart might be recommended.
• In cases of pulmonary conditions causing RAD, treatments like oxygen therapy, bronchodilators, or anticoagulation might be prescribed.

Conclusion

Right axis deviation provides valuable insights into the electrical function of the heart and can be a sign of underlying pathology. Its recognition and understanding are essential for clinicians to ensure appropriate diagnosis and management of the underlying conditions leading to the deviation.

References

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