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Dextrocardia

Dextrocardia and X-ray
Main Cardiac Vector
ECG and Decreased R Wave Progression
ECG and Dextrocardia
Mirror Chest Electrodes
Reversed Arm Electrodes vs. Dextrocardia

Dextrocardia and X-ray

Levocardia

It is the physiological position of the heart, with the apex of the heart pointing to the left

Dextroposition

The entire heart is shifted to the right in the chest
The apex of the heart still points to the left

Dextrocardia

It is a congenital developmental defect of the heart
The position of the heart base is shifted only minimally
The apex of the heart points to the right

The main electrical vector also points to the right

A chest X-ray is sufficient for diagnosing dextrocardia

No ECG is needed

Main Cardiac Vector

Dextrocardia and direction of heart electrical vector

In dextrocardia, the heart points to the right

The main electrical vector points to the right

The vector points away from left-sided leads (I, aVL, V5-V6)
Characteristic changes occur in

Limb leads (I, II, III, aVF, aVL, aVF)
Precordial leads (V1-V6)

ECG and Decreased R Wave Progression

In levocardia

The main vector points to V5-V6
R wave increases from V1 to V5

In dextrocardia

The main vector points away from V5-V6
R wave does not increase from V1 to V5

Decreased R wave progression is:

R wave in V3 < 4mm

The R wave does not increase from V1 to V5

or amputated R waves

R wave (V1-V3) is absent

ECG poor R wave progression, R wave in V3 less than 4mm

ECG and Dextrocardia

Extreme Axis Deviation to the Right

Dominant R in aVR (Positive P, QRS, and T waves)
Dominant S in lead I (Negative P, QRS, and T waves)

Decreased R Wave Progression (R wave does not increase from V1 to V5)

ECG dextrocardia criteria: inverted I lead, poor r wave progression,

Mirror Chest Electrodes

Dextrocardia diagnosis with ecg right sided leads (V1R-V6R)

In case of suspicion of dextrocardia (for extreme axis deviation to the right)

Mirror chest electrodes (V1R-V6R) are placed

If normal R wave progression appears in the mirror leads

It indicates dextrocardia

Reversed Arm Electrodes vs. Dextrocardia

ECG appearance of dextrocardia in limb leads (in levocardia)

Occurs if you swap the limb electrodes on the arms (left arm for right arm)

Reversed limb electrodes on the arms

However, they preserve R wave progression
Because chest leads are intact and the vector points towards V5-V6 leads

ECG differential diagnosis dextrocardia vs. reversal of the left and right arm electrodes

Differential Diagnosis: Dextrocardia vs. Reversed Arm Electrodes

If Lead I is completely negative (P, QRS, T)
Differentiate based on R wave progression:

Reversed arm electrodes (Decreased R wave progression)
Dextrocardia (Decreased R wave progression)

Dextrocardia

Extreme Right Axis Deviation

Dominant R in aVR
Dominant S in Lead I

Decreased R Wave Progression

R wave from V1 to V6 may even decrease

ECG reversal of the left and right arm electrodes, with normal R wave progression

Reversed Arm Electrodes

Extreme Right Axis Deviation

Dominant R in aVR
Dominant S in Lead I

R Wave Progression

R wave from V1 to V6 increases

Dextrocardia

Extreme Right Axis Deviation

Dominant R in aVR (Positive QRS in aVR)
Dominant S in Lead I (Negative QRS in Lead I)

Decreased R Wave Progression (R wave from V1 to V5 does not increase)

R wave in V3 < 4mm

ECG with reveral limb leads right arm and left arm with normal r wave progression and reversal I lead

Reversed Arm Electrodes

Extreme Right Axis Deviation

Dominant R in aVR
Dominant S in Lead I

R Wave Progression

R wave from V1 to V6 increases

The patient has reversed limb electrodes (left arm/right arm)

ECG with correct lieb leads (right arm, left arm) position and with normal r wave progression, and with positive lead I

Correctly Placed Arm Electrodes

This is an ECG from a previous patient

Electrodes on the arms are now correctly placed

Note the normalization of QRS complexes in the limb leads

ECG dextrocardia with old inferior STEMI infarction. Poor r wave progression

Dextrocardia and Old Inferior Myocardial Infarction

Old Inferior Myocardial Infarction

Pathological Q (II, III, aVF) - red arrows
Negative T (II, III, aVF) - blue arrows

Dextrocardia

Dominant R in aVR - green arrows
Dominant S in lead I - purple arrow
Reduced R Wave Progression - brown-yellow arrows

R wave amplitude V1-V6 decreases

ECG Right sided precordial leads, old inferior stemi, dextrocardia with poor r wave progression

Right-Sided Chest Leads (V1R-V6R)

This is an ECG from a previous patient
The chest leads are mirror-image placed on the right
- They are labeled (V1R-V6R)
- The ECG shows R wave progression from V1 to V6
- The limb leads remain unchanged
The ECG shows R wave progression (brown-yellow arrows)

Because the vector points to the right towards leads VR5-VR6

12-lead ECG with Right sided precordial leads

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers

Home /

Dextrocardia

Dextrocardia and X-ray
Main Cardiac Vector
ECG and Decreased R Wave Progression
ECG and Dextrocardia
Mirror Chest Electrodes
Reversed Arm Electrodes vs. Dextrocardia

Dextrocardia and X-ray

Levocardia

It is the physiological position of the heart, with the apex of the heart pointing to the left

Dextroposition

The entire heart is shifted to the right in the chest
The apex of the heart still points to the left

Dextrocardia

It is a congenital developmental defect of the heart
The position of the heart base is shifted only minimally
The apex of the heart points to the right

The main electrical vector also points to the right

A chest X-ray is sufficient for diagnosing dextrocardia

No ECG is needed

Main Cardiac Vector

In dextrocardia, the heart points to the right

The main electrical vector points to the right

The vector points away from left-sided leads (I, aVL, V5-V6)
Characteristic changes occur in

Limb leads (I, II, III, aVF, aVL, aVF)
Precordial leads (V1-V6)

ECG and Decreased R Wave Progression

In levocardia

The main vector points to V5-V6
R wave increases from V1 to V5

In dextrocardia

The main vector points away from V5-V6
R wave does not increase from V1 to V5

Decreased R wave progression is:

R wave in V3 < 4mm

The R wave does not increase from V1 to V5

or amputated R waves

R wave (V1-V3) is absent

ECG and Dextrocardia

Extreme Axis Deviation to the Right

Dominant R in aVR (Positive P, QRS, and T waves)
Dominant S in lead I (Negative P, QRS, and T waves)

Decreased R Wave Progression (R wave does not increase from V1 to V5)

Mirror Chest Electrodes

In case of suspicion of dextrocardia (for extreme axis deviation to the right)

Mirror chest electrodes (V1R-V6R) are placed

If normal R wave progression appears in the mirror leads

It indicates dextrocardia

Reversed Arm Electrodes vs. Dextrocardia

ECG appearance of dextrocardia in limb leads (in levocardia)

Occurs if you swap the limb electrodes on the arms (left arm for right arm)

Reversed limb electrodes on the arms

However, they preserve R wave progression
Because chest leads are intact and the vector points towards V5-V6 leads

Differential Diagnosis: Dextrocardia vs. Reversed Arm Electrodes

If Lead I is completely negative (P, QRS, T)
Differentiate based on R wave progression:

Reversed arm electrodes (Decreased R wave progression)
Dextrocardia (Decreased R wave progression)

Dextrocardia

Extreme Right Axis Deviation

Dominant R in aVR
Dominant S in Lead I

Decreased R Wave Progression

R wave from V1 to V6 may even decrease

Reversed Arm Electrodes

Extreme Right Axis Deviation

Dominant R in aVR
Dominant S in Lead I

R Wave Progression

R wave from V1 to V6 increases

Dextrocardia

Extreme Right Axis Deviation

Dominant R in aVR (Positive QRS in aVR)
Dominant S in Lead I (Negative QRS in Lead I)

Decreased R Wave Progression (R wave from V1 to V5 does not increase)

R wave in V3 < 4mm

Reversed Arm Electrodes

Extreme Right Axis Deviation

Dominant R in aVR
Dominant S in Lead I

R Wave Progression

R wave from V1 to V6 increases

The patient has reversed limb electrodes (left arm/right arm)

Correctly Placed Arm Electrodes

This is an ECG from a previous patient

Electrodes on the arms are now correctly placed

Note the normalization of QRS complexes in the limb leads

Dextrocardia and Old Inferior Myocardial Infarction

Old Inferior Myocardial Infarction

Pathological Q (II, III, aVF) - red arrows
Negative T (II, III, aVF) - blue arrows

Dextrocardia

Dominant R in aVR - green arrows
Dominant S in lead I - purple arrow
Reduced R Wave Progression - brown-yellow arrows

R wave amplitude V1-V6 decreases

Right-Sided Chest Leads (V1R-V6R)

This is an ECG from a previous patient
The chest leads are mirror-image placed on the right
- They are labeled (V1R-V6R)
- The ECG shows R wave progression from V1 to V6
- The limb leads remain unchanged
The ECG shows R wave progression (brown-yellow arrows)

Because the vector points to the right towards leads VR5-VR6

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers