MRCEM Notes

ECG: axis deviation

Causes of left axis deviation (LAD)
  • left anterior hemiblock
  • left bundle branch block
  • Wolff-Parkinson-White syndrome* - right-sided accessory pathway
  • hyperkalaemia
  • congenital: ostium primum ASD, tricuspid atresia
  • minor LAD in obese people

Causes of right axis deviation (RAD)
  • right ventricular hypertrophy
  • left posterior hemiblock
  • chronic lung disease → cor pulmonale
  • pulmonary embolism
  • ostium secundum ASD
  • Wolff-Parkinson-White syndrome* - left-sided accessory pathway
  • normal in infant < 1 years old
  • minor RAD in tall people

*in the majority of cases, or in a question without qualification, Wolff-Parkinson-White syndrome is associated with left axis deviation
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