Dextrocardia and reversed limb leads - Cardiac Monitoring Service
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Dextrocardia and reversed limb leads

By Assoc Prof Harry Mond
November 12, 2020

In the previous ECG presentation, we learnt how to recognize reversed arm leads.

Here is a summary:

Lead I is flipped and leads aVR and aVL are reversed.

This same scenario occurs with dextrocardia, where the leads are not reversed, but rather the heart is positioned with the apex of the left ventricle on the right side.

Here is an ECG from a patient with dextrocardia:

With dextrocardia the chest leads are very different.

Leads V1 and V2 are reversed and leads V3 to V6 appear as they would, if the leads were placed on the right side (V3R to V6R) in a normal patient.

Here is another example of dextrocardia:

Now let us change the arm leads (no need to swap the leg leads) and place the chest leads on the right.

Presto; We have a near-normal looking ECG.

I have seen an inexperienced technician place the leads on the right side of the chest, but the limb leads normal!

The ECG reporter can often get confused, when the chest leads are inadvertently reversed, but on the left side of the chest. I have seen this reported as dextrocardia.

Here is an example:

Finally, the pièce de résistance!

I call this the “full hand” and I have seen it several times.

There are reversed arm and chest (on the left side) leads.

Remember, keep your eyes open when reporting ECGs!

Harry Mond

About Assoc Prof Harry Mond

In 49+ years as a practicing cardiologist, Assoc Prof Harry Mond has published 260+ published manuscripts & books. A co-founder of Cardiac Monitoring Service, he remains Medical Director and oversees 500K+ heart studies each year.

Download his full profile here.

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