Dextrocardia electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [[2]]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Claudia Hochberg, M.D.; Assistant Editor-In-Chief: Kristin Feeney, B.S. [[5]]


Electrocardiogram may be used as a diagnostic tool in the evaluation of an atrial septal defect. ECG findings associated with dextrocardia include an R wave inversion.


An ECG may be helpful in the diagnosis of dextrocardia. Findings on an ECG suggestive of/diagnostic of [disease name] include:[1][2]

  • Inversion of P waves in leads I and aVL
  • Dominant S waves in leads I and V1 to V6
  • Reversed R wave progression in chest leads
  • Low voltage QRS axis in V4 to V6
  • Extreme QRS axis
  • Flattened T waves in V4 to V6 and aVR
  • inverted T waves in lead I and aVL

It is possible to distinguish lead reversal and dextrocardia by watching the precordial leads. Dextrocardia will show an R wave inversion, whereas lead reversal will not.

The bottom EKG shows marked right axis deviation and loss of voltage across the precordium. There are also inverted P waves in leads I and aVL. The differential for inverted P waves in lead I and aVL is Dextrocardia vs Reversed Arm Leads. Since there is loss of voltage across the precordium this is Dextrocardia.

Special considerations

ECG leads must be placed in reversed positions on a person with Dextrocardia.

Shown below is an explanation of EKG findings in dextrocardia.

Inverted P waves in leads and aVL. CableReversal1.png

Shown below is an image of EKG in a patient with Dextrocardia .

EKG demonstrates right axis deviation and loss of voltage across the precordium. There are also inverted P waves in leads I and aVL. Dextrocardia.jpg

Shown below is an image of EKG in a patient with Dextrocardia .



Copyleft images obtained courtesy of ECGpedia,


  1. Khoury M, Harbieh B, Heriopian A (2013). "Isolated dextrocardia and congenital heart blocking". Radiol Case Rep. 8 (1): 521. doi:10.2484/rcr.v8i1.521. PMC 4900208. PMID 27330607.
  2. Ogunlade O, Ayoka AO, Akomolafe RO, Akinsomisoye OS, Irinoye AI, Ajao A; et al. (2015). "The role of electrocardiogram in the diagnosis of dextrocardia with mirror image atrial arrangement and ventricular position in a young adult Nigerian in Ile-Ife: a case report". J Med Case Rep. 9: 222. doi:10.1186/s13256-015-0695-4. PMC 4584464. PMID 26411880.

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