February 7, 2023

Lead Misplacement or Dextrocardia

 What is the dx?

Difficulty level:⭐️⭐️

Digitize using #PMCardio

What is your ECG rhythm interpretation?


B Ectopic atrial rhythm

C.SR, old lateral wall MI

D Wrong lead placement

Answer: This is lead misplacement (RA/LA reversal).

This indeed looked dextrocardia - I is reversed/ aVR looked like aVL.

However, the Rwave progression looked normal from L>R (increasing Rwave from V1>V6). So, this is a big blue that this is lead misplacement.

In  RA and LA reversal, the following are noted:

Lead I is reversed. 

Lead II becomes lead III and vice versa.

Lead aVR become lead aVL and vice versa. 

Lead aVF is unchanged.

A repeat ECG is shown.

Here is a link for sample cases of dextrocardia. 


Twitter link: https://twitter.com/ecgrhythms/status/1622725870321532932?s=20&t=1SSl-LA861llfPTryjMQTA

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