How to diagnose Dextrocardia on ECG

How to diagnose Dextrocardia on ECG?

DEXTROCARDIA – ECG SUMMARY (High-Yield)

Classic ECG Findings

Limb Leads

Lead I: inverted P, QRS, T (often QS)

aVR: upright P, QRS, T

Inferior leads (II, III, aVF): usually positive

Precordial Leads (Left-sided placement)

Absent R-wave progression

Dominant S waves V1–V6

All QRS predominantly negative

Key Concept Electrical forces directed rightward because heart is located on right side.

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Confirmation

1. Apex beat on right side

2. Chest X-ray → right-sided cardiac shadow

3. Repeat ECG with right-sided leads (V1R–V6R) → normal R progression appears

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Differential Diagnosis

1) RA–LA Limb Lead Reversal (Most common mimic)

Lead I negative

aVR positive

BUT normal R-wave progression in chest leads

→ Chest leads differentiate it

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2) Extreme Right Axis Deviation

Lead I negative

Inferior leads may vary

Normal precordial progression

→ Does NOT give global negative V1–V6

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3) Severe COPD / Vertical heart

Low voltage

Delayed R progression

Not global negative QRS

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4) Incorrect Precordial Lead Placement

Abnormal R progression

Limb leads normal

One-Line Diagnostic Rule

Negative Lead I + Positive aVR + Global negative V1–V6

= Dextrocardia until proven otherwise.

Comments

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