ECG Rhythms : Lead Misplacement or Dextrocardia

What is the dx?

Difficulty level:⭐️⭐️

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What is your ECG rhythm interpretation?

A.Dextrocardia

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.

ECG Rhythms