Left axis deviation

Source: Wikipedia, the free encyclopedia.
The hexaxial reference system is a diagram that is used to determine the heart's electrical axis in the frontal plane.

In

mean electrical axis of ventricular contraction of the heart lies in a frontal plane direction between −30° and −90°. This is reflected by a QRS complex positive in lead I and negative in leads aVF and II.[1]

There are several potential causes of LAD. Some of the causes include normal variation,

paced rhythm.[2]

Symptoms and treatment of left axis deviation depend on the underlying cause.

Defining left axis deviation

Cardiac axis in electrocardiography represents the sum of depolarization vectors generated by individual cardiac myocytes. To interpret the cardiac axis, one has to determine the relationship between the QRS axis and limb leads of the ECG. Usually, left ventricles makes up most of the heart muscles, so a normal cardiac axis is directed downward and slightly to the left. In a normal axis, QRS is between -30° and +90°. In contrast to that, left axis deviation (LAD) is defined as QRS axis between −30° and −90°, and right axis deviation is defined as QRS axis greater than +90°, while extreme axis deviation occurs when QRS axis is between -90° and 180°.[3]

Determining left axis deviation

Determining the electrical axis can provide insight into underlying disease states and help steer the differential diagnosis.[2] There are several methods to determining the ECG axis. The easiest method is the quadrant method, where one looks at lead I and lead aVF. First, examine the QRS complex in both leads I and avF and determine if the QRS complex is positive (height of R wave > S wave), equiphasic (R wave = S wave), or negative (R wave < S wave). If lead I is positive and lead aVF is negative, then this is a possible LAD. To determine a true LAD, examine QRS in lead II. If the QRS complex is positive in lead II, then this is a normal axis. On the other hand, if QRS complex is negative in lead II, then this is a LAD.Another method of determining LAD is called the Isoelectric lead, which allows for a more precise estimation of the QRS axis.[3]

Causes

There are several potential causes of LAD. These include normal variation, left ventricular hypertrophy, conduction defects, inferior wall myocardial infarction, preexcitation syndrome, ventricular ectopic rhythms, congenital heart disease, hyperkalemia, emphysema, mechanical shift and pacemaker-generated paced rhythm. Normal variation causing LAD is an age-related physiologic change. Conduction defects such as

sudden cardiac death.[4]

Signs and symptoms

Left axis deviation symptoms depend on the underlying cause.

fainting.[6] If a conduction defect such as left bundle branch block is the cause of LAD, there may not be any symptoms unless the conduction defect is caused by heart failure, in which case there can be symptoms of heart failure such as shortness of breath or fatigue.[7]

Treatment

Left axis deviation per se does not require treatment, however the underlying cause can be treated.

angiotensin receptor blockers (ARBs), calcium channel blockers, diuretics, and beta-blockers. If LVH is due to valvular issues such as aortic valve stenosis, surgical repair of the valve or replacement of the valve is required.[8]

See also

References

  1. ^ Jenkins, Dean (1996). "The electrical axis at a glance". www.ecglibrary.com. Retrieved 2016-11-12.
  2. ^
    PMID 29262101
    , retrieved 2021-07-26
  3. ^ a b Cadogan, Mike; Buttner, Robert (2021-01-05). "ECG Axis Interpretation". Life in the Fast Lane • LITFL. Retrieved 2021-07-26.
  4. PMID 28231933
    .
  5. ^ a b Team, Health Jade (2020-03-19). "Heart left axis deviation causes, symptoms & treatment". Health Jade. Retrieved 2021-07-26.
  6. ^ "What is Left Ventricular Hypertrophy (LVH)?". www.heart.org. Retrieved 2021-07-26.
  7. ^ Kang MD, Steven. "Left Bundle Branch Block". Cedars-Sinai. Retrieved 2021-07-26.
  8. ^ "Left ventricular hypertrophy - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Retrieved 2021-07-26.
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