Past GSWs and Present ECG Axis

We recently ran a 56 YOF with diffuse abdominal pain, n/v, and syncope. Vitals were of little remark. History was most notable for previous (10+ years past) multiple (n=9) gunshot wounds to abdomen and chest. We performed a routine 12-lead ECG. I was struck by the patient’s peculiar axis. Because every frontal plane wave was substantially biphasic in character, she probably counts as having an indeterminate axis. I felt an argument could also be made that she was deep into the right inferior axis quadrant because III (120°) and aVR (-150°) were mildly positive (R wave dominant), and she was therefore right axis deviated. Unfortunately I did not retain the numbers from the monitor (Zoll E) to compare the algorithm’s opinion. I found myself wondering – whichever the appropriate category – whether her abnormal axis could be secondary to the extensive past penetrating chest injury. She detailed damages to her liver, pancreas, and spleen, but was less knowledgeable about which of her thoracic structures may have been damaged from the assault.

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