Northwest axis in the electrocardiogram — A sign of right ventricular remodeling in tetralogy of Fallot. A case report

The typical ECG changes in tetralogy of Fallot are right axis deviation, large R waves in the anterior precordial  leads and large S waves in the lateral precordial leads. We present a patient with extreme deviation of the frontal  QRS axis between − 90◦ and ± 180◦. The child underwent open heart surgery twice before one year of age and a  third time at nine years of age. The axis change persisted into adulthood.