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Top 3 emergent causes of new rightward axis + ST segment elevation mimicking STEMI (which usually does not produce rightward axis) to consider:
Acute right heart strain/Pulmonary hypertension (e.g. PE)
Na+ channel blocker toxicity
Hyperkalemia
Complete list of the differentials to consider in rightward axis deviation:
Pulmonary hypertension (acute and chronic, e.g. COPD)
Na+ channel blocker toxicity
Hyperkalemia
Right ventricular hypertrophy
Left posterior fascicular block
Old lateral MI (Q-waves in lead I)
Ventricular beats/ectopy
Misplaced leads
Situs inversus/Dextrocardia
Newborns/infant
KEY PEARL:
Remember that STEMI's don't tend to produce a rightward axis. Large PE's can often mimic STEMI. Pay attention to the Axis!
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