Left axis deviation

April is a 41-year-old woman who has recently applied for life insurance. She is extremely fit, does boxing and goes to the gym most days, has no known medical problems and takes no medications. She has been to your practice numerous times for simple conditions and preventive healthcare. On one occasion, when she was suffering a viral illness, she was documented as having a mitral systolic murmur, grade 2/6, and so the insurance company required her to have an echocardiogram and ECG before considering her application. April’s echocardiogram was essentially normal, showing mild mitral valve regurgitation with mild left atrial dilation, trivial tricuspid valve regurgitation and normal ventricular function, left ventricular ejection fraction and pulmonary artery pressure.