Short but Thick R Wave in V1: Posterior Infarction

Report:

Sinus rhythm 60/min

PR interval 0.20”

Old inferoposterior infarction

Comment:

Primary R wave in V1 ≥ 0.04” is as much sign of posterior infarction as R > S configuration. Dominant R in V2-3 – the early transition – of course supports the diagnosis, especially with T waves still upright – but this can be a normal variant.

Inferior Q waves are rather thin, but present in all three inferior leads and associated with broad primary R in V1. Most posterior infarcts also show inferior Q waves.

45. 54 year old with crushing chest pain as he lit his first ever cigarette!

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