Tombstones in V2
Report:
Sinus rhythm 80/min
Acute anterior infarction
Comment:
The pattern in V2 is as good a picture of tombstones or tombstoning as it gets. It is somewhat unusual to see it in only one lead. Tombstones are most commonly seen between leads V2 and V466.This pattern is important not for its evocative value (which is considerable) but for the degree of ST segment hyperelevation predicting infarct size and subsequent LV dysfunction67. Note the disappearance of S waves in V2-3 and the J point/R wave ratio (in V2) > 0.5; this constitutes Grade 3 ischaemia in the Sclarovsky-Birnbaum classification referred to above.
An hour later (below, Fig 92a), following thrombolysis, the ST elevation has almost completely resolved, with encouraging early T wave inversion68.
92a.
93. 66 year old lady in Casualty with chest pain.
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