V1 Inversion: Doubly True Posterior Infarct
Report:
Sinus rhythm
Old inferolateral infarction
Early transition
Probable posterior infarction
Lead V1 mounted upside-down
Comment:
There are pathological Q waves in the inferior leads and V6, evidence of inferolateral infarction. In this context, lead V1 morphology - dominant R wave with upright T wave - looks, superficially, convincing enough of an associated posterior infarction. The upside-down writing tells all.
However, as Oscar Wilde put it, the truth is seldom plain and never simple. The true R wave in V1 is still 0.04â long and its true T wave is indeed upright. The V2 R wave is dominant, which may be a normal variant, but in this case adds evidence for a posterior infarction. Itâs posterior MI either way!
183. 53 year old with severe constant chest pain and history of pericarditis 10 years previously
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