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 0.04” 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. It’s posterior MI either way!

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