What Is This ST Elevation?
Highlights
- Suspect leads V1 and/or V2 have been placed 1 or 2 interspacestoo high on the chest IF one or more of the following clues are present:
• C****LUE #1 — If there is an r’ in leads V1 and/or V2, especially if the other finding for incomplete RBBB (ie, terminal s waves in lateral leads I and V6) is absent.
• **C**LUE #2 — If there is a significant negative component to the P wave in lead V1 and/or V2.
• **C**LUE **#**3 — If the appearance of the QRS complex and the ST-T wave in leads V1 and V2 looks very much like the QRS and ST-T wave in lead aVR. (View Highlight)
- There may normally be a negative component to the P wave in leads V1 and/or V2 — especially if atrial size and/or pressure is increased (ie, one of the ECG criteria for left atrial abnormality is a deep negative component to the P wave in lead V1). That said, most of the time — the depth and width of a “normal” negative component to the P wave in leads V1 and/or V2 will not be nearly as prominent (View Highlight)
- Physiologically — the presence of a terminal r' deflection means that the last component of ventricular depolarization (from the viewpoint of leads V1 and V2) is directed toward the right (ie, toward the right ventricular outflow track). An r’ in lead V1 (and even incomplete RBBB) are not necessarily abnormal findings in a small but significant percentage of otherwise young, healthy adults — since ventricular depolarization of this portion of the RV is sometimes slightly delayed relative to LV depolarization as a normal phenomenon. (View Highlight)
(View Highlight)