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ECG library

Posterior infarction: the mirror pattern

advanced

Ongoing chest pain, and 'only ST depression' in V1 to V3.

25 mm/s · 10 mm/mV · synthetic tracing
100%
IIIIIIaVRaVLaVFV1V2V3V4V5V6
II (rhythm)
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.

Key findings

  • ST depression maximal V1-V3
  • Ongoing pain
  • Think in mirrors

Learning points

  • The standard 12 leads have no posterior electrode; the anterior leads show the infarct reflected.
  • Flip the tracing mentally (or physically): depression becomes elevation, tall R becomes Q.

Connected