This ECG
was recorded 24 hours later. Note the persistent injury pattern
in II, III, aVF. Q-waves have appeared in these leads indicating
inferior necrosis or infarction. The resultant loss of inferior
myocardium has shifted the frontal plane axis superiorly
(or leftward).
There is
also persistent ST depression in Leads V1 through V4 and look
what has happened to the R-waves in those leads. They're very
tall. This development of tall R-waves in the right precordium
should be interpreted as evidence of POSTERIOR
myocardial infarction. The horizontal axis is therefore shifted
anteriorly.
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