MIscllaneous

Reversed Arm Leads: Yes or No?

Discussion
When the QRS complex is entirely inverted in lead l, reversed arm leads come to
mind. The first thing that should be checked is the P wave. If it is also inverted,
then one is indeed dealing with reversed arm leads or, more rarely, dextrocardia.
Here, the P wave is upright, so the arm leads were not misplaced.
This patient has an extensive anterior myocardial infarction involving the
precordial leads as well as leads l and aVL. Thus, a trivial finding such as the P
wave direction can, at times, play a decisive role.