Literature Review: Precordial lead placement and its impact on ECG interpretation and clinical care

Emergency Cardiology Literature Review & Updates with Dr. Amal Mattu


A 46-year-old man with no known significant PMHx aside from tobacco smoking presents to the emergency department with sharp midsternal chest pain. Symptoms have been ongoing for 1 day without any known alleviating or aggravating factors. Vital signs are normal on arrival and the following ECG is obtained:

Before watching the video, look closely at this ECG and ask yourself:

  1. What do you think of the P waves in the precordial leads?
  2. What is the most likely cause of the septal Q waves and ST segment abnormalities in V1-V2?
  3. Would you activate the cath lab?