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Patient
61-year-old woman suffered an inferior myocardial infarction 3 years earlier;
Trace
Sinus rhythm; probable inferior (Q-waves in leads II, III and aVF) and posterior infarction (tall R waves in V1, V2, with R/S ratio > 1);
Trace
Tracing recorded simultaneously with right-sided and posterior leads; deep Q-waves in the posterior leads with reciprocal R waves in the right leads;
Exergue
The presence of a tall R wave in V1 with an R/S ratio> 1 may reflect the a posterior infarction or can be observed in patients with right ventricular hypertrophy, hypertrophic cardiomyopathy, right bundle branch block, left Wolff-Parkinson-White syndrome or left ventricular-paced patients.
This patient had gone through a inferior infarction with posterior extension in conjunction with a thrombosis of a dominant circumflex requiring urgent angioplasty six hours after onset of chest pain.