High V1/V2 misplacement

It is very common to place the first two chest electrodes too high. If this has happened, the QRS complex may have developed ‘evil bunny ears’ that can be easily mistaken for an incomplete right bundle branch block. The T waves in these leads may also become inverted and mimic a heart attack. This will all go back to normal if the ECG is repeated with the V1 and V2 electrodes in the 4th intercostal space.

See also: Electrode misplacement

Can you add to the information on this page?

This ECG Archive is an academic, non-commercial #FOAMed project aiming to crowdsource a free open access database of ECGs and signs. If you include your personal details such as your name you will be attributed for your contribution, unless you tell us that you don't want this to happen. Personal contact details such as email addresses will not be published but may be used to email you in reply. Full project details and participant information available here.

Featured Example

ECG Library (10)

Sort by:
TitleDate
ASCDESC
Show:
31230
Columns:
In the ECGquest archives, this ECG has been tagged with: - 12-Lead High V1/V2 misplacement RSR' Saddleback ST elevation Dr Smith's ECG Blog CC BY-NC
Saddleback ST Elevation. Is it STEMI? Is it type II Brugada?

This ECG is from a man in his 50s who presented with epigastric and chest pain.

This ECG shows saddleback ST elevation, but a RSR pattern in V1 that suggested lead misplacement. When the electrodes were repositioned there was no evidence of ischemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Dr Smith's ECG Blog CC BY-NC
Chest Pain and Q-waves in V1 and V2. Is there previous septal MI?

This ECG is from a middle aged woman who presented with chest pain.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Inferior ST elevation Reciprocal ST depression Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
A 50-something woman with chest pain and 2 “normal” ECGs at triage

This ECG is from a woman in her 50s who presented with one hour of chest tightness on a background of diabetes and hypertension.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Hyperacute T waves Late R wave transition Terminal QRS distortion Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Prehospital OMI recognized immediately by a fantastic paramedic

This ECG is from a woman in her 60s who presented with chest pain and feeling clammy, on a background of hypertension and high cholesterol. This was her first prehospital ECG.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Serial 12-lead Anterior ST elevation Hyperacute T waves Terminal QRS distortion Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Prehospital OMI recognized immediately by a fantastic paramedic: 2 – En route to cath center

This ECG is from a woman in her 60s who presented with chest pain and feeling clammy, on a background of hypertension and high cholesterol. This was her second ECG en route to the hospital.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Serial 12-lead Anterior ST elevation Hyperacute T waves Terminal QRS distortion Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Prehospital OMI recognized immediately by a fantastic paramedic: 3 – En route to cath center

This ECG is from a woman in her 60s who presented with chest pain and feeling clammy, on a background of hypertension and high cholesterol. This ECG was recorded en route to the hospital.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Serial 12-lead Anterior ST elevation Hyperacute T waves Terminal QRS distortion Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Prehospital OMI recognized immediately by a fantastic paramedic: 4 – En route to cath center

This ECG is from a woman in her 60s who presented with chest pain and feeling clammy, on a background of hypertension and high cholesterol. This ECG was recorded en route to the hospital.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead High V1/V2 misplacement Serial 12-lead Normal Axis Normal P waves Normal T waves Normal Sinus Rhythm Normal Dr Smith's ECG Blog CC BY-NC
A pathognomonic ECG you should recognize instantly. Baseline ECG

This ECG is from a patient of unknown age who presented with generalised weakness and malaise. This was the baseline ECG from a previous presentation.

In the ECGquest archives, this ECG has been tagged with: - Chest pain High V1/V2 misplacement LVH ECG Interpretation CC-BY-NC-SA
ECG Blog #127 (Acute STEMI – Lead Malposition – LVH – Reciprocal Changes)