TABLE 476 Some Clinical Conditions Where the Electrocardiogram Interpretation Can Be Difficult

Right ventricular pacing causes secondary repolarization changes of opposing polarity to that of the predominant QRS complex. Most leads have predominant negative QRS complexes followed by ST-segment elevation and positive T waves. ST-segment elevation 35 mm was most indicative of AMI in leads with predominantly negative QRS complexes. Any ST-segment elevation concordant to the QRS complex in a predominantly positive QRS complex was highly specific for AMI. The QRS complex is predominantly negative in leads V! to V3. ST-segment depression in these leads had 80 percent specificity for AMI.9

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