Lead on, John Doone

Rave on John Donne, rave on thy Holy fool
Down through the weeks of ages
In the moss borne dark dank pools

"Rave On, John Donne" Lyrics by Van Morrison

This 45 year old man presented with atypical chest pain.

Figure 1. Forty five year old man with atypical chest pain

Figure 1. Forty five year old man with atypical chest pain

Figure 2. Lead II from forty five year old man with atypical chest pain 

Figure 2. Lead II from forty five year old man with atypical chest pain 

+ Describe the main findings

  • Sinus rhythm is present at a rate of about 65 beats per minute

  • Artefact due to alternating current is present in Lead II and Lead aVF

  • Look at the progression of the QRS complexes in the precordial leads. It is clear that Lead V1 and Lead V2 have been transposed

  • There is slight ST segment elevation in Lead II, Lead aVF and Leads V5 and V6

  • There is slight ST depression in Lead V2 (labelled V1) and Lead V3

Key Point: Check the precordial leads for normal progression of the QRS complexes