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June 11, 1973

"Lead Thirteen" Electrocardiograph

JAMA. 1973;224(11):1533. doi:10.1001/jama.1973.03220250055028

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To the Editor.—  As sophisticated concepts and techniques in electrocardiography proliferate, there is the danger that significant basic principles may be overlooked. I have encountered many serious instances of misdiagnosis in the interpretation of a Q and inverted T wave in lead III.Figure 1, left, demonstrates lead III (death) in a 39-year-old man whose medical history was totally devoid of cardiac stigmata and continued to be so for a period of more than 11 years. Figure 2, left also represents lead III (death) in a 22-year-old woman without any evidence of cardiovascular disorder. Each case was initially diagnosed elsewhere as having either actual or "possible" inferior myocardial infarction.Repetition of lead III in deep inspiration (Fig 1 and 2, middle) clearly demonstrates the positional origin of the "changes" and, with or without aVf confirmation (Fig 1 and 2, right), provides a means of differentiating important pathological findings from