A 78-year-old woman is admitted to the cardiovascular ICU after repair of a ruptured abdominal aortic aneurysm. She is known to have a congenital cardiac abnormality:

• P waves negative in lead I, positive in lead 2 – Right axis deviation
• Unusual QRS progression from V2 to V6, with similar pattern and decreasing voltage
• These findings are compatible with dextrocardia
•  Sinus rhythm
•  Ventricular rate 73/min
•  Two interpolated premature ventricular complexes

 An ECG tracing with reversal of lead I and recording of the right chest leads should be obtained.

The patient had marked blood loss that was vigorously treated and her cardiac condition is stable and satisfactory. This ECG is recorded 14 ours after ECG 1 with the arm cables reversed and the right chest leads recording:

• Sinus tachycardia, 102/min
• Non-specific T wave abnormality