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Summary:The six limb leads are normally presented in a format the logic of which is traditional rather than anatomical and does not allow visual interpolation such as is customary with the six chest leads. The sequence: aVL, I, -aVR, 11, aVF, 111 was suggested years ago, and is used in some European countries, particularly Sweden. It provides a better impression of the extent of the changes of inferior infarction and makes the rather neglected lead aVR much more useful, though reversed in polarity. It also provides a more direct indication of the electrical axis, and simplifies comparisons with the frontal plane vectorcardiogram. Because modem digital electrocardiographs can provide the sequenced format, this seems a good time to review the advantages of adopting it.

We herein describe a case of acute myocarditis which may mimic myocardial infarction, since affected patients experience ‘typical’ chest pain, the ECG changes are identical to those observed in acute coronary syndromes, and serum markers are increased. This case emphasises the importance of performing appropriate cardiac MRI to help in the differential and definitive diagnosis as well as the extent of myocardial involvement. ST elevation myocardial infarction is rare in young adults and when it is encountered, it should raise the differential diagnosis of its mimickers.

We describe an 82-yr-old patient with platypnea-orthodeoxia without identifiable lung disease in whom the diagnosis was suspected because of clinical history, echocardiography, and orthostatic measurement of arterial blood gases. Recumbent and upright cardiac catheterization techniques confirmed the presence of orthostatic variation in the degree of right to left shunt across the fossa ovalis. This was successfully treated by surgical closure of the interatrial communication in the region of the fossa ovalis.

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