An electrically horizontal heart has tall qR waves in the horizontal leads (I, AVL) and therefore rS waves in II, III, AVF.
An electrically vertical heart has tall qR waves in the vertical leads of II, III, AVF, and therefore there are rS waves in I, AVL.
If I, AVL and II, AVF all show positive complexes, then the heart is in an "intermediate position".
The importance of all this is that the T wave is allowed to be inverted if you are S wave dominant.
The important exceptions to know are:
- you are allowed to have a negative T wave in lead III.
- the T wave is positive in lead II because it is negative in AVR.
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