ST elevation myocardial infarction EKG examples: Difference between revisions

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__NOTOC__
__NOTOC__
{{ST elevation myocardial infarction}}
{{CMG}}
{{CMG}}


'''For the main page on ST elevation MI, click [[ST elevation myocardial infarction|here]]'''.
==EKG Examples==
==EKG Examples==
Shown below is an EKG demonstrating the evolution of an [[infarct]] on the EKG. [[ST elevation]], [[Q wave]] formation, [[T wave inversion]], normalization with a persistent Q wave suggest STEMI.


Shown below is the EKG recording shows sinus rhythm. The remarkable feature is the some what poor [[R wave]] progression in the V1 and V2 leads and the ST elevation and T wave changes in leads V1 to V4 and I and aVL. The cardiogram suggests an anterior/ lateral MI possibly acute. There is also terminal P wave negativity in V1 suggesting a left atrial abnormality.
[[Image:STEMI evolution.png|center|800px]]
[[Image:Acute ant-lateral MI.jpg|center|800px]]
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:AMI_evolutie.png
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:E209.jpg
 
===Anterior Myocardial Infarction===
 
Shown below is an EKG demonstrating loss of R waves throughout the anterior wall ([[Electrocardiogram#Precordial|V1]]-[[Electrocardiogram#Precordial|V6]]). QS complexes in [[Electrocardiogram#Precordial|V3]]-[[Electrocardiogram#Precordial|V5]]. [[ST elevation]] in [[Electrocardiogram#Precordial|V1]]-[[Electrocardiogram#Precordial|V5]] with terminal negative T waves.  
[[Image:STEMI 7.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of EKG illustrating acute inferior MI. ST elevation in the precordial and limb leads.
Shown below is an EKG demonstrating acute anterior MI. LAD artery occlusion.
[[Image:STEMI 2.jpg|center|800px]]
[[Image:STEMI 10.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG showing [[sinus rhythm]] with anteroseptal myocardial infarction depicting [[ST elevation]] in [[Electrocardiogram#Precordial|V1]]-[[Electrocardiogram#Precordial|V6]] and in lead [[Electrocardiogram#Limb|I]].  
[[Image:STEMI 11.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of EKG showing Acute inferoposterior MI: ST elevation in II, III, AVF (in III > II). ST depression in I, AVL, V2. Tall R in V2, otherwise normal QRS morphology.
Shown below is an EKG demonstrating acute anterior myocardial infarction and [[left anterior hemiblock]] depicting [[ST elevation]] in [[precordial lead]]s.
[[Image:STEMI 3.jpg|center|800px]]
[[Image:STEMI 14.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating old anterior myocardial infarction and [[bifascicular block]] ([[RBBB]] and [[LAHB]]) as indicated in the anterior chest leads.
[[Image:STEMI 15.jpg|center|800px]]


Shown below is an example of EKG demonstrating changes during acute inferior MI depicting ST elevation in leads II, III and aVF .
[[Image:STEMI 4.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG illustrating acute MI with proximal LAD occlusion depicting [[ST elevation]] in anterior [[precordial lead]]s.
[[Image:STEMI 16.jpg|center|800px]]


Shown below is an example of EKG demonstrating changes during acute posterolateral MI depicting ST depression in precordial leads V2-V6.
[[Image:STEMI 5.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating a 2 days old anterior infarction with [[Q wave]]s in V1-V4 with persisting [[ST elevation]], a sign of left [[ventricular aneurysm]] formation.  
Shown below is an example of EKG showing acute inferolateral MI: ST depression in V1, V4, tall R in V2. ST elevation in II, III, AVF, V5 and V6.
[[Image:STEMI 17.jpg|center|800px]]
[[Image:STEMI 6.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating a 2 weeks old anterior infarction with [[Q wave]]s in [[Electrocardiogram#Precordial|V2]]-[[Electrocardiogram#Precordial|V4]] and persisting ST elevation, a sign of left [[ventricular aneurysm]] formation.
Shown below is an example of EKG demonstrating acute anterior MI. Loss of R waves throughout the anterior wall (V1-V6). QS complexes in V3-V5. ST elevation in V1-V5 with terminal negative T waves.  
[[Image:STEMI 18.jpg|center|800px]]
[[Image:STEMI 7.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of EKG with sinus bradycardia with first degree AV block and inferior-posterior-lateral myocardial infarction.
Shown below is an EKG showing [[ST elevation]] in the anterior [[precordial lead]]s, low voltages in all the leads, poor R wave progression in the precordial leads.
[[Image:STEMI 8.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
[[Image:AMI_anterior_LAD.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-AMI_anterior_LAD_2days.jpg
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Shown below is an [[EKG]] demonstrating [[ST elevation|ST segment elevation]] in [[precordial lead]]s signifying anterior myocardial infarction.


Shown below is an example of EKG showing sinus bradycardia with inferior-lateral myocardial infarction.
[[Image:De-AMI_anterior.png|center|500px]]
[[Image:STEMI 9.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-AMI_anterior.png
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Shown below is an example of EKG demonstrating acute anterior MI. LAD artery occlusion.
Shown below is an EKG showing [[sinus rhythm]] with abnormal [[QRS]] and a [[Q wave]] in lead [[Electrocardiogram#Precordial|V2]] which is suggestive of a previous anterior wall myocardial infarction.
[[Image:STEMI 10.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
[[Image:Previous_anterior_wall_myocardial_infartion..jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:E289.jpg
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Shown below is an example of EKG showing sinus rhythm with anteroseptal myocardial infarction depicting ST elevation in V1-V6 and in lead I.
Shown below is an EKG demonstrating acute MI in a patient with [[LBBB]]
[[Image:STEMI 11.jpg|center|800px]]
[[Image:STEMI 26.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of EKG demonstrating sinus rhythm with [[left bundle branch block]], comparison with an old EKG is mandatory to evaluate whether the [[LBBB]] is new (a sign of myocardial infarction) or old.
Shown below is an EKG demonstrating [[sinus rhythm]] with [[left bundle branch block]], comparison with an old EKG is mandatory to evaluate whether the [[LBBB]] is new (a sign of myocardial infarction) or old.
[[Image:STEMI 12.jpg|center|800px]]
[[Image:STEMI 12.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of EKG illustrating inferior-posterior myocardial infarction with complete AV block and ventricular excape rhythm with [[RBBB]] pattern and left axis, followed by sinus rhythm.
Shown below is an EKG showing Q wave in leads I and aVL consistent with an anterior myocardial infarction of undetermined age.
[[Image:STEMI 13.jpg|center|800px]]
[[File:Q wave anterior distribution 2.PNG|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
 
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Shown below is an example of EKG showing acute anterior myocardial infarction and left anterior hemiblock depicting ST elevation in precordial leads.
Shown below are two EKGs of the same subject: while the first EKG demonstrates no Q waves, the second EKG performed after a year shows Q wave in leads I and aVL consistent with an anterior myocardial infarction of undetermined age.
[[Image:STEMI 14.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Shown below is the first EKG.
[[File:Q wave absent in anterior distribution.PNG|center|800px]]
 
Shown below is the second EKG of the same subject.
[[File:Q wave anterior distribution.PNG|center|800px]]
 
===Lateral Myocardial Infarction===
Shown below is an EKG demonstrating [[sinus rhythm]] and a [[QRS]] with a rightward axis, as well as [[wide Q waves]] in leads [[Electrocardiogram#Limb|I]] and [[Electrocardiogram#Augmented lead|aVL]] as well as a poor R wave progression across the anterior chest leads. There is also slight [[ST elevation]] in leads [[Electrocardiogram#Limb|I]],[[Electrocardiogram#Augmented lead|aVL]] , and [[T wave inversion]] in the lateral leads. The EKG is consistent with a lateral wall myocardial infarction.  


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[[Image:STEMI 35.jpg |center|800px]]


Shown below is an example of EKG demonstrating old anterior myocardial infarction and bifascicular block ([[RBBB]] and [[LAHB]]) as  indicated in the anterior chest leads.
[[Image:STEMI 15.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of an EKG illustrating acute MI with proximal LAD occlusion depicting ST elevation in anterior precordial leads.
===Anterolateral Myocardial Infarction===
[[Image:STEMI 16.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Shown below is an EKG demonstrating [[sinus rhythm]]. The remarkable feature is the poor [[R wave]] progression in the [[Electrocardiogram#Precordial|V1]] and [[Electrocardiogram#Precordial|V2]] leads and the [[ST elevation]] and T wave changes in leads [[Electrocardiogram#Precordial|V1]] to [[Electrocardiogram#Precordial|V4]] and [[Electrocardiogram#Limb|I]] and [[Electrocardiogram#Augmented limb|aVL]]. The cardiogram suggests an anterior/ lateral MI possibly acute. There is also terminal P wave negativity in [[Electrocardiogram#Precordial|V1]] suggesting a left atrial abnormality.
[[Image:Acute ant-lateral MI.jpg|center|800px]]


Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:E209.jpg
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Shown below is an example of EKG demonstrating a 2 days old anterior infarction with Q waves in V1-V4 with persisting ST elevation, a sign of left ventricular aneurysm formation.  
Shown below is an EKG demonstrating acute myocardial infarction in in a patient with a pacemaker and [[LBBB]]. Concordant ST elevation in [[Electrocardiogram#Precordial|V5]]-[[Electrocardiogram#Precordial|V6]] are clearly visible. There is discordant [[ST elevation|ST segment elevation]] > 5 mm in lead [[Electrocardiogram#Precordial|V3]].
[[Image:STEMI 17.jpg|center|800px]]
[[Image:STEMI 25.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of EKG demonstrating a 2 weeks old anterior infarction with Q waves in V2-V4 and persisting ST elevation, a sign of left ventricular aneurysm formation.
Shown below is an EKG demonstrating findings in the same patient as in the first example 2 months before the myocardial infarction. Normal [[LBBB]] pattern.
[[Image:STEMI 18.jpg|center|800px]]
[[Image:STEMI 25 a.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of an EKG demonstrating a large anterior wall infarction on admission. This image depicts ST elevation in  V2- V5 leads.
Shown below is an EKG showing ST elevation MI.
[[Image:STEMI 19.jpg|center|800px]]
[[Image:STEMI_29.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus12.jpg
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Shown below is an example of an EKG demonstrating a trial fibrillation and inferior-posterior myocardial infarction.
===Inferior Myocardial Infarction===
[[Image:STEMI 20.jpg|center|800px]]
Shown below is an EKG demonstrating [[ST elevation]] in the [[Precordial lead|precordial]] and [[limb lead]]s depicting acute inferior MI.
 
[[Image:STEMI 2.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


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Shown below is an example of an EKG demonstrating inferior-posterior-lateral myocardial infarction with a nodal escape rhythm
Shown below is an EKG demonstrating changes during acute inferior MI depicting [[ST elevation]] in leads [[Electrocardiogram#Limb|II]], [[Electrocardiogram#Limb|III]] and [[Electrocardiogram#Augmented limb|aVF]].
[[Image:STEMI 21.jpg|center|800px]]
 
[[Image:STEMI 4.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


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Shown below is an example of an EKG demonstrating [[RBBB]] and inferior MI. Note to left axis deviation.
Shown below is an EKG demonstrating [[RBBB]] and inferior MI. Note to [[left axis deviation]].
[[Image:STEMI 22.jpg|center|800px]]
[[Image:STEMI 22.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating lead [[Electrocardiogram#Precordial|V4R]] in a patient with [[RBBB]] and inferior MI, which clearly shows [[ST elevation]].
Shown below is an example of an EKG demonstrating lead V4R in the same patient with [[RBBB]] and inferior MI clearly shows ST elevation.
[[Image:STEMI 23.jpg|center|800px]]
[[Image:STEMI 23.jpg|center|800px]]
Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of an EKG demonstrating cute myocardial infarction in in a patient with a pacemaker and [[LBBB]]. Concordant ST elevation in V5-V6 are clearly visible. There is discordant ST segment elevation > 5 mm in lead V3.
Shown below is an EKG demonstrating atrial fibrillation with inferior-posterior-lateral myocardial infarction and incomplete [[right bundle branch block]]. Lead I shows ST depression, suggestive of right coronary artery involvement.
[[Image:STEMI 25.jpg|center|800px]]
[[Image:STEMI 27.jpg|center|800px]]
Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG showing [[ST elevation]] in inferior leads.
[[Image:STEMI_30.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0007.jpg
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Shown below is an example of an EKG demonstrating findings in the same patient as in the first example 2 months before the myocardial infarction. Normal [[LBBB]] pattern.
Shown below is an EKG showing ST elevation MI.
[[Image:STEMI 25 a.jpg|center|800px]]
[[Image:STEMI_32.jpg|center|800px]]
Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus16.jpg
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Shown below is an EKG showing ST elevation in inferior leads.
[[Image:STEMI_33.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0011.jpg
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Shown below is an example of an EKG demonstrating acute MI in a patient with [[LBBB]]
Shown below is an EKG demonstrating [[sinus rhythm]]. The [[QRS]] shows [[Q wave]]s in the inferior leads which are wide (>30ms) and about 25% of the QRS height in [[aVF]]. There is also slight [[ST elevation]] in the [[inferior]] leads and [[T wave inversion]]. The EKG suggests an inferior wall infarction, probably old. (the best way to determine "old" is to see a previous cardiogram).
[[Image:STEMI 26.jpg|center|800px]]
 
[[Image:Old inferior wall MI 1.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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===Posterior Myocardial Infarction===
 
Shown below is an EKG with [[ST elevation]] in [[Electrocardiogram#Limb|II]], [[Electrocardiogram#Limb|III]], [[Electrocardiogram#Augmented limb|aVF]] (in [[Electrocardiogram#Limb|III]] > [[Electrocardiogram#Limb|II]]), [[ST depression]] in [[Electrocardiogram#Limb|I]], [[Electrocardiogram#Augmented limb|aVL]], [[Electrocardiogram#Precordial|V2]]. Tall R in [[Electrocardiogram#Precordial|V2]], otherwise normal QRS morphology. The findings are suggestive of acute posteroinferior MI.
[[Image:STEMI 3.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating changes during acute posterolateral MI depicting [[ST depression]] in [[precordial lead]]s [[Electrocardiogram#Precordial|V2]]-[[Electrocardiogram#Precordial|V6]].


[[Image:STEMI 5.jpg|center|800px]]


Shown below is an example of an EKG demonstrating [[Wellens' sign]] in proximal LAD lesion; characterized by symmetrical, often deep >2mm, [[T wave inversion]]s in the anterior [[precordial lead]]; classically occurs during pain free period
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
[[Image:Wellen sign in proximal LAD.jpg|center|800px]]
 
Copyleft image obtained courtesy of,
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===Infero-Posterior Myocardial Infarction===
Shown below is an EKG with [[ST depression]] in [[Electrocardiogram#Precordial|V1]], [[Electrocardiogram#Precordial|V4]], [[tall R]]  in [[Electrocardiogram#Precordial|V2]]. [[ST elevation]] in [[Electrocardiogram#Limb|II]], [[Electrocardiogram#Limb|III]], [[Electrocardiogram#Augmented limb|aVF]], [[Electrocardiogram#Precordial|V5]] and [[Electrocardiogram#Precordial|V6]].
[[Image:STEMI 6.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of an EKG demonstrating atrial fibrillation with inferior-posterior-lateral myocardial infarction and incomplete right bundle branch block. Lead I shows ST depression, suggestive of right coronary artery involvement.
Shown below is an EKG with sinus [[bradycardia]] with [[first degree AV block]] and inferior-posterior-lateral myocardial infarction.
[[Image:STEMI 27.jpg|center|800px]]
[[Image:STEMI 8.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG depicting [[sinus bradycardia]] with inferior-lateral myocardial infarction.  
[[Image:STEMI 9.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of an EKG demonstrating typical negative T waves post anterior myocardial infarction. This patient also shows QTc prolongation. Whether this has an effect on prognosis is debated. <ref name="pmid18019666">{{cite journal |author=Novotný T, Sisáková M, Floriánová A, ''et al'' |title=[QT dynamicity in risk stratification in patients after myocardial infarction] |language=Czech |journal=Vnitr Lek |volume=53 |issue=9 |pages=964–7 |year=2007 |month=September |pmid=18019666 |doi= |url=}}</ref><ref name="pmid15851335">{{cite journal |author=Jensen BT, Abildstrom SZ, Larroude CE, ''et al'' |title=QT dynamics in risk stratification after myocardial infarction |journal=Heart Rhythm |volume=2 |issue=4 |pages=357–64 |year=2005 |month=April |pmid=15851335 |doi=10.1016/j.hrthm.2004.12.028 |url=}}</ref><ref name="pmid12716101">{{cite journal |author=Chevalier P, Burri H, Adeleine P, ''et al'' |title=QT dynamicity and sudden death after myocardial infarction: results of a long-term follow-up study |journal=J. Cardiovasc. Electrophysiol. |volume=14 |issue=3 |pages=227–33 |year=2003 |month=March |pmid=12716101 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1045-3873&date=2003&volume=14&issue=3&spage=227}}</ref>
Shown below is an EKG illustrating inferior-posterior myocardial infarction with [[complete AV block]] and [[ventricular escape beat|ventricular escape rhythm]] with [[RBBB]] pattern and left axis, followed by [[sinus rhythm]].
[[Image:STEMI 28.png|center|800px]]
[[Image:STEMI 13.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of EKG showing ST elevation MI.
 
[[Image:STEMI_29.jpg|center|800px]]
Shown below is an EKG demonstrating [[atrial fibrillation]] and inferior-posterior myocardial infarction.
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus12.jpg
[[Image:STEMI 20.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an example of EKG showing ST elevation in inferior leads.
 
[[Image:STEMI_30.jpg|center|800px]]
Shown below is an EKG demonstrating inferior-posterior-lateral myocardial infarction with a nodal escape rhythm
Copyleft image obtained courtesy of,
[[Image:STEMI 21.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
 
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Shown below is an example of EKG showing ST elevation MI.
 
Shown below is an EKG showing ST elevation MI.
[[Image:STEMI_31.jpg|center|800px]]
[[Image:STEMI_31.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus13.jpg
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus13.jpg
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Shown below is an example of EKG showing ST elevation MI.
 
[[Image:STEMI_32.jpg|center|800px]]
Shown below is an EKG showing ST elevation MI.
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus16.jpg
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Shown below is an example of EKG showing ST elevation in inferior leads.
[[Image:STEMI_33.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0011.jpg
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Shown below is an example of EKG showing ST elevation MI.
[[Image:STEMI_34.jpg|center|800px]]
[[Image:STEMI_34.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0010.jpg
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0010.jpg
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Shown below is an example of an EKG showing ST elevation in the anterior precordial leads, low voltages in all the leads, poor R wave progression in the precordial leads.
Shown below is an EKG demonstrating ST elevation in leads II, III and aVF and ST depression in leads V1, V2 and V3 depicting a [[posterior MI]].
[[Image:Posterior MI patient.jpg|center|800px]]


[[Image:AMI_anterior_LAD.jpg|center|800px]]
Copyleft image obtained courtesy of,
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Shown below is an example of EKG demonstrating ST segment elevation in precordial leads signifying anterior myocardial infarction.
===Right Ventricular Myocardial Infarction===
Shown below is an EKG demonstrating [[ST elevation]] in lead [[Electrocardiogram#Precordial|V1]] and [[Electrocardiogram#Augmented limb|aVR]]; reversal of [[Electrocardiogram#Precordial|V6]].
[[Image:ST elevation in V1 and aVr.jpg|center|800px]]


[[Image:De-AMI_anterior.png|center|500px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of,
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Shown below is an example of an EKG showing sinus rhythm with abnormal QRS and a Q wave in lead V2 which is suggestive of a previous anterior wall myocardial infarction.
Shown below is an EKG demonstrating STEMI changes in the right [[precordial lead]]s.
[[Image:Previous_anterior_wall_myocardial_infartion..jpg|center|800px]]
[[Image:STEMI 1 RV.jpg|center|800px]]
Copyleft image obtained courtesy of,
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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The EKG below shows sinus rhythm. The QRS shows [[Q wave]]s in the inferior leads which are wide (>30ms) and about 25% of the QRS height in [[aVF]]. There is also slight ST elevation in the inferior leads and [[T wave inversion]]. The EKG suggests an inferior wall infarction, probably old. (the best way to determine "old" is to see a previous cardiogram).
Shown below is an EKG demonstrating clear [[ST elevation]] in the right [[precordial lead]]s. A [[coronary angiography]] revealed a proximal right coronary artery occlusion.  
[[Image:Old inferior wall MI 1.jpg|center|800px]]
[[Image:STEMI 20 a.jpg|center|800px]]
Copyleft image obtained courtesy of,
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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The EKG below shows sinus rhythm and a QRS with a rightward axis, as well as wide Q waves in leads I and AVL as well as a poor r wave progression across the anterior chest leads. There is also slight ST elevation in leads I, aVL, and T wave inversion in the lateral leads. The EKG is consistent with a lateral wall myocardial infarction. The patient had had a myocardial infarction a few months before. This event was associated with a cardiac arrest due to ventricular fibrillation which was successfully treated by the 911 ambulance service.


[[Image:STEMI 35.jpg |center|800px]]
Copyleft image obtained courtesy of,
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==References==
==References==
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Latest revision as of 00:17, 30 July 2020

Acute Coronary Syndrome Main Page

ST Elevation Myocardial Infarction Microchapters

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ST elevation myocardial infarction EKG examples On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

EKG Examples

Shown below is an EKG demonstrating the evolution of an infarct on the EKG. ST elevation, Q wave formation, T wave inversion, normalization with a persistent Q wave suggest STEMI.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:AMI_evolutie.png

Anterior Myocardial Infarction

Shown below is an EKG demonstrating loss of R waves throughout the anterior wall (V1-V6). QS complexes in V3-V5. ST elevation in V1-V5 with terminal negative T waves.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating acute anterior MI. LAD artery occlusion.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG showing sinus rhythm with anteroseptal myocardial infarction depicting ST elevation in V1-V6 and in lead I.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating acute anterior myocardial infarction and left anterior hemiblock depicting ST elevation in precordial leads.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating old anterior myocardial infarction and bifascicular block (RBBB and LAHB) as indicated in the anterior chest leads.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG illustrating acute MI with proximal LAD occlusion depicting ST elevation in anterior precordial leads.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating a 2 days old anterior infarction with Q waves in V1-V4 with persisting ST elevation, a sign of left ventricular aneurysm formation.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating a 2 weeks old anterior infarction with Q waves in V2-V4 and persisting ST elevation, a sign of left ventricular aneurysm formation.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG showing ST elevation in the anterior precordial leads, low voltages in all the leads, poor R wave progression in the precordial leads.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-AMI_anterior_LAD_2days.jpg

Shown below is an EKG demonstrating ST segment elevation in precordial leads signifying anterior myocardial infarction.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-AMI_anterior.png

Shown below is an EKG showing sinus rhythm with abnormal QRS and a Q wave in lead V2 which is suggestive of a previous anterior wall myocardial infarction.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:E289.jpg

Shown below is an EKG demonstrating acute MI in a patient with LBBB

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating sinus rhythm with left bundle branch block, comparison with an old EKG is mandatory to evaluate whether the LBBB is new (a sign of myocardial infarction) or old.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG showing Q wave in leads I and aVL consistent with an anterior myocardial infarction of undetermined age.

Shown below are two EKGs of the same subject: while the first EKG demonstrates no Q waves, the second EKG performed after a year shows Q wave in leads I and aVL consistent with an anterior myocardial infarction of undetermined age.

Shown below is the first EKG.

Shown below is the second EKG of the same subject.

Lateral Myocardial Infarction

Shown below is an EKG demonstrating sinus rhythm and a QRS with a rightward axis, as well as wide Q waves in leads I and aVL as well as a poor R wave progression across the anterior chest leads. There is also slight ST elevation in leads I,aVL , and T wave inversion in the lateral leads. The EKG is consistent with a lateral wall myocardial infarction.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Anterolateral Myocardial Infarction

Shown below is an EKG demonstrating sinus rhythm. The remarkable feature is the poor R wave progression in the V1 and V2 leads and the ST elevation and T wave changes in leads V1 to V4 and I and aVL. The cardiogram suggests an anterior/ lateral MI possibly acute. There is also terminal P wave negativity in V1 suggesting a left atrial abnormality.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:E209.jpg

Shown below is an EKG demonstrating acute myocardial infarction in in a patient with a pacemaker and LBBB. Concordant ST elevation in V5-V6 are clearly visible. There is discordant ST segment elevation > 5 mm in lead V3.

Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating findings in the same patient as in the first example 2 months before the myocardial infarction. Normal LBBB pattern.

Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG showing ST elevation MI.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus12.jpg

Inferior Myocardial Infarction

Shown below is an EKG demonstrating ST elevation in the precordial and limb leads depicting acute inferior MI.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating changes during acute inferior MI depicting ST elevation in leads II, III and aVF.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating RBBB and inferior MI. Note to left axis deviation.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating lead V4R in a patient with RBBB and inferior MI, which clearly shows ST elevation.

Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating atrial fibrillation with inferior-posterior-lateral myocardial infarction and incomplete right bundle branch block. Lead I shows ST depression, suggestive of right coronary artery involvement.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG showing ST elevation in inferior leads.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0007.jpg

Shown below is an EKG showing ST elevation MI.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus16.jpg

Shown below is an EKG showing ST elevation in inferior leads.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0011.jpg

Shown below is an EKG demonstrating sinus rhythm. The QRS shows Q waves in the inferior leads which are wide (>30ms) and about 25% of the QRS height in aVF. There is also slight ST elevation in the inferior leads and T wave inversion. The EKG suggests an inferior wall infarction, probably old. (the best way to determine "old" is to see a previous cardiogram).

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Posterior Myocardial Infarction

Shown below is an EKG with ST elevation in II, III, aVF (in III > II), ST depression in I, aVL, V2. Tall R in V2, otherwise normal QRS morphology. The findings are suggestive of acute posteroinferior MI.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating changes during acute posterolateral MI depicting ST depression in precordial leads V2-V6.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Infero-Posterior Myocardial Infarction

Shown below is an EKG with ST depression in V1, V4, tall R in V2. ST elevation in II, III, aVF, V5 and V6.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG with sinus bradycardia with first degree AV block and inferior-posterior-lateral myocardial infarction.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG depicting sinus bradycardia with inferior-lateral myocardial infarction.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG illustrating inferior-posterior myocardial infarction with complete AV block and ventricular escape rhythm with RBBB pattern and left axis, followed by sinus rhythm.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating atrial fibrillation and inferior-posterior myocardial infarction.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating inferior-posterior-lateral myocardial infarction with a nodal escape rhythm

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG showing ST elevation MI.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus13.jpg

Shown below is an EKG showing ST elevation MI.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0010.jpg

Shown below is an EKG demonstrating ST elevation in leads II, III and aVF and ST depression in leads V1, V2 and V3 depicting a posterior MI.

Right Ventricular Myocardial Infarction

Shown below is an EKG demonstrating ST elevation in lead V1 and aVR; reversal of V6.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating STEMI changes in the right precordial leads.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating clear ST elevation in the right precordial leads. A coronary angiography revealed a proximal right coronary artery occlusion.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

References

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