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| {{CMG}}
| | #redirect:[[Posterior myocardial infarction]] |
| {{SK}}
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| ==Overview==
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| A posterior MI is a [[heart attack]] or cessation of blood flow to the [[heart muscle]] that involves the backside or posterior side of the heart. Rather than causing the traditional [[ST segment elevation]] characteristic of the electrocardiogram of many heart attacks (a "[[STEMI]]"), because the heart attack is on the opposite side of the heart, the ST segments are depressed in the anterior precordial leads rather than elevated.
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| __NOTOC__
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| {{ST elevation myocardial infarction}}
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| {{CMG}}
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| ==EKG Examples==
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| 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.
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| [[Image:STEMI evolution.png|center|800px]]
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| Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:AMI_evolutie.png
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| ----
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| Shown below is an EKG demonstrating [[ST elevation]] in lead [[Electrocardiogram#Precordial|V1]] and [[Electrocardiogram#Augmented limb|aVR]]; reversal of [[Electrocardiogram#Precordial|V6]].
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| [[Image:ST elevation in V1 and aVr.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG demonstrating STEMI changes in the right [[precordial lead]]s.
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| [[Image:STEMI 1 RV.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| 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.
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| [[Image:Acute ant-lateral MI.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:E209.jpg
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| Shown below is an EKG demonstrating [[ST elevation]] in the [[Precordial lead|precordial]] and [[limb lead]]s depicting acute inferior MI.
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| [[Image:STEMI 2.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| 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.
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| [[Image:STEMI 3.jpg|center|800px]]
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| 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 inferior MI depicting [[ST elevation]] in leads [[Electrocardiogram#Limb|II]], [[Electrocardiogram#Limb|III]] and [[Electrocardiogram#Augmented limb|aVF]].
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| [[Image:STEMI 4.jpg|center|800px]]
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| 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]].
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| [[Image:STEMI 5.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| 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]].
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| [[Image:STEMI 6.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| 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.
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| [[Image:STEMI 7.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG with sinus [[bradycardia]] with [[first degree AV block]] and inferior-posterior-lateral myocardial infarction.
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| [[Image:STEMI 8.jpg|center|800px]]
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| 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.
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| [[Image:STEMI 9.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG demonstrating acute anterior MI. LAD artery occlusion.
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| [[Image:STEMI 10.jpg|center|800px]]
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| 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]].
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| [[Image:STEMI 11.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| 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.
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| [[Image:STEMI 12.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| 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]].
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| [[Image:STEMI 13.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG demonstrating acute anterior myocardial infarction and [[left anterior hemiblock]] depicting [[ST elevation]] in [[precordial lead]]s.
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| [[Image:STEMI 14.jpg|center|800px]]
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| 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.
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| [[Image:STEMI 15.jpg|center|800px]]
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| 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.
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| [[Image:STEMI 16.jpg|center|800px]]
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| 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.
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| [[Image:STEMI 17.jpg|center|800px]]
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| 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.
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| [[Image:STEMI 18.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG demonstrating a large anterior wall infarction on admission. This image depicts [[ST elevation]] in [[Electrocardiogram#Precordial|V2]]-[[Electrocardiogram#Precordial|V5]] leads.
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| [[Image:STEMI 19.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG demonstrating [[atrial fibrillation]] and inferior-posterior myocardial infarction.
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| [[Image:STEMI 20.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| 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.
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| [[Image:STEMI 20 a.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG demonstrating inferior-posterior-lateral myocardial infarction with a nodal escape rhythm
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| [[Image:STEMI 21.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG demonstrating [[RBBB]] and inferior MI. Note to [[left axis deviation]].
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| [[Image:STEMI 22.jpg|center|800px]]
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| 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]].
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| [[Image:STEMI 23.jpg|center|800px]]
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| Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG demonstrating cute 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]].
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| [[Image:STEMI 25.jpg|center|800px]]
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| Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
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| 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.
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| [[Image:STEMI 25 a.jpg|center|800px]]
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| Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG demonstrating acute MI in a patient with [[LBBB]]
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| [[Image:STEMI 26.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| 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.
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| [[Image:STEMI 27.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is 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>
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| [[Image:STEMI 28.png|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| Shown below is an EKG showing ST elevation MI.
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| [[Image:STEMI_29.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus12.jpg
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| Shown below is an EKG showing [[ST elevation]] in inferior leads.
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| [[Image:STEMI_30.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0007.jpg
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| Shown below is an EKG showing ST elevation MI.
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| [[Image:STEMI_31.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus13.jpg
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| Shown below is an EKG showing ST elevation MI.
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| [[Image:STEMI_32.jpg|center|800px]]
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| 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.
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| [[Image:STEMI_33.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0011.jpg
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| Shown below is an EKG showing ST elevation MI.
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| [[Image:STEMI_34.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0010.jpg
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| 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.
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| [[Image:AMI_anterior_LAD.jpg|center|800px]]
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| 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.
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| [[Image:De-AMI_anterior.png|center|500px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-AMI_anterior.png
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| 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.
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| [[Image:Previous_anterior_wall_myocardial_infartion..jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:E289.jpg
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| 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).
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| [[Image:Old inferior wall MI 1.jpg|center|800px]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| 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]]
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| Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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| 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]].
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| [[Image:Posterior MI patient.jpg|center|800px]]
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| ==References==
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| {{Reflist|2}}
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| [[Category:Disease]]
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| [[Category:Cardiology]]
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| [[Category:Ischemic heart diseases]]
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| [[Category:Intensive care medicine]]
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| [[Category:Emergency medicine]]
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| [[Category:Primary care]]
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| [[Category:Up-To-Date]]
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| [[Category:Up-To-Date cardiology]]
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| [[Category:Mature chapter]]
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| {{WH}}
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| {{WS}}
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| ==References==
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| {{Reflist|2}}
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