ST elevation myocardial infarction EKG examples

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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.

STEMI evolution.png

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.

STEMI 7.jpg

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


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

STEMI 10.jpg

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.

STEMI 11.jpg

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.

STEMI 14.jpg

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.

STEMI 15.jpg

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.

STEMI 16.jpg

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.

STEMI 17.jpg

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.

STEMI 18.jpg

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.

Acute MI anterior LAD.jpg

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.

De-AMI anterior.png

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.

Previous anterior wall myocardial infartion..jpg

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

STEMI 26.jpg

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.

STEMI 12.jpg

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.

Q wave anterior distribution 2.PNG

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.

Q wave absent in anterior distribution.PNG

Shown below is the second EKG of the same subject.

Q wave anterior distribution.PNG

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.

STEMI 35.jpg

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.

Acute ant-lateral MI.jpg

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.

STEMI 25.jpg

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.

STEMI 25 a.jpg

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


Shown below is an EKG showing ST elevation MI.

STEMI 29.jpg

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.

STEMI 2.jpg

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.

STEMI 4.jpg

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.

STEMI 22.jpg

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.

STEMI 23.jpg

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.

STEMI 27.jpg

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


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

STEMI 30.jpg

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


Shown below is an EKG showing ST elevation MI.

STEMI 32.jpg

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.

STEMI 33.jpg

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).

Old inferior wall MI 1.jpg

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.

STEMI 3.jpg

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.

STEMI 5.jpg

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.

STEMI 6.jpg

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.

STEMI 8.jpg

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.

STEMI 9.jpg

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.

STEMI 13.jpg

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.

STEMI 20.jpg

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

STEMI 21.jpg

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


Shown below is an EKG showing ST elevation MI.

STEMI 31.jpg

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


Shown below is an EKG showing ST elevation MI.

STEMI 34.jpg

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.

Posterior MI patient.jpg

Right Ventricular Myocardial Infarction

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

ST elevation in V1 and aVr.jpg

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.

STEMI 1 RV.jpg

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.

STEMI 20 a.jpg

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


References


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