ECG Quest > Ischemia > Basic STEMI localisation > Acute Anterior MI

Acute Anterior MI

An acute Anterior STEMI is caused by acute occlusion of the left anterior descending artery. It features signs of coronary occlusion (hyperacute T waves, ST elevation, Q formation) in the anteroseptal leads along with reciprocal changes in the inferior leads. There may also be ST elevation in the lateral leads (anteroseptal MI) or inferior leads (wraparound LAD).

See also: Basic STEMI localisation

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Hyperacute T waves Acute Anterior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
A patient with chest pain that is resolving. Computer interprets ED ECG as completely Normal.

This ECG is from a man in his 60s who presented with resolving chest pain.

This ECG shows hyperacute T waves in V2-4. The cause was an 80% obstruction of the LAD with a large thrombus. An earlier ECG showed ST segment elevation.

In the ECGquest archives, this ECG has been tagged with: - Hyperacute T waves Acute Anterior MI Acute Inferior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
The computer and the cardiologist called this a “Normal EKG”

This ECG is from a woman in her 40s who presented with 'heartburn' overnight and then worsening chest pain 1 hour prior to arrival.

This ECG shows subtle MI with inferior and anterior hyperacute T waves and some reciprocal ST depression in aVL. The cause was a complete occlusion of a wraparound LAD.

In the ECGquest archives, this ECG has been tagged with: - Anterior ST elevation Hyperacute T waves Inferior ST depression Lateral ST depression Acute Anterior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
A man in his sixties with chest pain at midnight with undetectable troponin

This ECG is from a man in his 60s who presented with 3 hours of chest pain.

This ECG shows ST elevation and hyperacute T waves in V2 with inferior and lateral ST depression. The cause was acute LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Anterior ST elevation Hyperacute T waves Acute Anterior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
A 50-something male with acute chest pain

This ECG is from a man in his 50s who presented with chest pain and diaphoresis.

This ECG shows anterior ST elevation and hyperacute T waves due to 100% LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - De Winter T waves Hyperacute T waves Acute Anterior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
Doctor, should we activate the hospital’s “STEMI alert”?

This ECG is from a woman in her 50s who presented with chest pain.

This ECG shows hyperacute T waves with de Winter's pattern in V3-5, due to a 100% proximal occlusion of the LAD.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Hyperacute T waves Acute Anterior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
How long would you like to wait for your Occlusion MI to show a STEMI? Sometimes serial ECGs minimizes the delay.

This ECG is from an elderly woman who presented with acute chest pain and shortness of breath.

This ECG shows sinus rhythm with minimal ST elevation in V1-3 and hyperacute T waves in V2. Serial ECGs evolved to a clear STEMI. The cause was a 100% mid-LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Anterior ST elevation Hyperacute T waves Late R wave transition Pathological Q waves Premature ventricular complex Acute Anterior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
What happens when a patient with LAD OMI does not go immediately to the cath lab?

This ECG is from an elderly woman who presented with chest pain.

This ECG shows ST elevation V2-4 with poor R progression and hyperacute T waves. The cause was an acute LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Hypertension Acute Anterior MI Normal vs. abnormal anterior ST elevation 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
What will you do for this patient transferred to you who is now asymptomatic?

This ECG is from a middle-aged woman who presented with 2 hours of chest pain and shortness of breath. She has a history of hypertension.

This ECG shows ST elevation in V1 and V2, caused by a proximal LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Hyperacute T waves Acute Anterior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
Anterior STEMI Evolves to de Winter’s T-waves – repeat ECG

This ECG is from a middle aged man who presented with chest pain. This was the repeat ECG 10 min after arrival.

This ECG shows anterior hyperacute T waves. Earlier ST elevation has all but resolved, likely due to transient reperfusion. The cause was a 100% proximal LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain De Winter T waves Acute Anterior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
Anterior STEMI Evolves to de Winter’s T-waves – repeat ECG

This ECG is from a middle aged man who presented with chest pain. This was the repeat ECG 40 min after arrival.

This ECG shows anterior De Winter T waves. Earlier ST elevation has all but resolved, likely due to transient reperfusion. The cause was a 100% proximal LAD occlusion.

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