Acute Inferior MI

An acute Inferior MI features signs of coronary occlusion (hyperacute T waves, ST elevation, Q formation) in the inferior leads (II, IIII, aVF) along with reciprocal changes in aVL +/- lead I. There may also be right ventricular infarction or posterior infarction. The culprit can be any of the three main coronary arteries, but is usually a dominant RCA occlusion. Less often it is a dominant left circumflex, or occasionally it is a wraparound LAD (anterior and inferior infarction).

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In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Acute Inferior MI Acute Posterior MI Serial ECGs & Dynamic Changes Dr Smith's ECG Blog CC BY-NC
A man in his 70s with chest pain during a bike ride

This ECG is from a man in his 70s who presented with chest pain that started during bike riding.

This ECG shows subtle ST depression in V2-6 and ST elevation in III. He had multi vessel disease with a near-occlusive culprit RCA lesion.

Chest pain 12-Lead Anterior ST depression Acute Inferior MI Acute Posterior MI Serial ECGs & Dynamic Changes Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Hypotension Syncope 12-Lead Sinus arrhythmia Sinus tachycardia High grade AV block Ventriculophasic sinus arrhythmia Acute Inferior MI Acute Posterior MI Right ventricular MI ECG Interpretation CC-BY-NC-SA
ECG Blog #168 (STEMI – complex AV Block – Laddergram – Calipers)

This ECG is from a middle-aged woman who presented with syncope and hypotension.

This ECG shows sinus tachycardia with inferior ST elevation and reciprocal ST depression in aVL. Also ST elevation in V1 and ST depression in V2-4. The most likely cause was acute inferoposterior MI due to proximal RCA occlusion.

Hypotension Syncope 12-Lead Sinus arrhythmia Sinus tachycardia High grade AV block Ventriculophasic sinus arrhythmia Acute Inferior MI Acute Posterior MI Right ventricular MI ECG Interpretation CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Inferior ST elevation Wide QRS LPFB RBBB Acute Inferior MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
Teach your learners: when the QRS is wide, the J-point will hide, so trace it down and copy it over!

This ECG is from a middle aged man who presented with chest pain and diaphoresis while exercising. He had a VSD repair at age 6.

This ECG shows sinus tachycardia with RBBB + LPFB. ST elevation in III and aVF with reciprocal ST depression in aVL. ST depression in V2-5. The cause was inferoposterior MI, due to severe triple vessel disease and a culprit 100% circumflex occlusion.

Chest pain 12-Lead Anterior ST depression Inferior ST elevation Wide QRS LPFB RBBB Acute Inferior MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Inferior ST elevation Reciprocal ST depression Acute Inferior MI ECG Interpretation CC-BY-NC-SA
ECG Blog #167 (Reciprocal-OMI-Normal)

This ECG shows inferior ST elevation with Q waves in III and reciprocal ST depression in aVL, most likely caused by an acute inferior MI.

12-Lead Inferior ST elevation Reciprocal ST depression Acute Inferior MI ECG Interpretation CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Inferior ST elevation Pathological Q waves Acute Inferior MI Acute Posterior MI Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Acute MI, pain onset 24-48 hours ago. Should the patient go for emergent angiogram/PCI?

This ECG is from a man in his 60s who presented with chest pain for 48h with diaphoresis.

This ECG shows inferior ST elevation with reciprocal depression in aVL and I. ST depression in V2-4. Deep Q waves inferior leads and tall R waves V1-3. The cause was a completed infarction with 2 likely culprits (RCA and circumflex).

Chest pain 12-Lead Anterior ST depression Inferior ST elevation Pathological Q waves Acute Inferior MI Acute Posterior MI Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Vomiting 12-Lead Inferior ST elevation Straightened ST segment Terminal QRS distortion Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
Inferior Subtle ST elevation: straight ST segment, but also no reciprocal ST depression in aVL: which is more important?

This ECG is from a man in his 60s who presented with chest pain radiating to the back and nausea/vomiting. He had a history of previous MI and stents.

This ECG shows inferior ST elevation (straightened ST segments) without reciprocal changes, with terminal QRS distortion in inferior leads. The cause was an inferior MI with some posterior involvement.

Chest pain Vomiting 12-Lead Inferior ST elevation Straightened ST segment Terminal QRS distortion Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Syncope 12-Lead Inferior ST elevation Reciprocal ST depression Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
2 ECGs texted to me. Minimal STE in inferior leads. How important is it?

This ECG is from a patient of unknown age who presented with a syncopal episode and vague chest pain. This was the second ECG taken 24 min later.

This ECG shows subtle inferior ST elevation with reciprocal ST depression in aVL. The cause was a 100% distal RCA occlusion.

Chest pain Syncope 12-Lead Inferior ST elevation Reciprocal ST depression Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Inferior ST elevation Lateral ST elevation Acute Inferior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
ST segment concavity is just one small piece of the puzzle that is pattern recognition

This ECG is from an ECG from a patient of unknown age, recorded just before the patient went into VF arrest.

This ECG shows massive concave ST elevation in inferior and lateral leads with ST depression in V2. There is also first degree heart block. The most likely cause was an acute MI.

12-Lead Inferior ST elevation Lateral ST elevation Acute Inferior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Hyperacute T waves Acute Anterior MI Acute Inferior MI 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.

12-Lead Hyperacute T waves Acute Anterior MI Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Concordant ST depression in V1-V3 Excessive discordant ST elevation Atrial pacemaker Ventricular pacemaker Acute Inferior MI Acute Lateral MI Acute Posterior MI Positive Sgarbossa criteria Dr Smith's ECG Blog CC BY-NC
Can you see through this paced rhythm?

This ECG is from an elderly woman who presented with 2 hours of chest pain on a background of multiple stents, a pacemaker, stroke and COPD.

This ECG shows paced rhythm with excessively discordant ST segments (modified Sgarbossa positive). The cause was a 95% thrombotic lesion of the RCA.

12-Lead Concordant ST depression in V1-V3 Excessive discordant ST elevation Atrial pacemaker Ventricular pacemaker Acute Inferior MI Acute Lateral MI Acute Posterior MI Positive Sgarbossa criteria Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Lateral ST depression Sinus arrhythmia Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
A 40 yo with Chest pain. Only ECG abnormality is minimal ST depression in I and aVL (computer interpretation: normal)

This ECG is from a man in his 40s who presented with 1 hour of chest pain.

This ECG shows sinus arrhythmia with slight ST depression in I and aVL. Serial ECGs showed evolution to an inferior STEMI, due to a 100% RCA occlusion.

Chest pain 12-Lead Lateral ST depression Sinus arrhythmia Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Inferior ST elevation Wide QRS Intraventricular conduction delay Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
IVCD, Saddleback STE in III, with reciprocal STD in aVL: Is it pseudoOMI or OMI? Echo with Speckle Tracking gives the answer.

This ECG is from a woman in her 70s who presented with acute chest pain and dyspnoea on a background of hypertension and congestive heart failure.

This ECG shows inferior ST elevation with an abnormally wide QRS (intraventricular conduction delay). The cause was an acute inferior MI.

Chest pain Dyspnoea 12-Lead Inferior ST elevation Wide QRS Intraventricular conduction delay Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
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