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

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).

See also: Basic STEMI localisation

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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.

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

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 12-Lead Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Lateral ST depression Sinus arrhythmia Acute Inferior MI 12-Lead 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 Lateral ST depression Sinus arrhythmia Acute Inferior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Inferior ST elevation Wide QRS Interventricular conduction defect Acute Inferior MI 12-Lead 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 Inferior ST elevation Wide QRS Interventricular conduction defect Acute Inferior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Inferior ST elevation Reciprocal ST depression Acute Inferior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
A Patient with Respiratory Failure and a Computer “Normal” ECG

This ECG is from a patient of unknown age who had recurrent presentations for shortness of breath due to asthma.

This ECG shows subtle ST elevation in III with reciprocal change in aVL. The cause was inferior MI.

Dyspnoea Inferior ST elevation Reciprocal ST depression Acute Inferior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Incorrect Machine Interpretation Inferior ST elevation Reciprocal ST depression Acute Inferior MI 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
Chest pain resolved, and a “Normal” ED ECG

This ECG is from a middle aged male who presented with chest pain. He was pain free at the time of this initial ECG.

This ECG shows subtle inferior ST elevation with reciprocal change in aVL. The cause was a large inferior infarct.

Chest pain Incorrect Machine Interpretation Inferior ST elevation Reciprocal ST depression Acute Inferior MI 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Inferior ST elevation Reciprocal ST depression Acute Inferior MI 12-Lead EMergucate CC-BY-NC-SA
ECG of the Week – 5th March 2019 – Interpretation

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

This ECG shows ST elevation in inferior leads with reciprocal changes in aVL and I

Chest pain Inferior ST elevation Reciprocal ST depression Acute Inferior MI 12-Lead EMergucate CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Chest pain Anterior ST depression Inferior ST elevation Reciprocal ST depression Acute Inferior MI Acute Posterior MI Right ventricular MI 12-Lead ECG Guru CC-BY-NC-SA
Instructors’ Collection ECG: Inferior Wall M.I. With Atrial Fibrillation or Atrial Flutter

This ECG is from a man in his 70s who presented with chest pain. He had a history of COPD.

This ECG shows massive inferior ST elevation with widespread ST depression. The most likely cause was an acute inferior infarct.

Chest pain Anterior ST depression Inferior ST elevation Reciprocal ST depression Acute Inferior MI Acute Posterior MI Right ventricular MI 12-Lead ECG Guru CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Chest pain Normal Axis Anterior ST elevation Acute Inferior MI Acute Lateral MI 12-Lead Dr Smith's ECG Blog CC BY-NC
Anterior ST Elevation and a High Initial Troponin.

This ECG is from a man in his 40s who presented with intermittent left sided pleuritic chest pain for 3 days.

This ECG shows anterior ST elevation, but there was no anterior wall motion abnormality on echo - there was an inferolateral regional wall motion abnormality instead. Initial troponin was very high. He was found to have a 100% obtuse marginal occlusion. The ECG did not evolve over the next few days, suggesting that it was the patient's baseline ECG.

Chest pain Normal Axis Anterior ST elevation Acute Inferior MI Acute Lateral MI 12-Lead Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Hyperacute T waves Inferior ST elevation Lateral ST elevation Acute Inferior MI Right ventricular MI 12-Lead Dr Smith's ECG Blog CC BY-NC
Inferolateral STEMI: is there right ventricular MI also?

This ECG is from a middle aged man who presented with 1 hour of chest pain.

This ECG shows ST elevation in inferior and lateral leads, caused by a proximal RCA occlusion.

Hyperacute T waves Inferior ST elevation Lateral ST elevation Acute Inferior MI Right ventricular MI 12-Lead Dr Smith's ECG Blog CC BY-NC
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This is a library of 2358 free, open access, re-usable ECGs from across the web.

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These ECGs were collected from Free Open Access Medical Education (#FOAMed) blogs, with the permission of their authors. You can find out more about each ECG's source by clicking on it.

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This is an experiment in digital curation. The idea is to collect resources to increase awareness and accessibility. Over time, more ECGs in the collection will be tagged to make it easier to find them and reused in new interactive quizzes.

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