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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ECG Library (122)

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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.

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).

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.

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.

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.

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.

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.

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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Inferior ST elevation Wide QRS Interventricular conduction defect 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.

In the ECGquest archives, this ECG has been tagged with: - Dyspnoea 12-Lead Inferior ST elevation Reciprocal ST depression Acute Inferior MI 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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Incorrect Machine Interpretation Inferior ST elevation Reciprocal ST depression Acute Inferior MI Dr Smith's ECG Blog 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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Inferior ST elevation Reciprocal ST depression Acute Inferior MI 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

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