Acute Lateral MI

An acute Lateral MI features signs of coronary occlusion (hyperacute T waves, ST elevation, Q formation) in the lateral leads (V5, V6, I, aVL) along with reciprocal changes in III and aVF. There may also be anterior infarction or posterior infarction. The culprit can be LAD (anterolateral), left circumflex (inferior-posterior-lateral) or smaller branches (isolated lateral).

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Dr Smith's ECG Blog

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ECG Library (65)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Flat T waves Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
Chest pain with NonDiagnostic ECG but Diagnostic CT Scan

This ECG is from an elderly woman who presented with several hours of chest pain radiating to the back.

This ECG shows flat T waves in aVL but otherwise normal. Troponin was elevated. CT showed no dissection but an area of transmural ischemia. Serial ECGs showed no change. The cause was an occluded OM1.

Chest pain 12-Lead Flat T waves Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Weakness 12-Lead Concordant ST depression in V1-V3 Concordant ST elevation Pacemaker spikes Wide QRS Ventricular pacemaker Acute Lateral MI Positive Sgarbossa criteria Dr Smith's ECG Blog CC BY-NC
Elderly with Paced Rhythm, Possible Ischemic symptoms, and an Equivocal Smith Modified Sgarbossa ECG

This ECG is from a woman in her 80s who presented with a couple of days of shortness of breath, weakness and diaphoresis.

This ECG shows ventricular paced rhythm with concordant ST elevation V5-6 and concordant ST depression in V3. The cause was an occlusion of the circumflex.

Dyspnoea Weakness 12-Lead Concordant ST depression in V1-V3 Concordant ST elevation Pacemaker spikes Wide QRS Ventricular pacemaker Acute Lateral MI Positive Sgarbossa criteria 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 Lateral ST elevation RBBB Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
Two patients with RBBB

This ECG is from a man in his 50s who presented with intermittent chest pain and shortness of breath for the past 3 days with vomiting.

This ECG shows RBBB with inferior and lateral ST elevation due to an acute MI (occluded OM2).

Chest pain Dyspnoea 12-Lead Inferior ST elevation Lateral ST elevation RBBB Acute Lateral 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 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: - Abdominal pain Chest pain 12-Lead Reciprocal ST depression ST elevation in aVL Acute Lateral MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
Epigastric pain radiating to the chest for 18 hours. ECG makes the Dx. Troponin makes the Dx. CT makes the Dx!

This ECG is from a middle aged man who presented with 18 hours of epigastric pain radiating to the chest.

This ECG shows ST elevation in aVL with reciprocal ST depression in inferior leads and V3-4, consistent with high lateral MI and posterior involvement.

Abdominal pain Chest pain 12-Lead Reciprocal ST depression ST elevation in aVL Acute Lateral MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Lateral ST elevation Acute Lateral MI ECG Interpretation CC-BY-NC-SA
ECG Blog #162 (STEMI – Coronary Circulation – Culprit – BBB)

This ECG is from an older woman who presented with new-onset chest pain.

This ECG shows acute infero-postero-lateral STEMI.

Chest pain 12-Lead Lateral ST elevation Acute Lateral MI ECG Interpretation CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Normal Axis Acute Inferior MI Acute Lateral MI 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 12-Lead Anterior ST elevation Normal Axis Acute Inferior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Electrode misplacement Lateral ST elevation Normal Axis Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
A man in his 80s with chest pain

This ECG is from a man in his 80s who presented with chest pain and shortness of breath.

Chest pain Dyspnoea 12-Lead Electrode misplacement Lateral ST elevation Normal Axis Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Electrode misplacement Lateral ST elevation Left Axis Deviation LAFB RBBB Acute Anterior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
A man in his 80s with chest pain

This ECG is from a man in his 80s who presented with chest pain and shortness of breath. This was the repeat ECG just before he arrested.

Chest pain Dyspnoea 12-Lead Electrode misplacement Lateral ST elevation Left Axis Deviation LAFB RBBB Acute Anterior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Lateral ST elevation Pathological Q waves Acute Anterior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
Anterior STEMI and multiform PVCs with Narrow Coupling Interval. When to give beta blockers in acute MI?

This ECG is from a middle aged man presented with 45 minutes of chest discomfort on a background of hyperlipidemia. This was his initial ECG.

Chest pain 12-Lead Anterior ST elevation Lateral ST elevation Pathological Q waves Acute Anterior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Pathological Q waves Acute Anterior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
Anterior STEMI and multiform PVCs with Narrow Coupling Interval. When to give beta blockers in acute MI? – repeat 24h later

This ECG is from a middle aged man presented with 45 minutes of chest discomfort on a background of hyperlipidemia. This was his repeat ECG 24h later, after stenting of an LAD occlusion.

Chest pain 12-Lead Anterior ST elevation Pathological Q waves Acute Anterior MI Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
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