Mid-anterior MI – ECG quest

Basics

Recording a 12-Lead ECG

12-Lead
Chest leads
Ladder diagram
Lewis lead
Limb leads
Mirrored 12-Lead (dextrocardia)
Paediatric
Posterior leads
Rhythm Strip
Right leads
Serial 12-lead

Nonspecific baseline artefact
Chest compression artefact
Electrical interference artefact
Electrode Detachment
Fistula artifact
Incorrect Machine Interpretation
Transcutaneous pacing artefact
Wandering baseline

Standard Calibration
Double speed 50 mm/sec

Electrode misplacement

High V1/V2 misplacement
LA/LL electrode reversal
LA/LL + RA/RL electrode reversals
LA/RA electrode reversal
LA/RL electrode reversal
RA/LL electrode reversal
RA/RL electrode reversal

Signs

Bradycardia
Extreme tachycardia
Normal rate
Tachycardia

Grouped
Irregular
Regular

Absent P waves
Asymmetrical P in V1
Extra P waves
Fibrillation waves
Flutter P waves
Hidden P waves
Inverted P waves
Normal P waves
Retrograde P waves
Tall P waves
Variable P waves
Wide P waves

PR interval & segment

Changing PR interval
Long PR
Normal PR
PR segment depression
Short PR

Changing Axis
Extreme Axis
Indeterminate axis
Left Axis Deviation
Normal Axis
Right Axis Deviation
Vertical axis

Capture beat
Dagger Q waves
Early R wave transition
Electrical alternans
Fragmented QRS
Fusion beat
Late R wave transition
Lead I sign
Narrow QRS
Normal Q wave
Normal R wave transition
Pathological Q waves
Prolonged R wave peak time
R in aVR
R in V1
S1Q3T3
Short QRS
Tall QRS
Terminal QRS distortion
Wide QRS

Biphasic T waves
De Winter T waves
Deeply inverted T waves
Flat T waves
Hyperacute T waves
Inverted T waves
Inverted U waves
Normal T waves
Normal U waves
Peaked T waves
Pseudo-normalised T waves
T-U waves
Tall U waves
Wellens Waves

Long QT
Normal QT
Short QT

Cabrera's sign
Chapman's sign
Delta wave
Epsilon wave
J wave
Osborn wave
Pacemaker spikes
Pseudo R' wave
RSR'
Sine wave
Spiked helmet sign
Spodick's sign
Ta wave

Rhythms

Normal Sinus Rhythm
Sinus arrest
Sinus arrhythmia
Sinus bradycardia
Sinus node re-entrant tachycardia
Sinus pause
Sinus tachycardia

Atrial fibrillation
Atrial flutter
Atrial tachycardia
Atrial tachycardia - multifocal
AVRT antidromic
AVRT orthodromic
Coronary sinus rhythm
Wandering atrial pacemaker

Junctional Rhythms

Accelerated junctional rhythm
AVNRT
AVNRT fast-slow
Junctional escape
Junctional tachycardia

Ventricular Rhythms

Accelerated idioventricular rhythm
Non-sustained VT
Right Ventricular Outflow Tract Tachycardia
Torsades de Pointes
Ventricular escape
Ventricular Fibrillation
Ventricular flutter
Ventricular standstill
Ventricular tachycardia
Ventricular tachycardia - bidirectional
Ventricular tachycardia - fascicular
Ventricular tachycardia - polymorphic

Atrial pacemaker
Failure to capture
ICD Overdrive Pacing
Pacemaker failure
Pacemaker mediated tachycardia
Ventricular pacemaker

Atrial bigeminy
Atrial escape beat
Bigeminy
Blocked premature atrial complex
Premature atrial complex
Premature junctional complex
Premature ventricular complex
Trigeminy
Ventricular escape beat

Asystole
Change in rhythm
Isorhythmic dissociation
Multiple rhythms
Parasystole
Pulseless Electrical Activity
SVT
Wide complex tachycardia

Blocks

Type I SA block
Type II SA block

First degree AV block
High grade AV block
Second degree AV block
Second degree AV block 2:1
Second degree AV block Mobitz type 2
Second degree AV block type 1 - Wenckebach
Third degree AV block
Ventriculophasic sinus arrhythmia

Ashman aberrancy
Incomplete LBBB
Incomplete RBBB
Intraventricular conduction delay
LAFB
LBBB
LPFB
RBBB

Multiple Blocks

Bifascicular block
Trifascicular block

Ischemia

Basic STEMI localisation

Acute Anterior MI
Acute Inferior MI
Acute Lateral MI
Mid-anterior MI
Multi-vessel disease
Acute Posterior MI
Right ventricular MI

Normal vs. abnormal anterior ST elevation

Old vs new ischemia

Old anterior MI
Old Inferior MI

Serial ECGs & Dynamic Changes

ST changes with LBBB

Positive Sgarbossa criteria

ST depression and ischemia

Diffuse subendocardial ischaemia
Left main occlusion
Left main stenosis
Proximal LAD occlusion

Widespread ST elevation

Other Conditions

Hypercalcaemia
Hyperkalemia
Hypocalcaemia
Hypokalemia
Hypomagnesaemia

Hypertrophy and enlargement

Hypertrophic cardiomyopathy
Left atrial enlargement
LVH
Right atrial enlargement
RVH

Pulmonary and Pericardial

Acute right heart strain
COPD
Cor pulmonale
Pericardial effusion
Pericarditis
Pulmonary embolism

CVA
LV aneurysm
MINOCA
Myocardial rupture

Arrhythmogenic Right Ventricular Cardiomyopathy
Brugada syndrome
Familial catecholaminergic polymorphic ventricular tachycardia
Long QT syndrome
Lown Ganong Levine syndrome
Short QT syndrome
Sick sinus syndrome
Wellens syndrome
Wolff Parkinson White syndrome

Toxicology / Overdose

Beta blocker toxicity
Calcium channel blocker toxicity
Carbamazepine toxicity
Digoxin effect
Digoxin toxicity
Propranolol toxicity
Quetiapine toxicity
Sodium channel blocker toxicity
Sotalol toxicity

Aortic dissection
Aortic stenosis
Atrial Septal Defect
Cardiac T-wave memory
Coronary artery spasm
Dextrocardia
Dilated cardiomyopathy
Hyperthermia
Hyperthyroidism
Hypothermia
Hypothyroidism
Juvenile T wave pattern
Metabolic acidosis
Myocardial Bridging
Myocarditis
Normal
Normal ST elevation
Raised intracranial pressure
Restrictive cardiomyopathy
Reverse Takotsubo
Spontaneous coronary artery dissection
Takotsubo cardiomyopathy

Clinical Problems

Systematic interpretation

Cardiovascular symptoms

Cardiac arrest
Chest pain
Hypertension
Hypotension
Palpitations

General symptoms

Cough
Dizziness
Dyspnoea
Fatigue
Loss of consciousness
Syncope
Weakness

Abdominal pain
Blunt Trauma
Chronic kidney disease
Diarrhoea
Fever
Long lie
Muscle pains
Seizure
Vomiting

ECG Library: Mid-anterior MI (5)

Sort by:

TitleDate

ASCDESC

Show:

31230

Columns:

1 23

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Hyperacute T waves Septal ST elevation Mid-anterior MI Dr Smith's ECG Blog CC BY-NC

The delay between OMI and STEMI claims yet another patient’s anterior wall

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

This ECG shows ST elevation in V2 with hyperacute T waves in V2-3. Even though this does not meet STEMI criteria, it is highly suspicious. Serial troponins did rise, pain was ongoing and the ECG evolved to meet STEMI criteria. A 100% mid-LAD occlusion was found to be the cause. Echo showed widespread wall motion abnormalities and reduced ejection fraction.

Chest pain Dyspnoea 12-Lead Hyperacute T waves Septal ST elevation Mid-anterior 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 depression Inferior ST depression ST elevation in aVL Mid-anterior MI Dr Smith's ECG Blog CC BY-NC

Thrombus propagation on 10 serial Prehospital ECGs: Can you explain the progression?

This ECG is from a patient of unknown age who presented with chest pain.

Chest pain 12-Lead Anterior ST depression Inferior ST depression ST elevation in aVL Mid-anterior 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 Inferior ST depression ST elevation in aVL LAFB Mid-anterior MI Dr Smith's ECG Blog CC BY-NC

Thrombus propagation on 10 serial Prehospital ECGs: Can you explain the progression?

This ECG is from a patient of unknown age who presented with chest pain. This was the repeat ECG 19 minutes later.

Chest pain 12-Lead Anterior ST elevation Inferior ST depression ST elevation in aVL LAFB Mid-anterior MI Dr Smith's ECG Blog CC BY-NC

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Normal ST segment Acute Anterior MI Mid-anterior MI Dr Smith's ECG Blog CC BY-NC

Is this acute coronary occlusion? Simple ACS? Where is the culprit lesion? – post cath ECG

12-Lead Serial 12-lead Normal ST segment Acute Anterior MI Mid-anterior MI Dr Smith's ECG Blog CC BY-NC

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Hyperacute T waves Inferior ST depression ST elevation in aVL Acute Anterior MI Mid-anterior MI Dr Smith's ECG Blog CC BY-NC

Is this acute coronary occlusion? Simple ACS? Where is the culprit lesion?

Chest pain 12-Lead Hyperacute T waves Inferior ST depression ST elevation in aVL Acute Anterior MI Mid-anterior MI Dr Smith's ECG Blog CC BY-NC

This is a library of 2409 free, open access, re-usable ECGs from across the web.

Where did they come from?

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.

Why are they here?

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.

How can I use these ECGs?

You can use these ECGs for your own learning, teaching or research - as long as you abide by the terms of each ECG's copyright licence as stipulated by the original author.

Comments & Feedback

This ECG Archive is an academic, non-commercial #FOAMed project aiming to crowdsource a free open access database of ECGs and signs. If you include your personal details such as your name in your feedback you will be attributed for your contribution, unless you tell us that you don't want this to happen. Personal contact details such as email addresses will not be published but may be used to email you in reply. Full project details and participant information available here.

Name (optional):

Email (optional):

Please keep my contribution private.

Please keep my contribution anonymous.