Old anterior infarction causes pathological Q waves in the anterior leads.See also: Old vs new ischemia
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This ECG is from a middle aged male who presented with a choking feeling in his throat, on a background of prior anterior STEMI complicated by cardiac arrest, and ICD.
This ECG shows QS waves with ST elevation in anterior leads. The T waves were larger than previous, so he was sent to the cath lab, but angiography was normal.