ECG - advanced - chest pain - 3 


Anterior myocardial infarction
 

Anterior myocardial infarctions are generally more serious than inferior ones, as the left coronary artery usually supplies a larger area of more important (left ventricular) cardiac muscle.    
 

 Antero-lateral myocardial infarction
This ECG shows widespread infarction affecting the anterior V2, septal (v3-4), and lateral parts of the left ventricle.   
 

ECG 

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Subtle changes
In this ECG, the changes of anterior MI are only easily seen in lead II and V5.   
 

ECG 

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Tombstone sign in anterior myocardial infarction
This series of two ECGs show the development of the 'tombstone' sign. This is the squared off appearance of the ECG tracing seen in V1 in the second tracing.
As might be guessed, this does not imply a good prognosis.   
 

ECG 

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ECG 

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Another subtle anterior infarction
In this trace, notice the upsloping trace in V2 and V3. On its own it would be easy to put this down to being 'high take off'. However aVL and lead I have mild, but significant ST elevation.
This is complemented by reciprocal changes seen in the inferior leads II, III and aVF.   
 

ECG 

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Antero-septal myocardial infarction
Here the ST elevation is predominantly seen in the septal leads, V3 and V4.   
 

ECG