ST T abnormalities in acute ST elevation MI

Location

Anterior MI

Inferior MI

Infero- lateral MI

High Lateral MI

Postero- lateral

True posterior MI (Isolated)

RV MI (Isolated)

Occlusion

(1) ProximalLAD [may include (3) and (4)]

(2) Distal LAD

(3) Septal perforator

(4) Diago -nal

RCA

Circumflex (18%)

.

Circum -flex

.

Cx 70%

.

ST elevation

Most

(V1-V2) V3-V6, I, aVL (I. aVL with diagonal)

.

V1-V2

I, aVL

II, III, aVF

II, III, aVF, I, aVL, V5-V6

II, III, aVF, V5-V6 with maximum in V5-V6

I, aVL, V5-V6

.

V7-V9

V1, V3R, V4R

Occa sional

V2

.

.

In precor dial leads

V5-V6

.

V2-V4

.

V5-V6

.

V5R, V6R

Rare

II

.

.

.

.

.

.

.

.

.

‡ V1-V5

Not

V1

.

.

.

.

.

.

.

.

Inf leads

.

Reciprocal change (ST depression)

Most

III, aVF

.

II, III, aVF, V5-V6

.

I, aVL †  (60%) V1-V3, more prominent in V2-V3

Cx occlusion causes moreV1-V3 ST depression

I, aVL, V1-V4

III, aVF

.

V1-V3 (T wave upright)

.

Occa sional

II

.

.

.

.

.

I, aVL, V1-V4

V1

V1-V3

.

.

Rare

.

.

.

.

.

.

.

.

.

.

.

Not

.

aVF

.

.

.

.

.

.

.

.

.

†  Coexisting RV infarct with inferior MI should be suspected if there is reciprocal ST depression in V2-V3 but with ST elevation in V1. ‡ Which may simulate anterior MI. Anterior MI ST elevation may be seen in V3R-V4R but rarely in V5R-V6R.

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