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ECG - ST Elevation Myocardial Infarction STEMI
ECG STEMI / MI Patterns: Acute Anterolateral MI
ST ↑ in I, aVL, V3–V6. Poor R wave progression. T wave inversion. Usually LAD occlusion ± RCA/LCx involvement.
Acute Inferior & Posterior MI
ST ↑ in II, III, aVF. Q waves, T inversion. Posterior MI shows ST ↓ in V1–V2 with tall R in V1. Most often due to RCA occlusion.
Acute Right Ventricular MI
ST ↑ in aVR (± V1). Often accompanies inferior MI. Due to proximal RCA occlusion. Can cause hypotension with nitrates.
Acute Septal MI
ST ↑ in V2–V3. Q waves, T inversion. Due to LAD septal branch occlusion.
Anterior STEMI with Tombstoning
Old Inferior MI
Q waves in II, III, aVF. T inversion/flattening. No acute ST changes.
Old Anterolateral MI
Q waves in I, aVL, V2–6. Loss of R waves in V2–5. T inversion V5–V6.
Acute Inferolateral MI
ST ↑ in I, II, aVL, aVF, V3–6. Pathological Q in aVL.
Acute Inf + True Posterior MI
Inferior ST ↑ (II, III, aVF). Posterior changes: ST ↓ V1–V2, tall R in V1.
⚠️ Emergency note: ST elevation + chest pain = treat as STEMI. Activate reperfusion pathway (PCI or thrombolysis) immediately.
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