1) A 60-year-old woman presented to the ER with chest pain and was found to have an anterior ST-elevation myocardial infarction (STEMI) on her ECG. 2) Anterior STEMIs result from occlusion of the left anterior descending artery and carry a worse prognosis due to larger infarct size. 3) The ECG showed ST elevation in the precordial leads V1-V6 indicative of a large anterior wall infarction involving the proximal left anterior descending artery.

1. Acute coronary
syndrome
STEMI (ECG SIGNS) 2

2. 60 year old Woman is brought in to the ER 5 hours
after symptom of chest pain
• ECG acquisition is done within 10 minutes
of arrival
 Immediate assessment, given aspirin 162mg
chewable po
 ECG shows a large anterior STEMI
• Antiplatelet therapies: Clopidogrel 600mg PO

3. Anterior STEMI
• Clinical facts:
• Results from occlusion of the
left anterior descending artery
(LAD).
• Carries the worst prognosis of
all infarcts , due to larger
infarct size
• How to Recognize an Anterior
STEMI
• ST segment elevation with Q
wave formation in the
precordial leads (V1-6)
• Reciprocal ST depression in
the inferior leads (mainly III
and aVF)

4. Infarct Pattern
• Septal : V1-V2
• Anterior : V2-V5
• Anteroseptal : VV1-V4
• Anterolateral : V3-V6, +/- I +aVL
• Extensive anterior/ anterolateral : V1-V6, + aVL

5. On this EKG, there's ST elevation with “tombstone” features in the precordial leads (V1-6) and high lateral leads (I, aVL)
 Occlusion is in proximal LAD and indicates large area infarction with a poor LV EF and increased chance of cardiogenic shock and
death

6. In this EKG, there’s maximal ST elevation in the anteroseptal leads (V1-4)
 Q waves are present in the septal leads (V1-2)
 Mild STE in I, aVL and V5, with reciprocal ST depression in lead III
 Hyperacute (peaked ) T waves in V2-4. These features indicate a hyperacute anteroseptal STEMI

7. In this ECG, there’s ST elevation in V1-6 plus I and aVL (most marked in V2-4).
 Minimal reciprocal ST depression in III and aVF
 Q waves in V1-2, reduced R wave height (a Q-wave equivalent) in V3-4
 A premature ventricular complex (PVC) with “R on T’ phenomenon at the end of
the ECG; this puts the patient at risk for ventricular arrhythmias

8. In this ECG, there’s Hyperacute T-waves in V2-6 (most marked in V2 and V3) with
loss of R wave height
 The rhythm is sinus with 1st degree AV block
 Premature atrial complexes (beat 4 on the rhythm strip)
 Multifocal ventricular ectopy (PVCs of two different types) indicating
an “irritable” myocardium at risk of ventricular fibrillation

9. Thanks for your
attention