ECG Case #42 - Question #1 Answer

The ECG findings include:

1. Normal sinus rhythm

2. Anterior ST elevation myocardial infarction

An anterior wall myocardial infarction (AWMI or anterior STEMI) occurs when anterior myocardial tissue usually supplied by the left anterior descending coronary artery (LAD) suffers injury due to lack of blood supply. When an AWMI extends to the septal and lateral regions as well, the culprit lesion is usually more proximal in the LAD or even in the left main coronary artery. This large anterior myocardial infarction is termed an "extensive anterior".
The ECG findings of an acute anterior wall myocardial infarction include:

1. ST segment elevation in the anterior leads (V3 and V4) and sometimes in septal and lateral leads depending on the extent of the myocardial infarction. This ST elevation is concave downward and frequently overwhelms the T wave. This is called "tombstoning" due to the similarity to the shape of a tombstone.

2. Reciprocal ST segment depression in the inferior leads (II, III and aVF).