Answer MI 13

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Where is this myocardial infarction located?

ECG MI 13. Click on image for enlargement.

Answer

Culprit lesion: LAD

1. sinustachycardia
2. about 100/min
3. normal conduction
4. intermediate heart axis
5. tall p wave in II consistent with right atrial dilatation. (the sawtooth-basline between the 2nd and 3rd complex in AVR is probably a motion artefact). PTA depression in II
6. Loss of R waves throughout the anterior wall (V1-V6). QS complexes in V3-V5.
7. ST elevation in V1-V5 with terminal negative T waves

• Conclusion: Large anterior MI due to LAD occlusion.

Characteristics that suggest a large infarct in this case are:

• Loss of R waves throughout the anterior wall (V1-V6). QS complexes in V3-V5.
• Left and right sided decompensation, resulting in right atrial dilatation and ischemia
• Tachycardia