Answer MI 20

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Previous ECG: MI 19 | Next ECG: MI 21

Where is this myocardial infarction located?

ECG MI 20. Click on image for enlargement.


  • Following the 7+2 steps:
    • Rhythm
      • The ECG shows a regular rhythm with normal P waves (positive in I, III and AVF, negative in AVR), followed by QRS complexes. Sinusrhythm
    • Heart rate
      • 100 bpm
    • Conduction (PQ,QRS,QT)
      • PQ: 140ms QRS: 100ms QT: 320ms QTc: 410ms
    • Heartaxis
      • QRS positive in I and AVF: normal heart axis
    • P wave morphology
      • The P waves have normal morphology.
    • QRS morphology
      • Narrow QRS. No left ventricular hypertrophy. No pathologic Q waves.
    • ST morphology
      • ST elevation in V1-V4 and lead I. ST depression in II, III, AVF and V6. Lead V3 shows V4R which is not elevated
    • Compare with the old ECG (not available, so skip this step)
    • Conclusion?

Sinusrhythm with anteroseptal infarction. Ischemic vector is pointing upwards (ST depression in AVF), a sign of proximal LAD occlusion.