Answer MI 21

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Previous ECG: MI 20 | Next ECG: MI 22

Where is this myocardial infarction located?

ECG MI 21. 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
      • 90 bpm
    • Conduction (PQ,QRS,QT)
      • PQ: 160ms QRS: 80 ms QT: 340ms QTc: 416ms
    • Heartaxis
      • QRS positive in I and negative in II and AVF: left heart axis deviation
    • P wave morphology
      • P wave positive in II, III and AVF, biphasic in V1. The P waves have normal morphology.
    • QRS morphology
      • Narrow QRS. QS in V1-V2. Q in V4. Reduced R wave progression.
    • ST morphology
      • ST elevation in I, AVL, V1-V5 (V3=V4R and not elevated). ST depression in III and AVF.
    • 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.