I now have 10 high-quality ECG images covering a wide range of MI findings. Here they are:
ECG Findings in Myocardial Infarction — 10 Images
1. Acute Inferior STEMI — "Shark Fin" Morphology
Leads II, III, aVF — ST elevation with shark-fin fusion of QRS/ST/T. Reciprocal depression in I, aVL. Posterior involvement suggested by V1–V3 depression.
2. Acute Anterior STEMI — LAD Occlusion
Prominent ST elevation across V1–V6, most marked in V2–V4. Mild elevation in I, II, III, aVF. Classic pattern of left anterior descending (LAD) territory occlusion.
3. Anterolateral STEMI — LAD with Lateral Extension
ST elevation in V1–V6 + I + aVL (hyperacute T waves). Reciprocal ST depression in inferior leads II, III, aVF. Indicates proximal LAD occlusion involving diagonal branches.
4. Inferior STEMI — Tombstone Morphology
"Tombstone" ST elevation in II, III, aVF with deep reciprocal depression in V1–V3 and aVL. Sinus tachycardia with rightward axis, suggesting RCA or LCx occlusion.
5. Inferolateral STEMI with Sinus Bradycardia
ST elevation in II, III, aVF + V5–V6 with hyperacute T waves. Reciprocal depression in V1–V4 and aVL. Sinus bradycardia (~45–50 bpm) — typical of RCA-territory STEMI with vagal response.
6. Evolving Anteroseptal MI — Pathological Q Waves + T Inversion
Pathological Q waves in V1–V2, ST elevation in V1–V3, and deep T-wave inversions in I, aVL, V2–V4. Classic progression from acute STEMI toward subacute/evolving phase in LAD territory.
7. Subacute Inferior MI — Q Waves + Symmetric T Inversion
Pathological Q waves with deep symmetric T-wave inversions in II, III, aVF. Lateral extension to V5–V6. Consistent with evolving/subacute inferior-lateral MI (e.g., post-SCAD or late-presenting STEMI).
8. Old Inferior MI + RBBB — Before & After Stenting
Panel (a): Pathological Q waves in II, III, aVF + ST depression + T inversion + RBBB (rSR' in V1). Panel (b): Post-stenting with resolution of ischemic changes — Q waves and RBBB persist as permanent markers.
9. NSTEMI — Diffuse ST Depression with aVR Elevation
Sinus tachycardia. Diffuse horizontal/downsloping ST depression in I, aVL, V4–V6, II, III, aVF. Reciprocal ST elevation in aVR — hallmark of global subendocardial ischemia or left main/proximal LAD disease.
10. Wellens' Syndrome — Spontaneously Reperfused STEMI
Resolving ST elevation in V2–V5 with deep terminal T-wave inversions — the "Wellens' pattern." No pathological Q waves. This is a critical pre-infarction warning of proximal LAD critical stenosis requiring urgent intervention.
Quick Reference: ECG Findings by MI Type
| Type | Key Finding | Leads Affected |
|---|
| Anterior STEMI | ST elevation | V1–V4 |
| Anterolateral STEMI | ST elevation + lateral | V1–V6, I, aVL |
| Inferior STEMI | ST elevation | II, III, aVF |
| Inferolateral STEMI | ST elevation | II, III, aVF, V5–V6 |
| NSTEMI | ST depression ± T inversion | Diffuse / aVR elevation |
| Evolving MI | Pathological Q waves + T inversion | Territory-specific |
| Wellens' Syndrome | Biphasic/deep T inversion | V2–V5 |
| Posterior MI | Tall R + ST depression | V1–V3 (mirror image) |