ECG Findings
• ST segment elevation in the anterior precordial leads.
• V1-V4: Anteroseptal injury.
• V3-V4: Anterior injury.
• V3-V6: Anterolateral injury. Leads I and aVL may also be involved, especially if the circumflex artery is affected (high lateral injury).
• Reciprocal ST segment depressions are often present in the inferior leads (II, III, aVF).
Important Points To Remember:
1. The left anterior descending artery supplies blood to the anterior and lateral left ventricle and ventricular septum.
2. Normal R-wave progression (increasing upward amplitude with R wave > S wave at V3 or V4) may be interrupted.
3. The development of pathologic Q waves in any of the V leads other than V1 strongly suggests that the injury has progressed to an infarction, as seen in this example.
Pathologic ST-segment elevation beyond 1 mm (double arrow) with pathologic Q waves (arrow) in lead V3. The ST segment demonstrates a convex upward, or “tombstone,” morphology.