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Ischemia is associated with flat or inverted symmetrical T waves.
Infarct and injury are represented by ST segment elevation or
depression (reciprocal leads). Q waves indicate infarction (acute
and old), although tiny Q waves (< 0.04 sec) may be normally
seen in I, II, aVL, V5 and V6. LBBB complicates the diagnosis
of acute MI.
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Location |
Leads |
Vessels |
Anterior |
V2-V4 |
Left Ant.Descending (LAD) |
Anteroseptal |
V1-V4 |
LAD |
Anterolateral |
V1-V6, I, aVL |
LAD, Diagonal |
Inferior |
II, III, aVF |
RAC, Circumflex |
Right Ventr. |
V1-V3, V3R-V6R |
RCA |
Lateral |
I,aVL, V5-V6 |
Circumflex, Diagonal |
Posterior |
V1-V3: large R + STdepression |
RCA |
DDx ST elevation myocardial injury,
pericarditis, ventricular aneurysm, Prinzmetal's Angina (coronary
artery spasm), LBBB, early repolarization, hypothermia; J point
elevation (early repolarization) may be normal with children,
black men, or healthy young adults.
DDx ST depression Dig., Subendocardial
MI, angina, LVH, RVH, ischemia, TC's, Strain, hypokalemia, hypomagnesemia,
WPW, critical anemia, BBB's.
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