ECG Case 009

This ECG is an example of hyperacute anterolateral STEMI:

• There are markedly peaked, asymmetrical T waves (= hyperacute T waves) in V2-5
• The associated loss of R wave height (analogous to early Q wave formation) causes the enlarging precordial T waves to tower over the diminishing R waves
• There is also some subtle ST elevation in aVL, indicating LAD occlusion proximal to the D1
• There are frequent ventricular ectopic beats, which are concerning in this context as they suggest underlying myocardial irritability and a risk of deterioration to malignant ventricular dysrhythmias such as VF or VT

Serial ECGs of this patient showed evolving anterolateral ST elevation (V1-6, I, aVL) with development of inferior reciprocal change (lead III).

Further Reading

• Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course. Understand ECG basics. Medmastery
• Wiesbauer F, Kühn P. ECG Mastery: Blue Belt online course: Become an ECG expert. Medmastery
• Kühn P, Houghton A. ECG Mastery: Black Belt Workshop. Advanced ECG interpretation. Medmastery
• Rawshani A. Clinical ECG Interpretation ECG Waves
• Smith SW. Dr Smith’s ECG blog.
• Wiesbauer F. Little Black Book of ECG Secrets. Medmastery PDF