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).