70-year old patient presenting with chest pain and diaphoresis. Describe the ECG.

TOP 100 ECG QUIZ LITFL 026 2

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

This is a very worrying ECG demonstrating massive anterolateral STEMI with “tombstone” morphology:

  • Gross ST elevation in V1-6, I and aVL
  • Early Q wave formation in aVL
  • Reciprocal ST depression in inferior leads II, III and aVF

This ECG pattern is seen in proximal LAD occlusion and indicates a large territory infarction with a poor LV ejection fraction and high likelihood of cardiogenic shock and death.


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Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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