This is an interesting teaching ECG on many levels. It is obtained from a man with chest pain. No other history or follow up is available.
Acute M.I. Most striking is probably the clearly-seen anterior-septal wall M.I. There is ST segment elevation in Leads V1, V2, and V3, with ST depression in the low-lateral leads, V5 and V6. There is also ST depression in the inferior Leads II, III, and aVF. The ST elevations have a coved-upward (frown) shape in V1 and a straight shape in V2 and V3. Both of these ST shapes are abnormal and reflect injury. The depressions are presumed to be due to reciprocal changes, since there is no other ST-depression producing condition apparent. There are abnormal Q waves in V1, which could herald the onset of pathological Q waves, a sign of necrosis, in the anterior-septal wall.