This is a good example of acute anterior wall M.I., with ST elevation in V1 through V6, as well as in Leads I and aVL. The extensive distribution of ST segment elevations across the anterior and high lateral walls indicates a proximal LAD artery occlusion. In addition, this ECG shows right bundle branch block, with a QRS width of 144 ms (.14 sec.) and an rsR' pattern in V1. There is also a wide s wave in Lead I which is partly obscurred in V6 by the ST elevation. The right axis deviation (98 degrees) suggests a left posterior fascicular block which, when coupled with the RBBB, is a bi-fascicular block. P waves are difficult to see. Do you think they are found at the end of the QRS complexes, representing a long first-degree AVB? Look at leads V3 through V6 for clues.
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A good ECG to teach your students that a patient facing a life-threatening emergency may have a "normal" rate and regular rhythm. There is something in this ECG for beginners through advanced students.
A good teaching ECG, showing clearly elevated ST segments in V1 through V4. This patient had an LAD occlusion. In addition, he has new-onset atrial fib at a rate of about 120/min. Atrial fib has decreased cardiac output because of the loss of P waves prior to the QRS complexes, and a resultant decreased ventricular filling pressure. In addition, this fast rate contributes to increased myocardial oxygen demand and damage. An early priority, along with getting this patient to PCI, is slowing the rate.
This is a good ECG for demonstrating the voltage and ST criteria for LVH and acute anterior wall M.I. in the same patient, where both conditions have been confirmed by other tests. If you are teaching the topics of ST elevation M.I., or left ventricular hypertrophy, you will probably have to address the issue that LVH can be considered a "mimic" for STEMI, especially for beginners. This is because LVH causes ST depression in leads with upright QRS complexes, and reciprocal ST elevation in leads with negative QRS complexes. This is called ST segment discordance. The ST changes in LVH are due to the "strain" pattern, indicating strain on the left ventricular myocardium. It is true that some ST elevation will appear in V1 and V2 in these patients, and can be mistaken for M.I. In the ECG shown here, the patient has definite ST elevation in leads which would NORMALLY have depression in the LVH strain pattern. Leads V1 through V4 have ST elevation that is not discordant, and is definitely real. This patient was taken to the cath lab, and his left anterior descending artery stented.
