Does something about this ECG look "different" to you? This ECG shows a “classic” presentation of inferior-posterior M.I. when it is caused by a lesion in the right coronary artery (RCA). There are ST elevations in leads II, III, and aVF.Reciprocal ST depression is seen in Leads I and aVL.There is also reciprocal ST depression in Leads V1 – V3.These more rightward anterior leads are reciprocal to the posterior (or posterior-lateral) wall, so the ST elevation is actually posterior.Another sign that this is an RCA lesion is that the ST elevation in Lead III looks worse than the STE in Lead II.It would be helpful to check the right precordial leads, or at least V4 Right, as elevation there would indicate right ventricular M.I.
Depending on how experienced you are at evaluating ECGs, you might have immediately noticed something “different” about this tracing.It is printed in Cabrera format, which groups the leads (viewpoints) more geographically than a traditional ECG does. In addition to grouping the leads more geographically, instead of aVR, the machine records - aVR. That reverses the negative and positive poles of aVR, putting the positive ("seeking") electrode at 30 degrees - halfway between Leads I and II. Those of us who have been looking at ECGs for decades often feel a bit disconcerted by this format, because we have developed almost an intuitive way of seeing the ECG as a “map”, and this rearrangement thwarts our brains’ approach to the ECG.I would imagine, however, that this might make interpretation a bit easier for someone who is not prejudiced by the standard way of printing.This method is especially helpful when looking for inferior wall M.I., as we see here, because the lateral leads are together in a row, and the inferior leads are grouped together.