This ECG is from a 54-year-old woman who had an M.I. one week prior to this tracing. She did not receive interventional treatment, as it was not available where she lived when this happened years ago. Her ECG shows the signs of healing injury, as well as probable permanent damage.
Where was this M.I.? The affected leads are all of the precordial leads (V1 through V6), as well as I and aVL. The precordial leads reflect the anterior and low lateral walls of the heart, and Leads I and aVL show us the high lateral wall. This area is perfused by the left coronary artery, and she had a proximal lesion.
What ST and T wave changes are present? All of the leads listed above show a flattening of the ST segments. While they are no longer elevated (the acute injury is over), they are flat and almost convex upward. This shape is usually abnormal, and it has persisted even though the acute injury is subsiding. The T waves in the anterolateral leads are all inverted. This represents reperfusion of the injured tissue. Whether the offending clot is removed by invasive procedure, thrombolytic drugs, or natural degradation, the tissue that is still alive will reperfuse.