This is the anterior wall MI patient seen in ECG No. 1 in the Emergency Department.   This is a good ECG for teaching students not to "count blocks" when determining criteria for STEMI.  The American Heart Assoc. has published good criteria for STEMI http://my.americanheart.org/professional/index.jsp     This is an elderly patient with clearly alarming symptoms, his ST elevations are in related leads (V1-V3), and he has reciprocal ST depressions.  The sinus tach and PVCs are also signs of a cardiac event.  See ECG No 3 to follow.