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Arrhythmia Recognition Webcast Series
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Practice ECG 26
This ECG shows what an AMI would look like in a patient with low voltage. Look at the limb leads. We see ST elevation in leads I and aVL with reciprocal changes in III and aVF. This is indicative of a lateral AMI. There is also ST elevation in the precordial leads from V2 to V6. Note that the ST elevation is concave downward or flat, and is associated with flipped T waves. These changes are classic for an AMI. This is an anteroseptal AMI with lateral extension.
Advanced readers will note that there is a very late transition of the R waves in the precordials. The Z axis is 70 degrees posteriorly, which indicates a loss of the anterior forces, probably because of the AMI in this case. There is evidence of LAE in this patient and the QT interval is prolonged, also probably due to the AMI.
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