Evolving MI • Normal ECG prior to MI • Hyperacute T wave - increased T wave amplitude and width • Marked ST elevation with hyperacute T wave changes (transmural injury) • Pathologic Q waves, less ST elevation, terminal T wave inversion (necrosis) • Pathologic Q waves, T wave inversion (necrosis and fibrosis) • Pathologic Q waves, upright T waves (fibrosis) Inferior Family of MI´s • Inferior MI: Q waves and evolving ST-T changes in leads II, III, aVF • True posterior MI: ECG changes are seen in anterior precordial leads V1-3, but are the mirror image of an anteroseptal MI. Often seen with inferior MI • Right Ventricular MI (only seen with proximal right coronary occlusion). ECG findings usually require additional leads on right chest Inferior MI Inferoposterior MI Right Ventricular MI Anterior Family of MI´s • Anteroseptal: Q, QS, or qrS complexes in leads V1-V3 (V4), ST changes • Anterior MI (similar changes, but usually V1 is spared; if V4-6 involved call it "anterolateral") • High Lateral MI (typical MI features seen in leads I and/or aVL) Anteroseptal MI Anterolateral MI Lateral MI MI and LBBB • Often a difficult ECG diagnosis because in LBBB the right ventricle is activated first and left ventricular infarct Q waves may not appear at the beginning of the QRS complex . V1-V3 (V4), ST changes • Anterior MI (similar changes, but usually V1 is spared; if V 4 -6 involved call it "anterolateral") • High Lateral MI (typical MI features seen in leads I and/ or. waves, T wave inversion (necrosis and fibrosis) • Pathologic Q waves, upright T waves (fibrosis) Inferior Family of MI´s • Inferior MI: Q waves and evolving ST-T changes in leads II, III, aVF •. Evolving MI • Normal ECG prior to MI • Hyperacute T wave - increased T wave amplitude and width • Marked ST elevation with hyperacute T wave changes (transmural injury)