Hey! Its me in V3!

This may look like your ordinary inferior wall MI, but the expert ECG clinician will spot another potential indication to bypass the local ED in favor of a cath-capable facility... Don't look too closely!

12 lead ECG Interpretation

Sinus rhythm, inferior wall myocardial infarction

Discussion

Classic inferior wall changes are present in leads II, III, and aVF. STE of greater than or equal to 1mm is consistent with the field impression of ST elevation myocardial infarction. In addition, there's some ST segment depression (reciprocal change) in lead aVL.
Lead V3 also reveals a concerning finding: upsloging ST segment depression. This subtle, but important finding, usually indicates acute occlusion of the proximal LAD. The upsloping ST segments usually appear with tall and upright T waves in the anterior precordial leads.

Learn more about the de Winter ST/T wave complex here:
http://www.ahjonline.com/article/S0002-8703(10)00758-1/fulltext#s0040