Pathologic ST segment elevation usually occurs in two or more contiguous leads and is accompanied by reciprocal changes (ST segment depression). Always examine ST segment elevation with respect to the ECG baseline and do not hesitate to transmit abnormal or concerning ECGs. The following chart summarizes the locations and patterns associated with ST segment myocardial infarction:
ELEVATION
|
DEPRESSION (RECIPROCAL)
| |
INFERIOR WALL
|
II, III, aVF
|
I, aVL
|
ANTERIOR WALL
|
V2-V6
|
II, III, aVF
|
VENTRICULAR SEPTUM
|
V1-V3
| |
ISOLATED POSTERIOR WALL
|
V1-V2 (appears as depression!)
| |
LATERAL WALL
|
I, aVL
|
II, III, aVF
|
Remember that the ECG doesn't always correlate perfectly with anatomy. Given the differences in body habitus, the only way to truly discern the link between ECG changes and relevant anatomy is through angiography.
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