CONTENTS
[1/2] cornerstone findings of lateral OMI
- STE in I, aVL
- STE is often <1 mm, especially with low QRS voltages (rendering ECG insensitive to lateral occlusion).
- Inferior reciprocal ST deviation(s)
- This is often the most pronounced finding in occlusion of D1 or OM1.
- STD in >1 inferior lead is more specific for ischemia.
- Down-up T-waves in the inferior lead(s) highly suggest ischemia (this is a reciprocal finding of the Wellens A pattern in lateral leads).
- TWI in Lead II is more pathological than TWI in III and/or aVF (which may merely reflect the QRS complex is negative).
[2/2] findings that may depend on the exact location of MI
1st diagonal off LAD (“midanterior” or “mid-anterolateral”)
- [1] STE in I, aVL, V2:
- 💡 Key point: STE in aVL and V2 with STD in III indicates occlusive MI (even though V2 isn't traditionally considered contiguous with aVL). (Berberian 2021)
- V2 and aVL may be regarded as adjacent leads.
- [2] Reciprocal STD with TWI in Lead III +/- aVF.
- [3] Absence of prominent STE in other anterior leads:
- Some STE in V1/V3 may occur.
- However, if there is substantial STE in numerous anterior leads, this suggests a proximal LAD occlusion rather than a diagonal artery branch. 📖
- “Subendocardial ischemia” (STD with positive T-wave) may occur in V4-V5. (7960274)
posterolateral (LCX):
- Right precordial leads may show some ST flattening, down-sloping, or ST depression.
#1/6: anterolateral aneurysm
- Anterior aneurysm involving the lateral wall may create STE in the lateral leads, with inferior reciprocal STD.
#2/6: atrial flutter 📖
#3/6: hypercalcemia 📖
- Short ST segment creates a domed ST/T complex that mimics ST elevation.
- Hypercalcemia tends to mimic anterior and/or lateral OMI.
#4/6: pericarditis 📖
- Clues to suspect pericarditis:
- STE is more diffuse than usual for a lateral MI (e.g., STE in II and aVF).
- Key features of pericarditis:
- 🔑 STE:
- Concave or saddle-shaped.
- STE is greatest in II and V5-V6.
- STD in aVR.
- No reciprocal STD (especially in aVL).
- 🔑 Upright, relatively small T-waves (in V6, STE is >25% height of the T-wave).
- 🔑 PR depression (~80% sensitive, but nonspecific).
- 🔑 STE:
#5/6: Benign Early Repolarization
- Key features of BER:
- 🔑 Usually men (75%), <50-70 years old.
- 🔑 Widespread STE (greatest in V3-V4; often limb leads esp. II).
- 🔑 Notching/slurring at the J-point is followed by concave STE.
- 🔑 T-waves are usually tall and asymmetric, with STE in V6 <25% of the T-wave height (but benign TWI is possible).
- 🔑 R-waves and generally tall.
- 🔑 Often associated with STD in aVR.
- BER usually produces STE in the limb leads. However, sometimes, the STE vector can be closer to zero degrees, generating STE in Lead I and aVL with reciprocal STD in Lead III.
- Clues suggesting BER:
- Benign morphology (with J waves and upward concavity).
- Lack of hyperacute T-waves.
- Proportionally unimpressive ST deviation.
- BER in the anterior leads should also be present.
- Negative QRS complex in lead III (so the TWI is merely “following” the QRS complex).
#6/6: PE or RVH 📖
- RVH can cause STD in inferior leads with STE in aVL.
To keep this page small and fast, questions & discussion about this post can be found on another page here.
