d o
t o r e g . c o m
Dr. Mete ALPASLAN
Acute Anterior Myocardial Infarction
ECG 1a. The ECG above belongs to a patient complaining of chest pain. There is ST segment elevation and tall T waves
in anterior leads. There is also reciprocal ST depression in inferior leads. Lateral leads show 0.5mm ST segment
elevation.
Click here for a more detailed ECG
ECG 1b. This ECG is from the same patient. It was recorded just after the ending of thrombolytic therapy. Anterior leads show
that ST segment elevation have decreased and tall, peaked T waves became negative . The reciprocal ST depression in
inferior leads also disappeared.
Click here for a more detailed ECG
ECG 1c. This ECG was recorded after 24 hours and shows that amplitude of the negative T waves are greatly decreased.
Click here for a more detailed ECG
ECG 2. This is a different patient who came to the emergency room complaining of severe chest pain. ST segment elevation
and tall, peaked T waves in leads C1-C4 denote to acute anteroseptal myocardial infarction. There is also ST segment
depression in inferior leads, C5 and C6. He had undergone coronary angiography immediately which revealed total occlusion
of the left anterior descending (LAD) coronary artery at its ostia and also significant stenosis of the right coronary artery (RCA).
Click here for a more detailed ECG
ECG 3a. The ECG above belongs to a middle-aged man who was admitted to the emergency room with the complaint of chest.
pain. His ECG shows acute anteroseptal myocardial infarction. Thrombolytic therapy with alteplase infusion was started
immediately and the patient was transferred to our hospital for coronary angiography.
ECG 3b. Above is his ECG in our emergency room (1.5 hours after recording of the ECG 3a).
The ST elevation in anterior leads is decreased but not normalised.
He said that his chest pain had diminished but not disappeared completely.
He was taken to the coronary angiography laboratory and the 95% stenosis in LAD (after the 2nd Diagonal branch)
was opened successfully by a stent.
ECG 4a. The ECG above belongs to a middle-aged man. It was recorded 2.5 hours after the onset of chest pain:
acute anterolateral myocardial infarction is seen. He underwent coronary angiography 10 minutes after recording of this ECG
which showed that the LAD was totally occluded shortly after its origination.
LAD=Left Anterior Descending coronary artery
Click here for a more detailed ECG
ECG 4b. The same patient's ECG summary is seen above.
ECG 5. This ECG belongs to a 60 years-old woman who was admitted late (at the 9th hour of the chest pain) to the hospital.
She had received neither thrombolytic therapy nor coronary intervention prior to this ECG.
The ECG shows features of late (completed) anterior myocardial infarction: Q waves, elevated ST segments,
and negative T waves in anterior leads.
Click here for a more detailed ECG
ECG 6. The above ECG is from an 86 years-old woman who was admitted to the emergency room with the diagnosis of
cardiogenic shock. Right bundle branch block is seen.
The ST segment elevation in leads V1 to V4 denotes acute anterior wall myocardial infarction.
She had been previously diagnosed as pancreas carcinoma. She died minutes after recording the above ECG.
Click here for a more detailed ECG
ECG 7a. The ECG above belongs to a 60 years-old man experiencing acute anterior myocardial infarction.
Leads V1 to V3 show ST segment elevation.
The tall T waves in leads V2 and V3 are hyperacute T waves which are seen during the initial hours of acute myocardial infarction.
The hyperacute T waves in leads V2 and V3 are taller than the preceding QRS complexes.
Click here for a more detailed ECG
ECG 7b. The above ECG belongs to the same patient.
It was recorded after successful angioplasty of his LAD coronary artery (60 minutes after the ECG 7a).
ST segment elevation and tall T waves have disappeared after opening of his obstructed LAD coronary artery.
Click here for a more detailed ECG
ECG 8a. The ECG above belongs to a 45 years-old man. He was complaining of chest oppression for the last 4 hours.
Leads V1 to V4 show ST segment elevation and tall T waves. There are no leads showing reciprocal ST depression.
Does this ECG show early repolarization or acute anterior myocardial infarction?
What if a person with early repolarization pattern on ECG experiences acute anterior myocardial infarction?
In the above ECG, lead V2 shows 5 mm (0.5 mV) ST segment elevation, unusual for early repolarization.
Also, the T wave in lead V2 is taller than the preceding R wave.
These findings are not typical for early repolarization.
Immediately after recording of the above ECG, the patient underwent urgent coronary angiography.
The LAD (Left Anterior Descending) coronary artery had 98% stenosis after giving off its first Diagonal branch.
The stenotic LAD coronary artery was successfully stented.
The above ECG was donated by Dr. Ersin Sarıcam to our website.
Click here for a more detailed ECG
ECG 8b. The ECG above belongs to the same patient. It was recorded after successful stenting of the LAD coronary artery.
(35 minutes after the ECG 8a). Now, the ST segment elevation and T wave amplitude are decreased.
The above ECG was donated by Dr. Ersin Sarıcam to our website.
Click here for a more detailed ECG
ECG 8c. The ECG above belongs to the same patient. It was recorded 32 hours after the ECG 8a.
The above ECG was donated by Dr. Ersin Sarıcam to our website.
Click here for a more detailed ECG
ECG 9a. Above ECG belongs to a 58 years-old man with chest pain.
It was recorded approximately 75 minutes after the onset of chest pain.
Precordial leads show ST elevation.
On the same day, his town was affected by a natural (flood) disaster and he could not be transferred for coronary angiography.
until the 9th hour after onset of his chest pain.
Below, you will find several ECGs of him demonstrating progressive ECG changes in a patient with
acute anterior myocardial infarction and no early intervention.
Click here for a more detailed ECG
ECG 9b. The same patient's ECG, 2 hours after the onset of chest pain.
ST segment elevation increased.
Click here for a more detailed ECG
ECG 9c. The same patient's ECG, 3 hours after the onset of chest pain.
ST segment elevation is less.
Click here for a more detailed ECG
ECG 9d. The same patient's ECG, 5.5 hours after the onset of chest pain.
Negative T waves are seen.
Click here for a more detailed ECG
ECG 9e. The same patient's ECG, 8.5 hours after the onset of chest pain.
Thirty minutes after recording of the above ECG, the patient reached our hospital and directly underwent to coronary angiography.
A stent was implanted to his LAD coronary artery. Cx was dominant and normal.
His non-dominant right coronary artery was totally occluded proximally and its distal segment was filled by bridge collaterals.
Click here for a more detailed ECG
ECG 9f. The same patient's ECG, next day.
Click here for a more detailed ECG
ECG 1a. The ECG above belongs to a patient complaining of chest pain. There is ST segment elevation and tall T waves
in anterior leads. There is also reciprocal ST depression in inferior leads. Lateral leads show 0.5mm ST segment
elevation.
Click here for a more detailed ECG
ECG 1b. This ECG is from the same patient. It was recorded just after the ending of thrombolytic therapy. Anterior leads show
that ST segment elevation have decreased and tall, peaked T waves became negative . The reciprocal ST depression in
inferior leads also disappeared.
Click here for a more detailed ECG
ECG 1c. This ECG was recorded after 24 hours and shows that amplitude of the negative T waves are greatly decreased.
Click here for a more detailed ECG
ECG 2. This is a different patient who came to the emergency room complaining of severe chest pain. ST segment elevation
and tall, peaked T waves in leads C1-C4 denote to acute anteroseptal myocardial infarction. There is also ST segment
depression in inferior leads, C5 and C6. He had undergone coronary angiography immediately which revealed total occlusion
of the left anterior descending (LAD) coronary artery at its ostia and also significant stenosis of the right coronary artery (RCA).
Click here for a more detailed ECG
ECG 3a. The ECG above belongs to a middle-aged man who was admitted to the emergency room with the complaint of chest.
pain. His ECG shows acute anteroseptal myocardial infarction. Thrombolytic therapy with alteplase infusion was started
immediately and the patient was transferred to our hospital for coronary angiography.
ECG 3b. Above is his ECG in our emergency room (1.5 hours after recording of the ECG 3a).
The ST elevation in anterior leads is decreased but not normalised.
He said that his chest pain had diminished but not disappeared completely.
He was taken to the coronary angiography laboratory and the 95% stenosis in LAD (after the 2nd Diagonal branch)
was opened successfully by a stent.
ECG 4a. The ECG above belongs to a middle-aged man. It was recorded 2.5 hours after the onset of chest pain:
acute anterolateral myocardial infarction is seen. He underwent coronary angiography 10 minutes after recording of this ECG
which showed that the LAD was totally occluded shortly after its origination.
LAD=Left Anterior Descending coronary artery
Click here for a more detailed ECG
ECG 4b. The same patient's ECG summary is seen above.
ECG 5. This ECG belongs to a 60 years-old woman who was admitted late (at the 9th hour of the chest pain) to the hospital.
She had received neither thrombolytic therapy nor coronary intervention prior to this ECG.
The ECG shows features of late (completed) anterior myocardial infarction: Q waves, elevated ST segments,
and negative T waves in anterior leads.
Click here for a more detailed ECG
ECG 6. The above ECG is from an 86 years-old woman who was admitted to the emergency room with the diagnosis of
cardiogenic shock. Right bundle branch block is seen.
The ST segment elevation in leads V1 to V4 denotes acute anterior wall myocardial infarction.
She had been previously diagnosed as pancreas carcinoma. She died minutes after recording the above ECG.
Click here for a more detailed ECG
ECG 7a. The ECG above belongs to a 60 years-old man experiencing acute anterior myocardial infarction.
Leads V1 to V3 show ST segment elevation.
The tall T waves in leads V2 and V3 are hyperacute T waves which are seen during the initial hours of acute myocardial infarction.
The hyperacute T waves in leads V2 and V3 are taller than the preceding QRS complexes.
Click here for a more detailed ECG
ECG 7b. The above ECG belongs to the same patient.
It was recorded after successful angioplasty of his LAD coronary artery (60 minutes after the ECG 7a).
ST segment elevation and tall T waves have disappeared after opening of his obstructed LAD coronary artery.
Click here for a more detailed ECG
ECG 8a. The ECG above belongs to a 45 years-old man. He was complaining of chest oppression for the last 4 hours.
Leads V1 to V4 show ST segment elevation and tall T waves. There are no leads showing reciprocal ST depression.
Does this ECG show early repolarization or acute anterior myocardial infarction?
What if a person with early repolarization pattern on ECG experiences acute anterior myocardial infarction?
In the above ECG, lead V2 shows 5 mm (0.5 mV) ST segment elevation, unusual for early repolarization.
Also, the T wave in lead V2 is taller than the preceding R wave.
These findings are not typical for early repolarization.
Immediately after recording of the above ECG, the patient underwent urgent coronary angiography.
The LAD (Left Anterior Descending) coronary artery had 98% stenosis after giving off its first Diagonal branch.
The stenotic LAD coronary artery was successfully stented.
The above ECG was donated by Dr. Ersin Sarıcam to our website.
Click here for a more detailed ECG
ECG 8b. The ECG above belongs to the same patient. It was recorded after successful stenting of the LAD coronary artery.
(35 minutes after the ECG 8a). Now, the ST segment elevation and T wave amplitude are decreased.
The above ECG was donated by Dr. Ersin Sarıcam to our website.
Click here for a more detailed ECG
ECG 8c. The ECG above belongs to the same patient. It was recorded 32 hours after the ECG 8a.
The above ECG was donated by Dr. Ersin Sarıcam to our website.
Click here for a more detailed ECG
ECG 9a. Above ECG belongs to a 58 years-old man with chest pain.
It was recorded approximately 75 minutes after the onset of chest pain.
Precordial leads show ST elevation.
On the same day, his town was affected by a natural (flood) disaster and he could not be transferred for coronary angiography.
until the 9th hour after onset of his chest pain.
Below, you will find several ECGs of him demonstrating progressive ECG changes in a patient with
acute anterior myocardial infarction and no early intervention.
Click here for a more detailed ECG
ECG 9b. The same patient's ECG, 2 hours after the onset of chest pain.
ST segment elevation increased.
Click here for a more detailed ECG
ECG 9c. The same patient's ECG, 3 hours after the onset of chest pain.
ST segment elevation is less.
Click here for a more detailed ECG
ECG 9d. The same patient's ECG, 5.5 hours after the onset of chest pain.
Negative T waves are seen.
Click here for a more detailed ECG
ECG 9e. The same patient's ECG, 8.5 hours after the onset of chest pain.
Thirty minutes after recording of the above ECG, the patient reached our hospital and directly underwent to coronary angiography.
A stent was implanted to his LAD coronary artery. Cx was dominant and normal.
His non-dominant right coronary artery was totally occluded proximally and its distal segment was filled by bridge collaterals.
Click here for a more detailed ECG
ECG 9f. The same patient's ECG, next day.
Click here for a more detailed ECG