This week we have an EKG of a 65 year-old woman who presented with fatigue. She just didn’t seem to have the energy she normally has. No chest pain, shortness of breath, fever, cough or leg swelling. Her vital signs and exam were unremarkable.

Here is her EKG: EKG 2017-07-24

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Those who braved a guess did so correctly. This is a pretty obvious inferior ST elevation MI. There are a couple of important points to note:

  1. Obvious are the large ST-elevations in the inferior leads (II, III and aVF). The inferior leads are tricky and sometimes the ST-elevations can be very subtle. Not so, in this one.
  2. The high lateral leads (I and aVL) and high right (aVR) are the closest thing we have to “superior” leads. You can see the reciprocal changes of ST-depressions there.
  3. There is some lateral extension as evidenced by the ST-elevation in V5 and V6.
  4. There may be some posterior extension as seen by the reciprocal ST-depressions in the anterior leads (V1, V2, V3).

Image from Wikimedia Commons.

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