AWMI and IWMI Click on the image for a larger view
Q waves in II, III, and aVF without ST segment elevation or T wave inversion suggest an old inferior wall myocardial infarction (IWMI). Q waves in V2-V6, ST segment elevation in V1 to V5 and T wave inversion in I, aVL, V2 to V6 suggest a fresh anterior wall myocardial infarction (AWMI). Since the duration of the infarctions seem to be different, we can expect multivessel coronary artery disease with involvement of right coronary artery and left anterior descending coronary artery. Sometimes a combination of inferior and anterior wall infarction patterns on ECG can occur with occlusion of the mid segment of the left anterior descending (LAD) coronary artery alone, which is a type III LAD curving around the apex of the left ventricle.