ECG is suggestive of:
a) Acute anterior wall myocardial infarction
b) Old inferior wall infarction
c) Hyperacute inferior wall infarction
d) Posterior wall infarction
Answer: c) Hyperacute inferior wall infarction
The ECG show ST segment elevation in leads II, III and aVf of about 3mm. ST segment depression is seen in leads I, aVl and V1 to V5. Overall features are suggestive of hyperacute phase of inferior wall myocardial infarction with “reciprocal” ST segment depression in anterior leads. The hyperacute phase is diagnosed when the ST segment is elevated and the T waves are upright in those leads. The segment is upsloping in hyperacute phase as the T waves are upright and sometime a bit tall. ST segment becomes “coved” as the T waves get inverted in the later phase. The “reciprocal” ST depression in anterior leads could be just an electrical phenomenon due to the ST segment elevation in the inferior leads or due to ischemia in the corresponding territory. We will see what exactly was there in this case in the still pictures of left and right coronary angiograms below.
Angiographic pictures can be viewed at: http://cardiophile.org/2008/11/ecg-quiz-22/