Paramedics attend a 63year old presenting with ACS and strongly suspect a myocardial infarction. The 12 lead ECG shows:

Question

BlackTom AI · Accepted Answer

ST-segment elevation localized to the inferior leads (II, III and aVF) is the hallmark finding for an inferior ST-elevation myocardial infarction (STEMI). Inferior STEMI is most commonly due to acute occlusion of the right coronary artery (RCA) or sometimes the dominant left circumflex artery, and characteristically produces ST-elevation in those three inferior leads with reciprocal ST-segment depression in high lateral leads (I and aVL).

Step-by-step reasoning:
1. Identify the leads with primary ST changes: the ECG shows ST elevation in leads II, III and aVF. These leads view the inferior wall of the left ventricle.
2. Recognize the pattern: simultaneous ST-elevation in II, III and aVF confirms inferior ischemia/infarction. If ST elevation in lead III is greater than in lead II, that further suggests RCA involvement.
3. Look for reciprocal changes: ST depression in leads I and aVL is commonly present and supports the diagnosis of an inferior STEMI.
4. Exclude other patterns:
   - Anterior STEMI would show ST elevation in precordial leads V1–V4 (anterior leads), not isolated ST elevation in II, III, aVF.
   - Posterior STEMI often presents as ST depression in V1–V3 (mirror image of posterior ST elevation) with tall R waves and upright T waves in those leads; it does not primarily produce ST-elevation in II, III, aVF.
   - Right bundle branch block (RBBB) is defined by a widened QRS (>120 ms) with an rSR' pattern in V1–V3 and secondary repolarization changes; it does not present as isolated ST-elevation in the inferior leads.

Why the correct answer is correct: The pattern of ST-elevation localized to the inferior leads (II, III, aVF) with reciprocal changes matches the classic ECG presentation of an inferior STEMI. Other options describe different lead distributions or conduction abnormalities that are not consistent with these inferior-lead ST-elevations.

Conclusion: The ECG represents an Inferior STEMI, which matches the provided correct answer.

Paramedics attend a 63year old presenting with ACS and strongly suspect a myocardial infarction. The 12 lead ECG shows: Single choice

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