Leads II, III and aVF show inferior wall.

  Observation of q or Q waves suggest a diagnosis of OLD inferior wall myocardial infarction (MI).

  Absence of ST segment elevation in inferior leads also contribute to the diagnosis of OLD inferior MI.

      However, the reverse is not true. ST segment elevation may be seen in ACUTE MI as well as in

      OLD myocardial infarctions with left ventricular aneurysms.

  In patients undergoing early coronary recanalization, the development of q or Q waves may not be

      observed. In such cases, observation of symmetrical negative T waves in leads II, III and aVF may

      suggest the diagnosis of OLD MI.

  Unlike old anterior MI, the ECG findings in patients with OLD Inferior MI may fade out in the following

      years. This is especially true for the patients who have been intervened very early.





ECG 1. The ECG above belongs to a 67 years old man who had underwent coronary bypass greft operation after inferior wall
myocardial infarction. The ECG was recorded when the patient was asymptomatic. Observation of
Q waves in leads II, III and
aVF show OLD inferior wall myocadial infarction.
Positive T waves in inferior leads also support the diagnosis of OLD inferior
wall myocardial infarction.

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ECG 2a. This ECG belongs to a 52 years old man who had undergone stenting of the right coronary artery for the treatment of
acute inferior wall myocardial infarction 1 year ago. The ECG above was recorded during a routine control and the patient
was asymptomatic. There are
Q waves and negative T waves in the inferior leads. Lacking ST elevation and typical chest pain,
these ECG findings suggest OLD inferior wall myocardial infarction. The patient also has dextrocardia. Because of
dextrocardia,
QRS complex and T wave are upright in lead aVR while they are negative in lead I . This finding is not due to
arm lead reversal since there is no expected R wave progression in the chest leads. Contrarily, the
amplitude of the R wave
decreases from C1 to C6.

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ECG 2b. The above ECG belongs to the same patient but was recorded after the electrodes were symmetrically placed on the
right chest. The ECG now shows proper
R wave progression . Old inferior myocardial infarction and abnormal appearance in
lead aVR persists.

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ECG 3. This patient had inferior mycoardial infarction 10 years ago. Leads III and aVF show
Qr pattern while lead II shows
qr pattern
.

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ECG 4.
Q waves in leads II, III and aVF show old inferior wall myocardial infarction.

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ECG 5.
Q waves and negative T waves in leads II, III and aVF show old inferior wall myocardial infarction. This patient had
experienced acute inferior wall myocardial infarction 4 weeeks ago.

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ECG 6. The ECG above, belongs to a man who had acute inferior wall myocardial infarction one month ago. A stent was
implanted to his right coronary artery within the first hour of the infarction. Because of the early revascularization,
Q waves
are not formed in inferior leads
. The only evidence of an old inferior wall myocardial infarction in this patient is
symmetrical negative T waves in leads II, III and aVF
.

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ECG 7. The above ECG belongs to a 29 years old man who experienced acute inferior wall myocardial infarction 4 weeks ago.
The patient received thrombolytic therapy in the first hour of the infarction. Early recanalization prevented development of
Q waves in inferior leads. Only the negative T waves in leads III and aVF can be the evidence of an OLD inferior myocardial
infarction. Leads III and aVF have rS complex. After the initial medical therapy, the patient underwent coronary
angiography and a stent was implanted to the proximal right coronary artery. The other coronary arteries of this man were
normal.

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ECG 8. The ECG above was recorded before the 63 years-old male patient underwent coronary artery bypass graft operation.
He previously had acute inferior myocardial infarction. RBBB does not mask the diagnosis of old inferior myocardial infarction.

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ECG 9. The ECG above belongs to a 59 years-old man who previously had acute inferior wall myocardial infarction.
RBBB does not mask the diagnosis of old inferior myocardial infarction.

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ECG 10. The ECG above belongs to an 85 years-old man who had acute inferior wall myocardial infarction in the past.
The ECG shows RBBB and APC. The PR interval i,s at the upper limit of normal.
RBBB does not mask the diagnosis of old inferior wall myocardial infarction.

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