Usually tall and peaked T waves ( hyperacute T waves ) precedes onset of ST elevation.

      This finding alone is especially observed in the first 30 minutes of the infarction.

      However, not all patients are lucky enough to arrive the hospital so early.




ECG 1a. This ECG was recorded from a patient complaining of chest pain in the emergency room. There are
tall and peaked T
waves (hyperacute T)
and artifact in most leads. When sinus beat is delayed for 60 miliseconds, an atrial escape beat (ectopic
atrial beat)
arose. The shape of its P wave is different from those of the previous sinus beats.

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ECG 1b. This ECG belongs to the same patient and was recorded in the coronary care unit. It clearly shows acute anteroseptal
myocardial infarction. At this moment,
upwardly convex ST segment elevation accompanies the tall and peaked T waves
in leads V2-V4. Similar ST segment elevation is also observed in lead V1. The severe chest pain of myocardial infarction
resulted in sympathetic activation, which in turn resulted in sinus tachycardia.

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ECG 2a. This patient complained of typical retrosternal chest pain and he was diagnosed as acute inferior wall myocardial
infarction because of the
ST segment elevation in the inferior leads. There is also reciprocal ST segment depression in
leads I, aVL, C2 and C3.

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ECG 2b. The same patient's ECG recorded in the first minutes of thrombolytic therapy shows that
ST segment elevation in
inferior leads and
reciprocal ST depression in leads I, aVL and C2 have increased.

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ECG 2c. This is a right-sided ECG from the same patient. The
ST segment elevation in leads V4R, V5R and V6R show right
ventricular infarction. At the time of initial presentation, all patients with acute inferior wall myocardial infarction should have
right-sided ECG to rule out possible accompanying right ventricular infarction. Nitroglycerine should be avoided in patients
with right ventricular infarction.

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ECG 3a.
ST segment elevation in leads II, III and aVF is observed in a patient complaining of chest pain for the last one hour:
acute inferior wall myocardial infarction. In addition,
reciprocal ST segment depression is seen in lead aVL.

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ECG 3b. One month later, his ECG shows
o l d inferior myocardial infarction: negative T waves and qs complex in D2, D3 and
aVF.
Absence of ST elevation shows that there is no acute ischemia.

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ECG 4. In patients with low voltage and acute myocardial infarction, it may be difficult to recognize the
ST segment elevation
at first glance.

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