The ECG in the figure below:
is suggestive of:
Anteroseptal Infarction of uncertain age. This electrocardiogram has a sinus rhythm. There are lateral T-wave changes that are not specific, and there are QS waves in leads V1 through V3 . This is an anteroseptal infarction of uncertain age.
ECG shows:
Left Anterior Fascicular Block. Here, there is a normal sinus rhythm and marked left axis deviation. There are small Q waves in leads I and aVL with a slight activation delay in aVL. This is anterior hemiblock. Anterior hemiblock produces small Q waves in the right precordial leads. The QRS pattern seen in V2 is often very suggestive of anteroseptal infarction, but the specificity is much less in the presence of anterior fascicular block.
ST- and/or T-wave changes suggesting myocardial injury. In this patient, there are symmetric, prominent T waves that are upright. These are seen in the inferolateral leads and are associated with ST depression in leads V1 , V2 , and V3 . There are no Q waves so this is not an acute infarct, but it is an acute current of injury. The rhythm is sinus.
Inferoposterior and Lateral Infarction. On this electrocardiogram, there is a sinus rhythm. It is slow so sinus bradycardia. There are significant inferior Q waves and also Q waves in leads V5 and V6 . There is also a prominent R-wave vector in lead V1 , and the T waves are upright despite the presence of a right bundle branch block (complete). Usually with a right bundle branch block, ST-segment and Twave inversion are expected. In this case, the upright T wave is an example of a “primary” T wave. A prominent initial vector and upright T wave in V1 , associated with inferior and lateral Q waves, are interpreted as an inferoposterior and lateral infarct.
Posterior Infarction. This electrocardiogram has a sinus rhythm. There is a prominent initial vector in lead V1 that is greater than the S wave. T wave is upright. This is compatible with posterior infarct. That is supported by the presence of pathologic Q waves in leads III and aVF.
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