December 13, 2015

Inferior Wall STEMI

An adult pt with history of hypertension and dyslipidemia was brought in due to chest pain.

The rhythm is sinus, right bundle branch block (RBBB) with ST elevations in III, II and aVF and ST depression in aVL. This is inferior wall ST elevation MI. 

Classic ECG Pattern

  • Greatest magnitude od ST elevation (in descending order) - III, aVF and II
  • Reciprocal ST depresion in aVL

Patients with STE in inferior leads (II, III and aVF) have occlusion in the right coronary artery (RCA) in 80-90%. Occlusion of the left circumflex artery (LCx) can produce similar pattern.

A nice table showing common ECG features distinguishing culprit artery in IWMI.

For the case

CAG showed RCA lesion, EF 50% and inferior hypokinesis on LVgram. Intervention  done.


Alter S et al. 2006. Electrocardiographic Diagnosis of ST-elevation
Myocardial Infarction. Cardiol Clin 24 (2006) 343–365


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