>>13897361So in the first one you have a developing inferior OMI that requires urgent reperfusion:
There is 1st degree AV block, PR interval ~200ms
Q waves in lead III are pathological and extend into adjacent inferior leads, predominantly aVF
T waves in II, III and aVF are hyperacute in nature, with reduction in preceding QRS amplitude
T-wave inversion in aVL is abnormal here, as there is a widened QRS-T wave axis
Flattened ST segment in V2 is abnormal and concerning for “posterior” extension of infarct territory with right ventricular (RV) involvement
ST depression extends to V4-6 which may be reciprocal change to evolving inferior infarction, or due to diffuse subendocardial ischaemia in the context of undiagnosed triple vessel disease. However, it is unclear at this stage where the maximum ST depression will be when the full-blown ST vector becomes apparent.
And in the second one the patient has an evolved inferior STEMI.
Marked ST elevation in III and aVF, and reciprocal ST depression in aVL
ST elevation in III > II, and ST depression in V2 relative to V1, suggests RV infarction as earlier suspected
Earlier seen 1st degree AV block has now progressed to type I 2nd degree AV block — note there is a 3-beat grouping sequence, with gradual prolongation of the PR interval within these sequences. Non-conducted P waves are buried in the preceding T wave
As previously mentioned this patient suffered a VF arrest shortly after the above ECG was taken. CPR was commenced with subsequent ROSC. He was taken to the cath lab where a 100% mid-level right coronary artery occlusion was found, as well as severe triple vessel disease.
