Acute Inferior STEMI with Lateral Ischemia
🏥 Clinical Context
A 54-year-old male presents with 45 minutes of crushing chest pain radiating to the jaw. History of type 2 diabetes and smoking. He is pale, tachypneic, and diaphoretic on arrival. Vitals: BP 96/60, HR 80 bpm, SpO₂ 92% RA.
🔍 Interpretation Steps
✅ Observations:
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ST Elevation in Inferior Leads (II, III, aVF)
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Clear upward deflection at J-point
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Most prominent in III > II, which is classic for inferior STEMI
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Reciprocal ST Depression in Lateral Leads (I, aVL, V5–V6)
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ST segments are subtly but consistently depressed
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Confirms posterior reciprocal changes
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T Wave Inversions in V5–V6
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Seen alongside ST depression
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Sign of ischemia in lateral wall
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Sinus rhythm ~80 bpm
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Normal P waves and QRS morphology
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QRS duration appears normal
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📊 Final Diagnosis
Acute Inferior STEMI with Lateral Ischemia (reciprocal ST depression)
🎓 Teaching Pearl
Reciprocal ST depression in lateral leads confirms the diagnosis of an acute inferior MI and helps localize the ischemia zone more accurately.