Acute anterior ischemia in the setting of remote anterior (and inferior) MI

Interpretation by Matthew Schumaecker
EKG recorded and edited by Dr. M. Rosengarten, MUHC, 1997

This tracing shows sinus tachycardia at 112/minute. The PR interval is 140 ms. Right atrial enlargement is suggested by the tall P waves in lead II and left artrial abnormality by the negative P wave deflection in V1. There is a slight rSR' morphology in V1 and V2 but no deep S waves in I or V6. This could indicate the presence of a partial right bundle branch block.

Narrow but large Q waves are present without ST segment deviation in leads II, III and aVF suggesting an old inferior infarction. The deep QS wave in V3 suggest an anterior infaction. The peaked T waves in V3-V6 suggest the presence of acute anterior ischemia.
Q waves usually evolve later in a Q wave infarction. Here, the Q waves and peaked T waves coexist. An explanation for this is that the Q waves represent an old or remote infarction while the peaked T waves represent an active ischemic process, or that the Q waves have appeared more radily than expected.