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ECG library

Lateral STEMI

core

A 61-year-old smoker with an hour of crushing chest pain radiating to the left arm.

25 mm/s · 10 mm/mV · synthetic tracing
100%
IIIIIIaVRaVLaVFV1V2V3V4V5V6
II (rhythm)
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.

Key findings

  • STE in I, aVL, V5-V6
  • Reciprocal depression in III and aVF

Learning points

  • Lateral infarcts can be electrically quiet; aVL is the lead most often overlooked.
  • Reciprocal change is the strongest single confirmation that elevation is ischemic.

Connected