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Recognizing an old MI on an ECG is vital for risk stratification. It alerts the healthcare team that the patient has established coronary artery disease and may have a reduced ejection fraction. This finding often triggers further investigation, such as an echocardiogram to assess wall motion or a stress test to check for remaining viable muscle at risk.
Left Bundle Branch Block (LBBB): Can create deep QS complexes in the right precordial leads that look like an anterior MI. old myocardial infarction ecg
: T-waves may remain inverted or become upright and "flattened" over time.
The hallmark of an OMI on ECG is the presence of . ❌ Recognizing an old MI on an ECG
old inferior myocardial infarction - electrocardiography (ecg)
| Infarct location | Leads with pathologic Q waves | Coronary artery | Typical Q-wave morphology | |---|---|---|---| | | V2–V4 (may extend to V1–V5) | LAD | Loss of R wave progression; QR or QS in V2–V4 | | Inferior | II, III, aVF | RCA (80%) or LCx | Q ≥40 ms, often >1/3 of R in III, aVF | | Lateral | I, aVL, V5–V6 | LCx or diagonal | Narrow but deep Q; often subtle | | Posterior (old) | Tall R wave in V1–V2 (mirror of posterior Q) | RCA or LCx | R/S ratio >1 in V1-V2 with upright T wave (mirror test) | | Septal | V1–V2 | Septal perforators (LAD) | QS or QR; loss of small septal R | Left Bundle Branch Block (LBBB): Can create deep
Wolff-Parkinson-White (WPW) Syndrome: Delta waves can sometimes resemble pathologic Q waves (pseudo-infarction pattern).
: In anterior MIs, you may see a "poor R-wave progression" across precordial leads V1 through V6 . Clinical Context and Risk
The fundamental sign is in anatomically contiguous leads, without acute ST elevation.