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When we see widespread changes that cross "anatomical boundaries" (such as both anterior and inferior injury), we should be suspicious of an alternate explanation like pericarditis. With that said, can occlusion to one artery cause injury elsewhere? Definitely.

If we took right-sided heart leads, I wouldn't be surprised to see injury there too - and, as MSDelta alluded to, possibly posterior injury too if we looked there. Some people call this style of infarct an "apical MI." But with a fairly dominant RCA (that is, one that perfuses a relatively large area of the myocardium), it's not unusual for its influence to push up into the low lateral area of V5 and V6. The circumflex is usually associated with the high lateral wall, a la lead I (normal here) and aVL. The RCA/inferior/RVI patients will tend to have problems with hypotension and be preload dependent. Remeber also that the distal RCA provides 100% of the perfusion to the posterior leaflet of the mitral valve, and if THAT infarcts, your patient is in a world of hurt and will develop critical mitral regurg, pump failure, and will need a mitral valve replacement. If an inferior MI is caused by an LAD lesion, you will be more likely to have lateral and possibly even anterior or septal walls be contiguous, and have the issues that accompany them, vs the RCA lesion which causes the inferior wall MI, which then often involves the right ventricle and the posterior wall. Either one can cause a STEMI in the inferior wall, but with different consequenses. Some people have a dominant LAD, while others have a dominant RCA. Remember also that vascular anatomy is specific to the patient. Obvious inferior infarct but which of the other leads would have been most reliable as a reciprocal lead? Call for 55 y.o male with chest pains:ĮCG read ACUTE MI SUSPECTED, marked sinus brady with 1st degree AVB. It's funny I asked this question and 2 hours later I am on a call that pertains to it, running as an EMT-I preceptor. What might help you is to look at a vascular model of the heart to learn where an occlusion might occur and then picture how your leads look at that part of the heart. In my system I can't call a stemi alert based on depression alone, i have to have the elevation. Mine is ST elevation greater than 1mm in two contiguous leads, cardiac symptoms, QRS less than 0.120, and the computer has to read ***Acute MI***. In answer to your second question: it depends on what your STEMI protocol says. (there are people here who can give you a clearer description) You won't see depression in V1 or V2 though because it is a different part of the heart and not opposite of the infarct. A classic example is your inferior MI (elevation in II, III, AvF) which causes changes in Avl and some of the other lateral leads. In real life if the infarct is bad enough you will see reciprocal changes. Lots of damage causing destruction, but because of the balloon model the opposite side is also effected (in this case ST depression). The side that is being pushed in is where the active MI is occurring (ST elevation). If I push one side of the balloon in, the opposite side of the balloon pushes out. In answer to your question, yeah recip changes will be seen in the same leads every time.