Location of Ischemia or Infarction.
The ECG can be used to localize the MI, and sometimes, even predict the infarcted artery.
MI Localization by Ed Burns of Life in the Fast Lane. See here.
Check out this schematic at LITFL. It breaks down MI localization according to three arteries.
- LAD type lesions ±
- LCx type lesions ±
- RCA type lesions ±
| Anatomic location of MI or ACS | ECG leads with STE | Coronary Artery |
| Septal | V1-V2 | LAD occlusion (i.e. proximal LAD) |
| Anterior | V3-V4 | LAD occlusion |
| Apical | V5-V6 | |
| Lateral MI | I, aVL, V5-V6 | |
| Inferior MI | II, III, aVF | RCA (85%), LCx (15%) |
| R. Ventricle | V1-V2 and V4R (most sensitive) | RCA (Proximal RCA) |
| Posterior MI | ST depression in V1-V3 (reciprocal STE). STE in the posterior leads (V7-V9) if present. |
RCA or LCX |
**Even though leads V1 and V2 are placed over the R. side of the heart, they are more sensitive to the septal depolarization because the septal depolarization vector is directed to the right, in the direction of V1 and V2. In other words, the anatomic location of V1-V2 is over the right side of the heart, however, they function as septal leads.
| Anatomic location of MI or ACS | ECG leads with STE | Coronary Artery |
| Anteroseptal | V1-V2, and V3-V4 | |
| Anterolateral | V3-V4 and V5-V6, I, aVL | |
| Inferiolateral | II, II, aVF, I, aVL, V5-V6, ±V4R | |
Check out this link: https://www.uptodate.com/contents/electrocardiogram-in-the-diagnosis-of-myocardial-ischemia-and-infarction
Check out
References
Ed Burns, https://lifeinthefastlane.com/wp-content/uploads/2011/07/ECG-Anatomy-LITFL.jpg