De Winter et al reported findings in the ECG associated with occlusion of the proximal left anterior descending (LAD) coronary artery. This can be helpful to identify an important lesion in a patient with a myocardial infarction. The authors are from the Academic Medical Center in Amsterdam and the Cardiovascular Research Institute at Maastricht in the Netherlands.


Patient selection: acute myocardial infarction


Changes seen in the 12-lead ECG:

(1) persistent changes in the ST portion of the precordial leads (V1 to V6)

(1a) 1 to 3 mm up-sloping ST-segment depression at the J-point

(1b) tall, positive, symmetrical peaking of the T waves

(1c) absence of ST segment elevation

(2) often slight ST-segment elevation (1 or 2 mm) in the aVR


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