Evolved anterior wall myocardial infarction


ECG shows sinus rhythm at a rate of around 100/min, with QS complexes in anterior leads along with a coved ST segment elevation and T wave inversion, suggesting evolved anterior wall myocardial infarction (AWMI). The coved or convex upwards ST segment elevation in acute myocardial infarction has been called as Pardee’s sign [1]. P waves in V1 are prominently negative and indicates possible left atrial overload (also known as left atrial abnormality). QRS axis normal, indicating the absence of any hemiblock. Maximum ST segment elevation is seen in V2, which is usual with anterior wall myocardial infarction.

ST segment elevation in anterior leads can also occur in right ventricular infarction, in which case the ST segment elevation is likely to be more in V1 than in V2. In that case the QS complexes in V2 and V3 will not be there. Further confirmation can be obtained by recording right sided chest leads V3R and V4R which also will show ST segment elevation in right ventricular infarction. Moreover, right ventricular infarction is associated with inferior wall infarction and not anterior wall infarction.


1. Pardee HEB. An electrocardiographic sign of coronary artery obstruction. Arch Intern Med 1920; 26: 244-257.