a)    Describe the abnormalities.    (15% marks)
b)    List the potential complications of this condition.    (15% marks)

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College Answer

a)

  • ST elevation in leads II, III and aVF Q waves II, III and aVF
  • Reciprocal ST depression in aVL, V5-6
  • Consistent with inferior STEMI

b)

  • Bradycardia and heart block (2nd and 3rd degree)
  • Posterior infarction
  • Right ventricular infarction

Discussion

The image of the inferior STEMI above was acquired illegally, from some unknown source, via Google.

localisation of coronary artery territories

ST elevation in leads II, III and aVF and depression in aVL and V5-6 corresponds to a RCA or LCx territory "inferior infarct". One ought to expect some involvement of the nodes. Specifically, the sinoatrial node (RCA) and the AV node (LCx) should be affected.

In general, the best references for this come from Edward Burns, via LITFL. Specifically, his entry on inferior STEMI is superb. There is no way one could improve on it, even for an author in the habit of duplicating LITFL's efforts.