An inferior STEMI with III elevated more than II, ST elevation in V1, and ST elevation in the right-sided lead V4R.
A proximal right coronary occlusion that takes out the right ventricle along with the inferior wall (40% of inferior STEMIs). What makes you suspect it: III elevated more than II, and ST elevation in V1 (highly specific when V2 is depressed). ST elevation in the right-sided leads V3R-V6R confirms it. V4R goes in the 5th right intercostal space, midclavicular line. These patients depend on preload, which is why nitrates can drop the pressure sharply.
Each is a standard 12-lead: 2.5 seconds of each lead in four columns, with 10 seconds of lead II along the bottom, drawn to scale (25 mm a second, 10 mm a millivolt). The measurements are under each one.
ST elevation in II, III and aVF, with reciprocal ST depression in aVL.
Horizontal ST depression in V1-V3 with tall R waves and upright T waves, and ST elevation in the posterior leads V7-V9.
ST elevation across V1-V4, from an occluded left anterior descending artery.
The ECG tool in the app gives you a new 12-lead every time and walks you through reading it: rate, QRS, axis, then where the ST is up and down. It's part of the Paramedic level, and you can try 5 ECGs a day free.
Try the 12-lead drill
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