Electrocardiogram of a 48-year old woman who develped severe retrosternal chest heaviness with diaphoresis, dyspnea and nausea after a bowling game.

Rate 74/min
PR 0.16s
QRS 0.08s
QT 0.37s
QTc 0.41s
QRS axis 65º

Interpretation: Regular sinus rhythm. Borderline left atrial abnormality. Hyperacute ST segment elevation (Pardee wave) in the inferior leads II, III, aVF reperesenting current of injury and reciprocal ST segment depression in leads aVL, V1 - V4.

Reciprocal ST segment depression in the anterior precordial leads in patients with acute inferior MI has been explained by several possible mechanisms:

• subendocardial ischemia or infarction of the anterior wall, "ischemia at a distance" suggesting significant stenosis of the left anterior descending coronary artery.
• "true" posterior infarction, ST segment depression in V1, V2 representing "mirror image" of ST segment elevation with R wave of 0.04 s, and R/S ratio greater than 1 on serial cardiograms.
• true reciprocal electrical phenomenon.

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