ECGS
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 1. Typical example of an IMI. Note the Q-waves, the notched R-waves and negative T-waves in the inferior leads.		   Click to Enlarge
 2. Not all IMIs present with classical Q-waves. Many have atypical patterns associated with infarction. In this example of a large IMI, note the narrow Q-waves, reduced R-waves, and large S-waves in the inferior leads.
 
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 3. PMIs frequently occur without the classical tall, broad R-waves in V1 and V2. Often there is a reduction of >50% in the R-wave between leads V4 and V6 with S-wave reduction and prominent notching in the anterior chest leads. In addition, the amplitude of the T-waves in the anterior chest leads may be increased and appear atypically symmetrical.		   Click to Enlarge
 4. This represents a common ECG pattern recorded in a patient with an anteroapical MI. Note that although there are no anterior Q-waves, the precordial R-wave progression is poor and more importantly, the R-waves are notched or blunted and the T-waves may be inverted or flat.
 
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 5. An ECG from a patient with opposing inferior and anterolateral (superior) MIs. Note that although no Q-waves are present, there are complex QRS waveforms referred to as M and W complexes in both the inferior and anterolateral leads which are diagnostically equivalent to opposing Q-waves.		   Click to Enlarge
6. This ECG is from a patient with opposing anterior and posterior infarcts. Note the absence of initial r-waves V1-V3 due to the ASMI. The PMI results in the reduced amplitude with prominent notchings of S-wave in V2 and the reduced S-wave and small terminal r-wave in V1.
 
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 7. ECGs in patients with ischemic cardiomyopathy demonstrate an unusual repetition of this complex pattern characterized by prolonged QRS of the LV delay type, increased QRS voltage, tall narrow anterior R-waves, marked QRS notching, slurring and axis shifts.		   Click to Enlarge
 8. An ECG from a patient with left bundle branch block and an old IMI. Note the marked notching of the mid-QRS which reflects the time and location of the wavefront as it passes by the irregular border zone in the surviving subepicardium overlying the infarct.