Table of Contents
Sample ECG Images: STEMI vs. LVH
This page provides real, web-accessible ECG examples illustrating the differences between ST-elevation myocardial infarction (STEMI) and left ventricular hypertrophy (LVH). All images come from Wikimedia Commons and are freely available for educational use.
Use these ECGs to compare:
- ST-segment elevation patterns
- ST/T ratio differences
- Voltage criteria for LVH
- Repolarization abnormalities
- Distribution across contiguous leads
Anterior STEMI
This ECG shows classic acute anterior STEMI with marked ST elevation in leads V2–V4.
Key features:
- Convex (“tombstone”) ST elevation
- Hyperacute T waves
- Reciprocal ST depression in inferior leads (II, III, aVF)
- Localized to anterior wall (LAD territory)
Inferior STEMI
Example of inferior STEMI with ST elevation in leads II, III, and aVF.
Key features:
- ST elevation in II, III, aVF
- Reciprocal ST depression in I, aVL
- Possible right ventricular involvement (consider V4R)
Posterior MI (Reciprocal Pattern)
Posterior MI often presents as ST depression in V1–V3 with tall R waves—reciprocal of posterior ST elevation.
Key features:
- ST depression V1–V3
- Tall R waves (mirror image of Q waves)
- Upright T waves in anterior leads
LVH With Strain Pattern
Classic left ventricular hypertrophy using Sokolow-Lyon and Cornell voltage criteria, with secondary ST-T abnormalities.
Image to be added
Key features:
- Very high-voltage QRS complexes
- ST depression in lateral leads (I, aVL, V5, V6)
- T-wave inversion (“LVH strain”)
- Possible mild ST elevation in V1–V3 that mimics STEMI
LVH Mimicking STEMI (False STEMI Activation)
Example where LVH leads to ST elevation, especially in V1–V3, resembling anterior STEMI.
Image to be added
Key features:
- ST elevation but proportionate to QRS amplitude
- No reciprocal ST depression
- Distribution inconsistent with coronary territory
- ST/S ratio < 25% (supports LVH, not STEMI)
STEMI vs. LVH: Side-by-Side Comparison
| Feature | STEMI Example | LVH Example |
|---|---|---|
| ST elevation | Disproportionate, convex, contiguous leads | Mild, concave, proportionate to QRS voltage |
| Reciprocal changes | Common (supportive of occlusion) | Rare |
| QRS voltage | Usually normal | Very high voltage |
| T waves | Hyperacute near infarct location | Inverted in lateral leads (strain pattern) |
| ST/S ratio | > 25% suggests STEMI | < 25% suggests LVH |
| Distribution | Coronary territory (anterior, inferior, lateral, etc.) | Not confined to coronary pattern |
How to Use These Images for Teaching
- Compare ST elevation morphology across leads
- Evaluate the proportionality rule (ST/S ratio)
- Identify LVH strain pattern
- Teach recognition of reciprocal changes
- Incorporate into quizzes or image-based modules
- Use as reference images in The ECG Quiz training system