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Associated Leads

LEAD 1

HIGH LATERAL

AVR

High Lateral

V1

SEPTAL

V4

ANTERIOR

LEAD II

INFERIOR

AVL

HIGH LATERAL

V2

SEPTAL

V5

LOW LATERAL

LEAD III

INFERIOR

AVF

INFERIOR

V3

ANTERIOR

V6

LOW LATERAL

ECG criteria for STEMI

≥ 1mm ST segment elevation in at least two limb leads (I-AVL / II-III-AVF)

≥ 2mm ST segment elevation in two or more contiguous precordial leads (V1-V6)

≥ 2mm ST segment elevation in V2 & V3 is contiguous if not enough elevation in V1or V4

P-A-I-L-S for Reciprocal Changes

Remember the PAILS mnemonic when assessing for reciprocal changes. PAILS stands for:

P - posterior

- anterior

- inferior

- lateral

- septal

ST elevations in these leads most commonly create reciprocal ST depressions in the corresponding leads of the next letter in the mnemonic. That is to say, posterior ST elevation will usually cause anterior lead ST depressions and anterior lead ST elevations will usually be seen with inferior lead depressions.

Contact

Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5

416-327-7900

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