NORCET-11 Mains
Medical & Surgical Nursing
Medium
A 42-year-old client presents with acute chest pain. Which type of myocardial infarction is shown on the ECG? 
Appeared in: NORCET-11 Mains
Explanation
- The ECG shows ST-segment elevation in leads II, III, and aVF.
- These leads (II, III, aVF) directly view the inferior wall of the left ventricle.
- ST-segment elevation in this specific grouping is the hallmark of an acute injury to the inferior myocardial wall.
- The presence of reciprocal ST depression in leads I and aVL confirms the diagnosis of an inferior MI.
Why Other Options Were Wrong
- Option A: An anterior wall MI would present with ST-segment elevation in the precordial leads, specifically V1 through V4. The provided ECG does not show these changes.
- Option B: A lateral wall MI would show ST-segment elevation in the lateral leads (I, aVL, V5, V6). In this ECG, leads I and aVL actually show ST depression, which are reciprocal changes to the inferior injury.
- Option D: A posterior wall MI is typically identified by indirect (reciprocal) changes in the anterior leads (V1-V3), such as ST depression and tall R waves. While some ST depression might be present, the primary and most obvious finding is the ST elevation in the inferior leads.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain ECG Interpretation for Myocardial Infarction Localization as background academic context rather than a clinical decision trigger.
- Rapid identification of the MI location is critical for predicting potential complications. Inferior MIs are often associated with bradycardia and heart blocks because the Right Coronary Artery (RCA), which is usually the culprit, also supplies the SA and AV nodes.
- Nurses must be prepared to manage hypotension and bradycardia in patients with inferior MI. Atropine and temporary pacing may be required.
- It is crucial to obtain a right-sided ECG (e.g., lead V4R) in patients with inferior MI to assess for right ventricular involvement, as this significantly impacts treatment (e.g., nitrates should be used with extreme caution or avoided).
How to Approach the Question
- First, identify that the question requires interpretation of a 12-lead ECG to locate a myocardial infarction.
- Systematically scan all 12 leads, looking for the most significant abnormality. The key finding in an acute MI is ST-segment elevation.
- Observe that there is clear ST-segment elevation in leads II, III, and aVF.
- Recall or reference the standard ECG lead groupings. Leads II, III, and aVF correspond to the inferior wall of the heart.
- Look for reciprocal changes to confirm the finding. ST depression in leads I and aVL is the expected reciprocal pattern for an inferior MI.
- Based on the ST elevation in the inferior leads, conclude that the patient is having an inferior wall myocardial infarction and select the corresponding option.
Concept Tested & Keywords
- Concept Tested: ECG Interpretation for Myocardial Infarction Localization
- Stem keywords: ECG, acute chest pain, myocardial infarction
- Lead-in keywords: Which type
- Clinical cues: The presence of ST-segment elevation in leads II, III, and aVF is the key diagnostic finding.
Question ID
QBhNscmXR00ONQ-_lfIX7i
Reference Book
E6 Medicine Harrison 22e Part 1 pp. 1913-1915, 1914-1916
Practise the full NORCET-11 Mains
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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