Coronary artery disease affects more than 18 million people in the United States and continues to be the most common cause of death for men and women; it is responsible for more than 365000 deaths annually.1  Frequently, the onset of chest pain is what drives patients to seek medical care. The chest pain patients experience can be a diagnostic challenge. The 12-lead electrocardiogram (ECG) is at the center of decision-making to distinguish among myocardial ischemia (unstable angina), non–ST-segment myocardial infarction (NSTEMI), and ST-segment myocardial infarction (STEMI). These 3 cardiac events fall into a category called acute coronary syndromes, a spectrum of pathophysiological substrates producing myocardial ischemia, injury, and infarction; the category also includes a framework for interventions. The purpose of this column is to review the indicative and reciprocal ECG changes associated with STEMI and provide a review of the location of the common infarctions and the ECG leads...

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