The ECG is a two dimensional representation of a three dimensional structure ie., the heart. An inferior STEMI may affect the projection of the ST vectors such that a STEMI may present as a NSTEMI on ECG by not showing STE in two contiguous leads.
This new ecg pattern is responsible for a right coronary artery or circumflex artery occlusion, however without STE in two contiguous leads, in the classic sense.
The Study
Aslanger E et al. A new electrocardiographic pattern indicating inferior myocardial infarction. J of Electroc. 61 (2020) 41-46.
What They Did
The hypothesis was that: In an inferior MI the ST-vector shifts to be more rightward than usual, projects to the negative pole of lead II, but still points to the positive pole of lead III. The ecg would then show:
