Which ECG leads reflect an anterior wall infarction?

• A. V1 and V2
• B. II, III, aVF
• C. V3 and V4
• D. V5 and V6

Answer: (C)

Anterior wall involvement shows up on the ECG most clearly in the chest leads that look directly at the front surface of the left ventricle. The leads V3 and V4 are the most representative for this area, often with V2 also showing changes. This pattern occurs because these precordial leads are positioned over the anterior wall and detect transmural ischemia there, typically from a left anterior descending artery occlusion.

The other lead patterns point to different territories: the inferior leads pick up an inferior-wall infarction, while the lateral leads reflect the lateral wall. The septal/anteroseptal region is best seen in the more anterior chest leads like V1 and V2.