Heart attacks in the form of S T elevation may come with S T Depression Reciprocals. Using the PAIL mnemonic, we could remember the reciprocals associated with each S T elevated M I, and when you often think of somebody with a heart attack, they are often diaphoretic & pale. This is a mnemonic I did not come up with, but it is very useful. PAIL stands for posterior, anterior, inferior leads and high lateral leads. Using the letters in PAIL, the letter of the S T elevated M I will have reciprocals with the letter to the right of that S T elevated M I. For example, anterior S T elevated M I in V 3 and V 4 will have reciprocal S T depressions in the inferior leads of 2, 3 & A V F, because in the word PAIL, I for inferior is to the right of A for anterior, reflected here in the E K G. The next example is an inferior S T elevated M I in 2, 3 & A V F, which will have reciprocal S T depressions in the high lateral leads of 1 & A V L, again because the L in lateral is to the right of I for inferior. Now posterior ST elevated M Is are a bit tricky. The problem with a 12 lead E K G is that the posterior leads are not set up. So the only clue are the anterior and septal leads of V 1 through V 4 that cause S T depressions, which are the reciprocals. So if you see S T depressions in the anterior septal leads of V 1 through V 4. Think of a posterior S T elevated M I. As the letter A sits to the right of the letter P in the word PAIL, so turn the patient over and place leads V 7, V 8 and V 9 underneath the tip of the scapula to try to identify a posterior S T elevated M I. Lastly, you will notice that there is no letter after the letter L in PAIL. In this instance, simply go back to the letter I, because a high lateral ST elevated MI in the lateral leads will yield you reciprocals in the inferior leads of 2, 3 & A V F. And that is essentially it, the PAIL method. A brilliant mnemonic somebody out there has come up with that I can share with you today.
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