ECG of the Week 36 This ECG Dx should be immediately obvious to you. 2 questions? Does it involve the RV? Are there reciprocal changes? Show me the answer! It DOES involve the RV because the STE is greater in III than II AND there is STD in lead I (RCA occlusion). The STD in AVL is the only reciprocal change for an IMI. Anterior reciprocal changes only occur in the presence of posterior involvement. Related posts: ECG of the Week 34 ECG of the week 40 ECG of the week 28 ECG of the week 27 Share your thoughts Cancel replyYou must be logged in to post a comment. Alternatively, you can respond on Twitter or via the Share button above, with a link to this post.