The tombstone QRS morphology on ECG is most associated with which type of myocardial infarction?

• A. Inferior MI
• B. Lateral MI
• C. Right ventricular MI
• D. Anterior STEMI

Answer: (D)

Tombstone QRS morphology signals a large, transmural infarction where the ST elevations are tall and merge with the QRS, creating a blocky, tombstone-like appearance. This pattern most strongly points to extensive anterior wall involvement from LAD occlusion, which is why it’s classically seen in an anterior STEMI. The leads that reflect the anterior wall (precordial leads V1–V4) show these dramatic ST elevations, signaling a high-risk, full-thickness injury. While inferior, lateral, or right‑ventricular MIs produce ST elevations in their respective leads, tombstoning is most characteristic of an anterior STEMI due to the size and location of the affected area.