This ECG is from a 54 year old woman who presented with chest pain and vomiting. There is ST segment elevation in leads II, III and aVF and depression of the ST segment in leads I and aVL. Note that the ST elevation in lead III is greater than that in lead II and that there is a hint of ST elevation in lead V1 and slight ST segment depression in leads V2 and V3. These ST segment changes are consistent with an acute infarction of the inferior wall and predict an occlusion of the right coronary artery.