The first changes with MI is that the T waves are elevated in the leads looking at the infarcting area. The ST segment then moves the same way - 1/10th of a mV, except 2/10th in leads V1-3.
If there is severe ischaemia then the Purkinje fibres become ischaemic and so you see loss of the S wave praecordially.
The important thing to know about ST elevation is that you will always see it in leads V2 and V3 - so, the way you distinguish abnormal from normal is because in early repolarization you will see a short ST segment (meaning that the T wave takes off almost from the J point!).
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