In the present study, several electrocardiographic parameters were studied in 48 myocardial infarction (mi) patients with 16 (33.3%), 15 (31.25%), 12 (25%) and 5 (10.42%) cases respectively suffering from anterior, inferior, anterolateral and lateral myocardial infarction, in order to determine the correlation of cardiac axis, q waves, qrs-r voltage, r:s, st-t abnormalities with pertinent infarction site in electrocardiogram. it was found that st-t abnormalities and q waves were important predictors of acute and prior mi in electrocardiogram. strong association between pathological q, loss of r voltage and low qrs voltage was present in prior anterior mi. acute inferior ischemia was manifested by strong association between st segment elevation (ste), st segment depression (std), t inversion (ti), r/s>1 and hyperacute t while in inferior infarction q was correlated with low qrs voltage. acute lateral and anterolateral ischemia was manifested by strong association between ste, std, ti whereas the infarction was characterized by q, low qrs in both along with loss of r voltage in the former. thus, the study showed st elevation as the most important abnormality helpful in predicting acute myocardial ischemia along with the presence of hyperacute t waves. deviation of cardiac axis was not at all related to any of the electrocardiographic lead abnormality in mi. the r ≥0.04 s, r/s ratio in leads v1-v2 with or without positive t waves was of less use in prediction of prior mi. further study needs to be done to determine if the new ecg criteria differ from the old standard criteria through evaluation of the diagnostic performance of the revised criteria on a cohort of patients with symptoms of possible ischemia but a non-diagnostic initial ecg by the older standard criteria.