ECG Quest > Ischemia > Basic STEMI localisation > Acute Posterior MI

Acute Posterior MI

An acute

Posterior STEMI is caused by acute occlusion of the left anterior descending artery. It features signs of coronary occlusion (ST elevation, Q formation) in the posterior leads (V7-9) along with reciprocal changes in the anterior leads. There may also be inferior or lateral infarction.

Posterior infarction is easily missed. Note that the ST elevation need only be >0.5mm in the posterior leads.

See also: Basic STEMI localisation

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In the ECGquest archives, this ECG has been tagged with: - Concordant ST depression in V1-V3 Excessive discordant ST elevation Atrial pacemaker Ventricular pacemaker Acute Inferior MI Acute Lateral MI Acute Posterior MI Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
Can you see through this paced rhythm?

This ECG is from an elderly woman who presented with 2 hours of chest pain on a background of multiple stents, a pacemaker, stroke and COPD.

This ECG shows paced rhythm with excessively discordant ST segments (modified Sgarbossa positive). The cause was a 95% thrombotic lesion of the RCA.

In the ECGquest archives, this ECG has been tagged with: - Abdominal pain Chest pain Reciprocal ST depression ST elevation in aVL Acute Lateral MI Acute Posterior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
Epigastric pain radiating to the chest for 18 hours. ECG makes the Dx. Troponin makes the Dx. CT makes the Dx!

This ECG is from a middle aged man who presented with 18 hours of epigastric pain radiating to the chest.

This ECG shows ST elevation in aVL with reciprocal ST depression in inferior leads and V3-4, consistent with high lateral MI and posterior involvement.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Anterior ST depression Inferior ST elevation Reciprocal ST depression Acute Inferior MI Acute Posterior MI Right ventricular MI 12-Lead ECG Guru CC-BY-NC-SA
Instructors’ Collection ECG: Inferior Wall M.I. With Atrial Fibrillation or Atrial Flutter

This ECG is from a man in his 70s who presented with chest pain. He had a history of COPD.

This ECG shows massive inferior ST elevation with widespread ST depression. The most likely cause was an acute inferior infarct.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Anterior ST depression Acute Posterior MI 12-Lead Dr Smith's ECG Blog Dr Ken Grauer K. Wang CC BY-NC
How much time are you willing to wait for OMI to become STEMI (if it ever does)?

This ECG is from a man in his 60s who presented with chest pain on a background of stroke and hypertension. This was the initial ECG.

This ECG shows ST depression in V2-5 due to posterior MI.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Anterior ST depression ST elevation in posterior leads V7-9 Acute Posterior MI Posterior leads Dr Smith's ECG Blog Dr Ken Grauer K. Wang CC BY-NC
How much time are you willing to wait for OMI to become STEMI (if it ever does)?

This ECG is from a man in his 60s who presented with chest pain on a background of stroke and hypertension. This was the initial ECG.

This ECG shows ST depression in V2-3 and ST elevation in posterior leads V7-9 (leads labelled V4-6) due to posterior MI.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Regular Anterior ST depression Inferior ST elevation Lateral ST elevation Acute Lateral MI Acute Posterior MI 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer Dr Stephen W. Smith CC BY-NC
Posterolateral OMI resulting in VT, then R-on-T phenomenon and VF – third ECG after electrical cardioversion

This ECG is from a man in his 50s who presented with 1 hour of chest pain and shortness of breath. This was his repeat ECG after electrical cardioversion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Left Axis Deviation Regular Tachycardia Excessive discordant ST depression. Excessive discordant ST elevation R in aVR Wide QRS Ventricular tachycardia Acute Lateral MI Acute Posterior MI 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer Dr Stephen W. Smith CC BY-NC
Posterolateral OMI resulting in VT, then R-on-T phenomenon and VF – repeat after sudden worsening of shortness of breath.

This ECG is from a man in his 50s who presented with 1 hour of chest pain and shortness of breath. This was his second ECG after he suddenly became more short of breath.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Normal Axis Normal rate Anterior ST depression Inferior ST elevation Acute Inferior MI Acute Lateral MI Acute Posterior MI 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 6th August 2018 – Interpretation

This ECG is from a woman in her 70s who presented with 2 hours of central chest pain, on a background of hypertension and hypercholesterolaemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Normal rate Inferior ST elevation Inverted T waves Wide QRS RBBB Acute Inferior MI Acute Posterior MI 12-Lead Dr Smith's ECG Blog CC BY-NC
RBBB and inverted hyperacute T-wave in V3. Do not let negative posterior leads dissuade you!
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