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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This ECG is from a man in his 60s who presented with chest pain for 48h with diaphoresis.
This ECG shows inferior ST elevation with reciprocal depression in aVL and I. ST depression in V2-4. Deep Q waves inferior leads and tall R waves V1-3. The cause was a completed infarction with 2 likely culprits (RCA and circumflex).