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.

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In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Acute Inferior MI Acute Posterior MI Serial ECGs & Dynamic Changes Dr Smith's ECG Blog CC BY-NC
A man in his 70s with chest pain during a bike ride 31934

This ECG is from a man in his 70s who presented with chest pain that started during bike riding.

This ECG shows subtle ST depression in V2-6 and ST elevation in III. He had multi vessel disease with a near-occlusive culprit RCA lesion.

In the ECGquest archives, this ECG has been tagged with: - Hypotension Syncope 12-Lead Sinus arrhythmia Sinus tachycardia High grade AV block Ventriculophasic sinus arrhythmia Acute Inferior MI Acute Posterior MI Right ventricular MI ECG Interpretation CC-BY-NC-SA
ECG Blog #168 (STEMI – complex AV Block – Laddergram – Calipers) 31936

This ECG is from a middle-aged woman who presented with syncope and hypotension.

This ECG shows sinus tachycardia with inferior ST elevation and reciprocal ST depression in aVL. Also ST elevation in V1 and ST depression in V2-4. The most likely cause was acute inferoposterior MI due to proximal RCA occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Inferior ST elevation Wide QRS LPFB RBBB Acute Inferior MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
Teach your learners: when the QRS is wide, the J-point will hide, so trace it down and copy it over! 31813

This ECG is from a middle aged man who presented with chest pain and diaphoresis while exercising. He had a VSD repair at age 6.

This ECG shows sinus tachycardia with RBBB + LPFB. ST elevation in III and aVF with reciprocal ST depression in aVL. ST depression in V2-5. The cause was inferoposterior MI, due to severe triple vessel disease and a culprit 100% circumflex occlusion.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Anterior ST depression Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
A female in her 60s with sudden chest pressure 31276

This ECG is from a female in her 60s who presented with sudden chest tightness, nausea and diaphoresis.

This ECG shows ST depression in V1-3 and ST elevation in V6. The cause was a posterior MI.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Inferior ST elevation Pathological Q waves Acute Inferior MI Acute Posterior MI Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Acute MI, pain onset 24-48 hours ago. Should the patient go for emergent angiogram/PCI? 30678

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).

In the ECGquest archives, this ECG has been tagged with: - 12-Lead 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 Dr Smith's ECG Blog CC BY-NC
Can you see through this paced rhythm? 30424

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 12-Lead Reciprocal ST depression ST elevation in aVL Acute Lateral MI Acute Posterior MI 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! 30216

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 12-Lead Anterior ST depression Inferior ST elevation Reciprocal ST depression Acute Inferior MI Acute Posterior MI Right ventricular MI ECG Guru CC-BY-NC-SA
Instructors’ Collection ECG: Inferior Wall M.I. With Atrial Fibrillation or Atrial Flutter 29691

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 12-Lead Anterior ST depression Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
How much time are you willing to wait for OMI to become STEMI (if it ever does)? 29547

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 Posterior leads Anterior ST depression ST elevation in posterior leads V7-9 Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
How much time are you willing to wait for OMI to become STEMI (if it ever does)? 29735

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 12-Lead Excessive discordant ST depression. Excessive discordant ST elevation Left Axis Deviation R in aVR Regular Tachycardia Wide QRS Ventricular tachycardia Acute Lateral MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
Posterolateral OMI resulting in VT, then R-on-T phenomenon and VF – repeat after sudden worsening of shortness of breath. 27573

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 Dyspnoea 12-Lead Anterior ST depression Inferior ST elevation Lateral ST elevation Regular Acute Lateral MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
Posterolateral OMI resulting in VT, then R-on-T phenomenon and VF – third ECG after electrical cardioversion 27576

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.