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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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.
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.
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).