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Posterior Myocardial Infarction Posterior Wall MI - Standard EKG (Example) Posterior Wall MI - Posterior EKG (Example) Inferior-Posterior Wall MI (Example 1) Inferior-Posterior Wall MI Right-sided ECG (Example 1) Inferior-Posterior Wall MI (Example 2) Inferior-Posterior Wall MI (Example 3) Inferior-Posterior Wall MI (Example 4) The ECG findings of a posterior wall MI are different than the typical ST elevation seen in other MIs. A posterior wall myocardial infarction occurs when posterior myocardial tissue, usually supplied by the posterior descending artery (a branch of the right coronary artery in 80% of people), dies due to thrombosus in that vessel. This frequently occurs along with an inferior wall MI. The ECG findings of an acute posterior wall MI include: 1) ST segment depression (not elevation) in the septal and anterior precodial leads (V1 to V4). This occurs since these EKG leads will see the MI backwards (since the leads are placed anteriorly, but the MI is posterior). 2) The ratio of the R wave to the S wave in leads V1 or V2 is > 1. 3) ST elevation in the posterior leads of a posterior EKG (leads V7 to V9). Suspicion for a posterior MI must remain high, especially if inferior ST elevation is also present. 4) ST elevation in the inferior leads (II, III, and aVF) may be seen if an inferior MI is also present. |
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