September 16, 2015

Something odd in the precordial leads? Posterior Wall MI

Elderly with hypertension and dyslipidemia came in due CP . No nausea and vomiting. Claimed to have been driving for hours. VS were normal BP 140/60.


Coronary angiogram revealed 95% stenosis of LCx and stent was deployed. Echo done reveal normal systolic function with EF in the 60's.

Posterior wall infarct may occur in isolation in about 4% of cases. It may present as ST changes in right precordial leads (V1-3)

-horizontal ST segment depression (seen in this case)
-a tall, upright T wave
-a tall, wide R wave
-R wave amplitude/S wave amplitude ratio greater than 1

Culprit lesion may be RCA, posterior descending branch, or the LCx (in this case).


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