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Posterior myocardial infarction with isolated ST elevations in V8 and V9: Is this an “ST elevation MI”?

Published online by Cambridge University Press:  21 May 2015

Lance Brown ,
Jessica Sims  and
Alessandra Conforto
Lance Brown*
Affiliation:
Emergency Department, Loma Linda University Medical Center, Loma Linda, Calif. Emergency Department, Los Angeles County Medical Center/Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
Jessica Sims
Affiliation:
Emergency Department, Los Angeles County Medical Center/Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
Alessandra Conforto
Affiliation:
Emergency Department, Los Angeles County Medical Center/Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
*
Department of Emergency Medicine A-108, Loma Linda University Medical Center, 11234 Anderson St., Loma Linda CA 92354 USA; 909 558-4344, fax 909 558-0121, LBrownMD@aol.com

Abstract

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We report a case of a 53-year-old man whose first manifestation of coronary artery disease was an acute isolated posterior myocardial infarction (IPMI). Acute IPMI is relatively uncommon and predominantly due to occlusion of the left circumflex coronary artery. IPMI is challenging to diagnose due to the absence of ST segment elevation on a standard 12-lead electrocardiogram (ECG) even in the setting of total coronary artery occlusion and transmural (Q-wave) infarct. We discuss the diagnostic implications of the absence of tall R waves in leads V1 and V2 on this patient’s ECG. The utility of posterior leads (V7 through V9) is demonstrated. The controversy surrounding the use of thrombolytic therapy or primary angioplasty in the setting of acute IPMI without ST segment elevation on a standard 12-lead ECG is reviewed.

Keywords

posterior myocardial infarctionposterior ECG leadsemergency department
Type
Case Report • Observations De Cas
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 2 , March 2003 , pp. 115 - 118
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

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