Emergency Cases Northwest Group

046 Posterior Problem

Situation

Patient had a posterior STEMI.

Background

A 66 year old man had 2 hours of crushing chest pain. His ECG showed slight inferior ST elevation and large septal ST depression. Posterior lead ECG showed ST elevation [more than the inferior leads]. Accepted by and transferred to PPCI.

Assessment

The slight ST elevation in the inferior leads didn’t seem quite enough for PPCI. However the confirmation of the posterior STEMI sealed the deal.

Recommendation

If an ECG shows horizontal ST depression in V1-V3, unusually large R waves or upright T waves in those same leads it could be a posterior STEMI.

Posterior STEMIs can occur with inferior or lateral STEMis, in which case just send to PPCI without delay.

However isolated posterior STEMIS can also present. In these cases know the above signs to look for on a 12 lead ECG and do a posterior lead ECG to confirm.

His 12 lead ECG looked like this:

https://emergencymedicinecases.com

The posterior lead ECG looked like this [slight ST elevation V9]:

https://emergencymedicinecases.com

Posterior lead ECG: simply move V4, V5 and V6 to these positions [only need 0.5mm ST elevation in the posterior leads to diagnose STEMI:

https://litfl.com/posterior-myocardial-infarction-ecg-library/

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group