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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Posterior Wall Myocardial Infarction on ECG
Introduction
Posterior Wall Myocardial Infarction (MI) is a less common but important type of heart attack. Because it does not always manifest with classic ECG changes seen in other types of MI, recognizing it requires attention to subtle electrocardiographic findings.
ECG Findings of Posterior MI
Since the posterior wall of the heart is not directly visualized by standard ECG leads, the diagnosis is often inferred from reciprocal changes seen in anterior leads (V1–V3). Some key findings include:
- ST depression in leads V1–V3 (due to reciprocal changes from the posterior wall infarction).
- Tall R waves in leads V1–V3 (mirror image of pathological Q waves in the posterior wall).
- Upright T waves in V1–V3 (opposite to what would be expected in classic ischemia).
- Confirmatory posterior leads (V7–V9) may show ST elevation, allowing direct visualization of posterior involvement.
Causes and Risk Factors
Posterior MI is usually due to occlusion of the left circumflex artery (LCX) or less commonly, the right coronary artery (RCA). Risk factors include:
- Hypertension
- Diabetes
- Smoking
- Hyperlipidemia
- Family history of coronary artery disease
Clinical Considerations
Since posterior MI often occurs with inferior or lateral infarctions, patients may present with typical chest pain but sometimes have vague symptoms. Early recognition and management are crucial to prevent complications such as heart failure or arrhythmias.
Management
- Immediate interventions: Administration of aspirin, oxygen, nitroglycerin, and antiplatelet therapy as per standard MI protocols.
- Reperfusion therapy: Primary percutaneous coronary intervention (PCI) or fibrinolytic therapy if PCI is unavailable.
- Monitoring and supportive care, including hemodynamic stabilization and treatment of complications.
Recognizing posterior MI on ECG enhances timely treatment and improves patient outcomes.
Source recommendations
1. American Heart Association Guidelines for Management of ST-Elevation Myocardial Infarction
- https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
- https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
- https://pubmed.ncbi.nlm.nih.gov/23256914/
- https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
- https://www.sciencedirect.com/science/article/pii/S073510972106157X
2. European Society of Cardiology Guidelines for the Management of Acute Coronary Syndromes
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
- https://academic.oup.com/eurheartj/article/44/38/3720/7243210
- https://pubmed.ncbi.nlm.nih.gov/37622654/
- https://academic.oup.com/eurheartj/article/42/14/1289/5898842
- https://pubmed.ncbi.nlm.nih.gov/21873419/
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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