Posterior MI: Difference between revisions

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{{CMG}}
{{CMG}}


==EKG Examples==
==EKG Examples of Posterior MI==
Shown below is an EKG demonstrating the evolution of an [[infarct]] on the EKG. [[ST elevation]], [[Q wave]] formation, [[T wave inversion]], normalization with a persistent Q wave suggest STEMI.
 
[[Image:STEMI evolution.png|center|800px]]
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:AMI_evolutie.png
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Shown below is an EKG demonstrating [[ST elevation]] in lead [[Electrocardiogram#Precordial|V1]] and [[Electrocardiogram#Augmented limb|aVR]]; reversal of [[Electrocardiogram#Precordial|V6]].
[[Image:ST elevation in V1 and aVr.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating STEMI changes in the right [[precordial lead]]s.
[[Image:STEMI 1 RV.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating [[sinus rhythm]]. The remarkable feature is the poor [[R wave]] progression in the [[Electrocardiogram#Precordial|V1]] and [[Electrocardiogram#Precordial|V2]] leads and the [[ST elevation]] and T wave changes in leads [[Electrocardiogram#Precordial|V1]] to [[Electrocardiogram#Precordial|V4]] and [[Electrocardiogram#Limb|I]] and [[Electrocardiogram#Augmented limb|aVL]]. The cardiogram suggests an anterior/ lateral MI possibly acute. There is also terminal P wave negativity in [[Electrocardiogram#Precordial|V1]] suggesting a left atrial abnormality.
[[Image:Acute ant-lateral MI.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:E209.jpg
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Shown below is an EKG demonstrating [[ST elevation]] in the [[Precordial lead|precordial]] and [[limb lead]]s depicting acute inferior MI.
 
[[Image:STEMI 2.jpg|center|800px]]
 
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
 
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Shown below is an EKG with [[ST elevation]] in [[Electrocardiogram#Limb|II]], [[Electrocardiogram#Limb|III]], [[Electrocardiogram#Augmented limb|aVF]] (in [[Electrocardiogram#Limb|III]] > [[Electrocardiogram#Limb|II]]), [[ST depression]] in [[Electrocardiogram#Limb|I]], [[Electrocardiogram#Augmented limb|aVL]], [[Electrocardiogram#Precordial|V2]]. Tall R in [[Electrocardiogram#Precordial|V2]], otherwise normal QRS morphology. The findings are suggestive of acute posteroinferior MI.
Shown below is an EKG with [[ST elevation]] in [[Electrocardiogram#Limb|II]], [[Electrocardiogram#Limb|III]], [[Electrocardiogram#Augmented limb|aVF]] (in [[Electrocardiogram#Limb|III]] > [[Electrocardiogram#Limb|II]]), [[ST depression]] in [[Electrocardiogram#Limb|I]], [[Electrocardiogram#Augmented limb|aVL]], [[Electrocardiogram#Precordial|V2]]. Tall R in [[Electrocardiogram#Precordial|V2]], otherwise normal QRS morphology. The findings are suggestive of acute posteroinferior MI.
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Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


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Shown below is an EKG demonstrating changes during acute inferior MI depicting [[ST elevation]] in leads [[Electrocardiogram#Limb|II]], [[Electrocardiogram#Limb|III]] and [[Electrocardiogram#Augmented limb|aVF]].
[[Image:STEMI 4.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


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[[Image:STEMI 6.jpg|center|800px]]
[[Image:STEMI 6.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating loss of R waves throughout the anterior wall ([[Electrocardiogram#Precordial|V1]]-[[Electrocardiogram#Precordial|V6]]). QS complexes in [[Electrocardiogram#Precordial|V3]]-[[Electrocardiogram#Precordial|V5]]. [[ST elevation]] in [[Electrocardiogram#Precordial|V1]]-[[Electrocardiogram#Precordial|V5]] with terminal negative T waves.
[[Image:STEMI 7.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG with sinus [[bradycardia]] with [[first degree AV block]] and inferior-posterior-lateral myocardial infarction.
[[Image:STEMI 8.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG depicting [[sinus bradycardia]] with inferior-lateral myocardial infarction.
[[Image:STEMI 9.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating acute anterior MI. LAD artery occlusion.
[[Image:STEMI 10.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG showing [[sinus rhythm]] with anteroseptal myocardial infarction depicting [[ST elevation]] in [[Electrocardiogram#Precordial|V1]]-[[Electrocardiogram#Precordial|V6]] and in lead [[Electrocardiogram#Limb|I]].
[[Image:STEMI 11.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating [[sinus rhythm]] with [[left bundle branch block]], comparison with an old EKG is mandatory to evaluate whether the [[LBBB]] is new (a sign of myocardial infarction) or old.
[[Image:STEMI 12.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG illustrating inferior-posterior myocardial infarction with [[complete AV block]] and [[ventricular escape beat|ventricular escape rhythm]] with [[RBBB]] pattern and left axis, followed by [[sinus rhythm]].
Shown below is an EKG illustrating inferior-posterior myocardial infarction with [[complete AV block]] and [[ventricular escape beat|ventricular escape rhythm]] with [[RBBB]] pattern and left axis, followed by [[sinus rhythm]].
[[Image:STEMI 13.jpg|center|800px]]
[[Image:STEMI 13.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating acute anterior myocardial infarction and [[left anterior hemiblock]] depicting [[ST elevation]] in [[precordial lead]]s.
[[Image:STEMI 14.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating old anterior myocardial infarction and [[bifascicular block]] ([[RBBB]] and [[LAHB]]) as indicated in the anterior chest leads.
[[Image:STEMI 15.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG illustrating acute MI with proximal LAD occlusion depicting [[ST elevation]] in anterior [[precordial lead]]s.
[[Image:STEMI 16.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating a 2 days old anterior infarction with [[Q wave]]s in V1-V4 with persisting [[ST elevation]], a sign of left [[ventricular aneurysm]] formation.
[[Image:STEMI 17.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating a 2 weeks old anterior infarction with [[Q wave]]s in [[Electrocardiogram#Precordial|V2]]-[[Electrocardiogram#Precordial|V4]] and persisting ST elevation, a sign of left [[ventricular aneurysm]] formation.
[[Image:STEMI 18.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating a large anterior wall infarction on admission. This image depicts [[ST elevation]] in  [[Electrocardiogram#Precordial|V2]]-[[Electrocardiogram#Precordial|V5]] leads.
[[Image:STEMI 19.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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[[Image:STEMI 20.jpg|center|800px]]
[[Image:STEMI 20.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating clear [[ST elevation]] in the right [[precordial lead]]s. A [[coronary angiography]] revealed a proximal right coronary artery occlusion.
[[Image:STEMI 20 a.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating inferior-posterior-lateral myocardial infarction with a nodal escape rhythm
Shown below is an EKG demonstrating inferior-posterior-lateral myocardial infarction with a nodal escape rhythm
[[Image:STEMI 21.jpg|center|800px]]
[[Image:STEMI 21.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating [[RBBB]] and inferior MI. Note to [[left axis deviation]].
[[Image:STEMI 22.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating lead [[Electrocardiogram#Precordial|V4R]] in a patient with [[RBBB]] and inferior MI, which clearly shows [[ST elevation]].
[[Image:STEMI 23.jpg|center|800px]]
Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating cute myocardial infarction in in a patient with a pacemaker and [[LBBB]]. Concordant ST elevation in [[Electrocardiogram#Precordial|V5]]-[[Electrocardiogram#Precordial|V6]] are clearly visible. There is discordant [[ST elevation|ST segment elevation]] > 5 mm in lead [[Electrocardiogram#Precordial|V3]].
[[Image:STEMI 25.jpg|center|800px]]
Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating findings in the same patient as in the first example 2 months before the myocardial infarction. Normal [[LBBB]] pattern.
[[Image:STEMI 25 a.jpg|center|800px]]
Copyleft image obtained courtesy of,http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating acute MI in a patient with [[LBBB]]
[[Image:STEMI 26.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


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[[Image:STEMI 28.png|center|800px]]
[[Image:STEMI 28.png|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
----
Shown below is an EKG showing ST elevation MI.
[[Image:STEMI_29.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus12.jpg
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Shown below is an EKG showing [[ST elevation]] in inferior leads.
[[Image:STEMI_30.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0007.jpg
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Shown below is an EKG showing ST elevation MI.
[[Image:STEMI_31.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus13.jpg
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Shown below is an EKG showing ST elevation MI.
[[Image:STEMI_32.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-KJcasus16.jpg
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Shown below is an EKG showing ST elevation in inferior leads.
[[Image:STEMI_33.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0011.jpg
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Shown below is an EKG showing ST elevation MI.
[[Image:STEMI_34.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-Ami0010.jpg
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Shown below is an EKG showing [[ST elevation]] in the anterior [[precordial lead]]s, low voltages in all the leads, poor R wave progression in the precordial leads.
[[Image:AMI_anterior_LAD.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-AMI_anterior_LAD_2days.jpg
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Shown below is an [[EKG]] demonstrating [[ST elevation|ST segment elevation]] in [[precordial lead]]s signifying anterior myocardial infarction.
[[Image:De-AMI_anterior.png|center|500px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:De-AMI_anterior.png
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Shown below is an EKG showing [[sinus rhythm]] with abnormal [[QRS]] and a [[Q wave]] in lead [[Electrocardiogram#Precordial|V2]] which is suggestive of a previous anterior wall myocardial infarction.
[[Image:Previous_anterior_wall_myocardial_infartion..jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/File:E289.jpg
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Shown below is an EKG demonstrating [[sinus rhythm]]. The [[QRS]] shows [[Q wave]]s in the inferior leads which are wide (>30ms) and about 25% of the QRS height in [[aVF]]. There is also slight [[ST elevation]] in the [[inferior]] leads and [[T wave inversion]]. The EKG suggests an inferior wall infarction, probably old. (the best way to determine "old" is to see a previous cardiogram).
[[Image:Old inferior wall MI 1.jpg|center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Shown below is an EKG demonstrating [[sinus rhythm]] and a [[QRS]] with a rightward axis, as well as [[wide Q waves]] in leads [[Electrocardiogram#Limb|I]] and [[Electrocardiogram#Augmented lead|aVL]] as well as a poor R wave progression across the anterior chest leads. There is also slight [[ST elevation]] in leads [[Electrocardiogram#Limb|I]],[[Electrocardiogram#Augmented lead|aVL]] , and [[T wave inversion]] in the lateral leads. The EKG is consistent with a lateral wall myocardial infarction.


[[Image:STEMI 35.jpg |center|800px]]
Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page
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Revision as of 20:16, 11 March 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Synonyms and keywords:

Overview

A posterior MI is a heart attack or cessation of blood flow to the heart muscle that involves the backside or posterior side of the heart. Rather than causing the traditional ST segment elevation characteristic of the electrocardiogram of many heart attacks (a "STEMI"), because the heart attack is on the opposite side of the heart, the ST segments are depressed in the anterior precordial leads rather than elevated.


Acute Coronary Syndrome Main Page

ST Elevation Myocardial Infarction Microchapters

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Patient Information

Overview

Pathophysiology

Pathophysiology of Vessel Occlusion
Pathophysiology of Reperfusion
Gross Pathology
Histopathology

Causes

Differentiating ST elevation myocardial infarction from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History and Complications

Risk Stratification and Prognosis

Pregnancy

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Chest X Ray

Cardiac MRI

Echocardiography

Coronary Angiography

Treatment

Pre-Hospital Care

Initial Care

Oxygen
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Analgesics
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The coronary care unit
The step down unit
STEMI and Out-of-Hospital Cardiac Arrest
Pharmacologic Reperfusion
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Fibrinolysis
Reperfusion at a Non–PCI-Capable Hospital:Recommendations
Mechanical Reperfusion
The importance of reducing Door-to-Balloon times
Primary PCI
Adjunctive and Rescue PCI
Rescue PCI
Facilitated PCI
Adjunctive PCI
CABG
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy
Antithrombin therapy
Unfractionated heparin
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Factor Xa Inhibition
DVT prophylaxis
Long term anticoagulation
Antiplatelet Agents
Aspirin
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Other Initial Therapy
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
Lipid Management

Pre-Discharge Care

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post Hospitalization Plan of Care

Long-Term Medical Therapy and Secondary Prevention

Overview
Inhibition of the Renin-Angiotensin-Aldosterone System
Cardiac Rehabilitation
Pacemaker Implantation
Long Term Anticoagulation
Implantable Cardioverter Defibrillator
ICD implantation within 40 days of myocardial infarction
ICD within 90 days of revascularization

Case Studies

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Posterior MI On the Web

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Blogs on Posterior MI

Directions to Hospitals Treating ST elevation myocardial infarction

Risk calculators and risk factors for Posterior MI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

EKG Examples of Posterior MI

Shown below is an EKG with ST elevation in II, III, aVF (in III > II), ST depression in I, aVL, V2. Tall R in V2, otherwise normal QRS morphology. The findings are suggestive of acute posteroinferior MI.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page


Shown below is an EKG demonstrating changes during acute posterolateral MI depicting ST depression in precordial leads V2-V6.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG with ST depression in V1, V4, tall R in V2. ST elevation in II, III, aVF, V5 and V6.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG illustrating inferior-posterior myocardial infarction with complete AV block and ventricular escape rhythm with RBBB pattern and left axis, followed by sinus rhythm.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating atrial fibrillation and inferior-posterior myocardial infarction.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating inferior-posterior-lateral myocardial infarction with a nodal escape rhythm

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating atrial fibrillation with inferior-posterior-lateral myocardial infarction and incomplete right bundle branch block. Lead I shows ST depression, suggestive of right coronary artery involvement.

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating typical negative T waves post anterior myocardial infarction. This patient also shows QTc prolongation. Whether this has an effect on prognosis is debated. [1][2][3]

Copyleft image obtained courtesy of, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an EKG demonstrating ST elevation in leads II, III and aVF and ST depression in leads V1, V2 and V3 depicting a posterior MI.

References

  1. ↑ Novotný T, Sisáková M, Floriánová A; et al. (2007). "[QT dynamicity in risk stratification in patients after myocardial infarction]". Vnitr Lek (in Czech). 53 (9): 964–7. PMID 18019666. Unknown parameter |month= ignored (help)
  2. ↑ Jensen BT, Abildstrom SZ, Larroude CE; et al. (2005). "QT dynamics in risk stratification after myocardial infarction". Heart Rhythm. 2 (4): 357–64. doi:10.1016/j.hrthm.2004.12.028. PMID 15851335. Unknown parameter |month= ignored (help)
  3. ↑ Chevalier P, Burri H, Adeleine P; et al. (2003). "QT dynamicity and sudden death after myocardial infarction: results of a long-term follow-up study". J. Cardiovasc. Electrophysiol. 14 (3): 227–33. PMID 12716101. Unknown parameter |month= ignored (help)

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References

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