Posterior MI

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

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.

Pathophysiology

A posterior MI is due to occlusion of the left circumflex artery.

EKG Examples of Posterior MI

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

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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

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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

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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

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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

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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

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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.

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

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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.

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