55yr old male DM, HTN, Smoker, presenting with central chest pain to ED, What does the ECG show?

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Evidence of inferolateral STEMI ST elevation in the inferior leads (II, III, aVF) ST elevation in the lateral leads (I, V5, V6) Evidence of posterior STEMI Horizontal ST depression in V1-4 (maximal in V2-3) Dominant R wave in V2 (R/S ratio > 1) Upright T wave in V2 This pattern of infero-postero-lateral STEMI is most likely caused by occlusion of a dominant left circumflex artery. Tips for spotting posterior infarction Look specifically at lead V2 for the combination of Horizontal ST depression. Tall, broad R wave (>30ms wide, R/S ratio > 1) this is a Q-wave equivalent. Upright T wave particularly the terminal portion of the T wave. PMI V2 Typical appearance of posterior infarction in V2 One common trick is to turn the ECG over, hold it up to the light and look through it from behind. This inverts lead V2, which then takes on the appearance of a classic STEMI. PMI V2 inverted V2 inverted the complexes now resemble a typical STEMI Look for evidence of posterior involvement in any patient with an inferior or lateral STEMI. Sometimes it can be difficult to determine whether ST depression in V2-3 is due to posterior STEMI or simply subendocardial ischaemia affecting the anteroseptal wall. The diagnosis can be confirmed by recording posterior leads V7-9.

thanks for explaining so well, very helpful,,,
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Posterior leads confirm the presence of posterior wall infarction by demonstrating typical STEMI morphology: ST elevation in V7-9 Q waves in V7-9 Inversion of the terminal portion of the T wave (U wave inversion) in V7-9 Simply move the V4-6 electrodes around to the back in the same horizontal plane as V6. Annotate the ECG accordingly. Approximate positions for V7-9 are: V7 posterior axillary line V8 tip of scapula V9 left paraspinal region

1) STE in II>III....s/o LCx 2 ) STD in V1-V3...S/O PM I ( We have to do Post chest Leads ECG V7-V9) 3)STE in V5- V6...s/o extension of infarct to lateral aspect of cardiac apex.s/o LCx 4) Get V4R ECG DIAGNOSIS:ACUTE IWI; PM I with Lat.Extension (Culprit Vessel..LtCx.

It's a case of acute inferior wall myocardial infarction.

hyperacute inferolateral wall mi..

Acute Inferior Wall STEMI. .

ST ^ 2,3,aVF & ST dep. marked in V1-V3, mild ST ^ in 1,V6--Infero-podtwall MI with dominant artery from LCx b'coz st ^ in V6 & 1

inferolateral mi also could be posterior wall mi may that is having DVD or TVD

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