AM Report 02/07/2017 Posterior STEMI

How do you recognize a Posterior STEMI?

-FIRST, you need to suspect it!
-Only 10 % occur as isolated Posterior STEMI, most occur WITH inferior or lateral STEMI

What do you look for on an EKG?

-Remember that the EKG leads look at the anterior heart so the mirror image must be true for a Posterior STEMI in leads V1-v3

-Instead of ST elevations, you see ST Depressions
-Instead of Q waves, you see tall R waves
-Instead of flipped T waves, you see upright T waves

Example

classic-posterior-stemi

How can you look at the posterior leads on an EKG?

Place 3 leads (V7,V8,V9) below the right scapula (see picture) and look for ST elevations, Q waves and T wave inversions!

posterior-leads

What coronary vessel is often implicated?

Posterior Descending Artery of the Right Coronary Artery (right dominant circulation)

350px-Coronary_arteries.png

How do you recognize a right ventricular infarction on an EKG?

-Often see ST elevations in V1, and in Lead III>Lead II
ST elevations in the right sided leads (especially V4R)-see picture below
Get that Right sided EKG if you suspect RV infarct!

right-sided-leads

Why is it important to recognize?

-Up to 40% of inferior STEMI can be associated with a RV infarction
-These patients are PRELOAD sensitive, so their blood pressures will tank if you give them nitrates or other preload reducers-they need FLUID RESUSCITATION

References

LITFL (Life in the Fast Lane)- an excellent resource for ECGs amongst others

 

2 thoughts on “AM Report 02/07/2017 Posterior STEMI”

  1. Can I replace my email for receiving these to Ekamclaudo@gmail.com?

    Thank you 🙂 Eric

    On Sat, Feb 18, 2017, 9:28 PM SCVMC Internal Medicine Residency wrote:

    > vmcimchiefs posted: “How do you recognize a Posterior STEMI? -FIRST, you > need to suspect it! -Only 10 % occur as isolated Posterior STEMI, most > occur WITH inferior or lateral STEMI What do you look for on an EKG? > -Remember that the EKG leads look at the anterior heart so t” >

    Like

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