Posterior Wall MI Review

The ECG findings of a posterior wall MI are different than the

typical ST elevation seen in other myocardial infarctions. A
posterior wall myocardial infarction occurs when posterior
myocardial tissue (now termed inferobasilar), usually supplied by
the posterior descending artery (a branch of the right coronary
artery in 80% of individuals), acutely loses blood supply due to
intracoronary thrombosis in that vessel. This frequently coincides
with an inferior wall myocardial infarction due to the shared
blood supply. The ECG findings on an acute posterior wall MI
include:
1. ST segment depression (not elevation) in the septal and
anterior precordial leads (V1 to V4). This occurs since these
ECG leads will see the MI backwards (since the leads are
placed anteriorly, but the myocardial injury is posterior).
2. The ratio of the R wave to the S wave in leads V1 or V2 is >
1.
3. ST elevation in the posterior leads of a posterior ECG (leads
V7 to V9). Suspicion for a posterior MI must remain high,
especially if inferior ST elevation is also present.
4. ST elevation in the inferior leads (II, III, and aVF) may be
seen if an inferior MI is also present.


1. Normal Sinus Rhythm
2. Posterior Wall Myocardial Infarction


1. Normal Sinus Rhythm
2. Inferior Wall Myocardial Infarction
3. Posterior Wall Myocardial Infarction


1. Normal Sinus Rhythm
2. Inferior Wall Myocardial Infarction
3. Posterior Wall Myocardial Infarction


1. Normal Sinus Rhythm
2. Inferior Wall Myocardial Infarction
3. Posterior Wall Myocardial Infarction


1. Normal Sinus Rhythm
2. Inferior Wall Myocardial Infarction
3. Posterior Wall Myocardial Infarction


1. Normal Sinus Rhythm
2. ST Depression consistent with Anterior Ischemia


1. Normal Sinus Rhythm
2. ST Depression consistent ischemia - specifically left main coronary occlusion