What is the diagnosis associated with this EKG, do additional leads assist in making the diagnosis?
ANSWER: Dx: Posterior wall MI
- Flip EKG over and invert it to look for a posterior MI!
- Posterior leads (V7-V9), which wrap over towards the patient’s left scapula represent a mirror image of septal leads (V1-V3). A posterior MI exists if you have ST elevation in ANY of leads V7-V9.
- Can be isolated or can occur with inferior or lateral MI (R coronary or L circumflex A)
- Suspect when EKG shows:
--- ST depression > 1 mm in V1-V3
--- Tall R in V1 or V2
--- Tall, upright T wave in V1 or V2
Management: Recent studies have shown patients may benefit from urgent revascularization; decision to be made in concert with cardiology!