Infero-posterior MI (ECG 1)

Patient. 54 year old male with previous inferior MI and underwent PCI/stent placement to circumflex and obtuse marginal branches in 7/02. Brachytherapy was performed for instent restenosis in these areas in 11/02. He was brought in this time with severe chest pain and became extremely agitate required heavy sedation and intubation during emergent PCI/drug eluded stent to circumflex and obtuse marginal branches again.

Comment. ST elevation in II, III, aVF, V6 is minimum, if there is any at all. Reciprocal ST depression in V1-3 is more easily recognized. The ST depression in V1-3 may lead to the diagnosis of non Q wave anterior MI and immediate reperfusion therapy will not be considered.

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Infero-posterior MI (ECG 2)

Further ECG changes: (1). Prominent R wave in early precordial leads (R/S >1). (2). Cannot exclude development of incomplete RBBB which may also cause prominent R in V1. (3). More ST depression in V1-4. 1# and 3# is consistent with acute posterior MI. ST T pattern in II, III, aVF, I and aVL is suspicious for diagnosis of infero-lateral MI.

Go to ECG 3 of the same patient

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