One thing that I started doing several years ago with acute inferior STEMI is to ignore the limb leads or pretend they look perfectly normal and concentrate on the right precordial leads. I imagine how I would interpret the ECG if the that was the ECG's only significant finding. It really helped me develop a keen eye for isolated posterior STEMI.
I'm assuming posterior infarction due to ST Depression (Reciprocal) in the precordial leads. STE in II, III, aVF. I've heard that with STE in lead III > II, that can help point to a right ventricular infarction, does the same apply to posterior infarction?
The ST-depression in the right precordial leads points to posterior infarct and STE in lead III > STE in lead II does suggest RVI. In other words, a proximal RCA occlusion. Often the RCA also supplies the posterior wall, so you'll often see these findings together.
One thing that I started doing several years ago with acute inferior STEMI is to ignore the limb leads or pretend they look perfectly normal and concentrate on the right precordial leads. I imagine how I would interpret the ECG if the that was the ECG's only significant finding. It really helped me develop a keen eye for isolated posterior STEMI.
ReplyDeleteTom
I'm assuming posterior infarction due to ST Depression (Reciprocal) in the precordial leads. STE in II, III, aVF. I've heard that with STE in lead III > II, that can help point to a right ventricular infarction, does the same apply to posterior infarction?
ReplyDeleteGeoff -
ReplyDeleteThe ST-depression in the right precordial leads points to posterior infarct and STE in lead III > STE in lead II does suggest RVI. In other words, a proximal RCA occlusion. Often the RCA also supplies the posterior wall, so you'll often see these findings together.
Tom