ECG of posterior wall MI

[ManUtdForever]

Can anybody explain to me why this is stated as posterior wall MI?
According to what i understand, supposed posterior wall MI should be mirror image of anterior wall MI in V1-V3. i.e Deep R wave for pathological Q and ST depression. Am i right?

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[Stuart Smalley]

Can anybody explain to me why this is stated as posterior wall MI?
According to what i understand, supposed posterior wall MI should be mirror image of anterior wall MI in V1-V3. i.e Deep R wave for pathological Q and ST depression. Am i right?

Not sure what you mean by "deep" R wave b/c R waves are positive. Should be a high R wave (which we're seeing) with depressed ST interval (can be seen on V3).

 

[ManUtdForever]

Not sure what you mean by "deep" R wave b/c R waves are positive. Should be a high R wave (which we're seeing) with depressed ST interval (can be seen on V3).

Yes sorry im too confused. Should be positive high R wave. So can i say that this patient is having posterior wall infarction due to high R wave in V3 and depressed ST interval? But as I can see there's also prominent elevation in V2. How can we explain this? Maybe the patient also having some anterior wall MI?

 

[Stuart Smalley]

I can not see any ST elevation at all in V2. You just have a wide, large T wave. Probably this is from ischemia in the endocardium... not surprising, since he's having an MI.

Look closely at lead V2. You can see a pretty clear angle as the S wave ends and it moves into the ST interval. That point is just about on baseline. You would see that angle be higher than baseline for ST elevation. (Of course, usually you can't see an actual sharp angle like here.)

Take a look at the pic on this website (I tried to attach it but couldn't) and note the height of where the S wave ends.
http://www.med.umich.edu/lrc/ecgoftheweek/cases/case11/summary03.html

Anyway, I'm no EKG expert by any stretch, so take what I say with a grain of salt.

 

[ManUtdForever]

I can not see any ST elevation at all in V2. You just have a wide, large T wave. Probably this is from ischemia in the endocardium... not surprising, since he's having an MI.

Look closely at lead V2. You can see a pretty clear angle as the S wave ends and it moves into the ST interval. That point is just about on baseline. You would see that angle be higher than baseline for ST elevation. (Of course, usually you can't see an actual sharp angle like here.)

Take a look at the pic on this website (I tried to attach it but couldn't) and note the height of where the S wave ends.
http://www.med.umich.edu/lrc/ecgoftheweek/cases/case11/summary03.html

Anyway, I'm no EKG expert by any stretch, so take what I say with a grain of salt.

Can you tell me what the parameter is for us to consider it as a depression or an elevation? In this case, is there any very obvious depression in precordial or other leads?

 

[GoSpursGo]

You already has other EKG threads and have been given suggestions multiple resources to help him with future EKG questions. If you have further questions, feel free to ask in those threads.