Acute Posterior Infarction

Report:

Sinus rhythm 80/min

ST segment depression c/c MI/ischæmia

Probable acute posterior infarction

Comment:

One can never be completely sure. Marked septal ST depression is a feature of uncommonly observed septal ischæmia or, as a reciprocal change, in acute inferior infarction. The inferior leads, however, also show ST depression, albeit of slow-rise, upward sloping variety. The third possibility, most likely in this case, is (hyper)acute posterior infarction; here again the depression is reciprocal to elevation where it cannot be seen, the back of the heart.

The next day, all is clear: V1 has a dominant R wave and an upright T wave: true posterior infarct (Fig 102a).

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