• The posterior (or basal-inferior) wall of the left ventricle is supplied by the posterior ascending artery (PDA) branch of the right coronary artery (RCA) if right-dominant, left circumflex artery (LCx) if left-dominant, or both RCA and LCx if co-dominant.
• Electrical activity of the posterior wall of the left ventricle is detected by the posterior leads (V7-9) placed over the upper left area of the patient's back.
• Since posterior leads are not part of the standard 12-lead ECG, posterior STEMI is often silent (easily missed).
• Patterns of posterior STEMI, corresponding ECG leads exhibiting ST elevation, and culprit lesion(s) are listed below:
Isolated posterior --- V7-9 --- PDA
Inferoposterior --- II, III, aVF + V7-9 --- PDA
Inferoposterolateral --- II, III, aVF + V7-9 + V5-6, aVL, I --- LCx/PDA or dominant LCx
• Isolated posterior MI is caused by an occlusion of the --
Posterior ascending artery (PDA) branch of the right coronary artery (RCA) if right-dominant, left circumflex artery (LCx) if left-dominant, or both RCA and LCx if co-dominant.
• ECG findings associated with isolated posterior MI include:
ST elevation in posterior leads (V7-9)
Reciprocal ST depression with upright T wave in anteroseptal leads (V1-3)
• On echocardiography, there is hypo/akinesis of the posterior wall (shaded in grey below) seen in apical 4 chamber, apical 2 chamber and parasternal short axis views.
• Inferoposterior MI is caused by an occlusion of the --
Posterior ascending artery (PDA) branch of the right coronary artery (RCA) if right-dominant, left circumflex artery (LCx) if left-dominant, or both RCA and LCx if co-dominant.
• ECG findings associated with inferoposterior MI include:
ST elevation in inferior (II, III, aVF) and posterior V7-9) leads
Reciprocal ST depression with upright T wave in anteroseptal leads (V1-3)
Reciprocal ST depression in lateral leads (I, aVL)
• On echocardiography, there are hypo/akineses of the inferior and posterior walls (shaded in grey below) seen in apical 4 chamber, apical 2 chamber and parasternal short axis views.
• Inferoposterolateral MI is an extension of inferolateral MI, caused by occlusion(s) of the --
Proximal dominant left circumflex artery (LCx) and its branches including the posterior descending artery (PDA), or
PDA branch of the dominant right coronary artery (RCA) (supplying the inferior and posterior walls) and the LCx (supplying the lateral wall)
• ECG findings associated with inferoposterolateral MI include:
ST elevation in inferior (II, III, aVF), posterior (V7-9), and lateral (I, aVL) leads
Reciprocal ST depression with upright T waves in anteroseptal leads (V1-3).
• On echocardiography, there are hypo/akineses of the inferior, posterior, and lateral walls (shaded in grey below) seen in apical 4- and 2- chamber, and parasternal long and short axis views.
