Right precordial ST depression in a patient with chest pain

Conclusion:Nobody would miss the precordial ST-depressions in this case. The problem is not in identifying these abnormalities, but rather in identifying their etiology.  Patients with Isolated Posterior STEMI often do not receive appropriate reperfusion therapy simply because infarction of this anatomical area of the myocardium may manifests without ST Elevation on standard 12-Lead ECG. Tips for recognizing Acute Posterior STEMI:1. Pattern recognition is one of the most powerful - and often subconscious - mechanisms by which we read ECGs. Remember this classic pattern of Posterior STEMI of Standard 12-Lead ECG.2. Remember the trick of " Flipping " the ECG3. You can always record a Posterior ECG. Elevation of 0.5 mm in any of leads V7-V9 appear to be most sensitive and specific. (Note: while the sensitivity of this criterion is good, it is not 100%. There may be cases of acute Posterior STEMI that simply will not meet this).4. Realize that ultimately none of the above will make the diagnosis of Posterior STEMI often enough. Therein lies the limitation of electrocardiography in diagnosing acute coronary occlusion. The most important concept to remember is that if you clinically feelyour patient is experiencing ischemic chest pain and you cannot control the symptoms with medical therapy, you must strongly consider that you ' re dealing with an acute coronary occlusion that will benefit from emergent reperfusion. 5. Echocardiography i...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs