Importance of posterior chest leads in patients with suspected myocardial infarction, but nondiagnostic, routine 12-lead electrocardiogram

Agarwal, Jai B.; Khaw, Kenneth; Aurignac, Fabian; LoCurto, Anthony

doi:10.1016/s0002-9149(98)00861-3

Cited by 73 publications

(41 citation statements)

References 16 publications

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“…Approximately 4% of acute MI patients show the presence ST elevation isolated to the posterior chest leads V 7 through V 9 and "hidden" from the standard 12 leads (187,195,196). The presence of posterior ST elevation is diagnostically important because it qualifies the patient for acute reperfusion therapy as an acute STEMI (1,197).…”

Section: Electrocardiogrammentioning

confidence: 99%

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Anderson

Adams²,

Antman³

et al. 2007

Circulation

1,237

490

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Section: Electrocardiogrammentioning

confidence: 99%

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Anderson

Adams²,

Antman³

et al. 2007

Circulation

1,237

490

View full text Add to dashboard Cite

“…25,26 However, ST depression in leads V 1 -V 3 suggests myocardial ischemia, especially when the terminal T-wave is positive (ST elevation equivalent), and may be confirmed by concomitant ST elevation Ն0.1 mV recorded in leads V 7 -V 9 . 27,28 The term 'posterior' to reflect the basal part of the LV wall that lies on the diaphragm is no longer recommended. It is preferable to refer to this territory as inferobasal.…”

Section: Ecg Abnormalities Of Myocardial Ischemia That May Evolve To mentioning

confidence: 99%

Universal Definition of Myocardial Infarction

2007

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“…In general, the 12 lead ECG is less sensitive in identifying left circumflex artery as a culprit IRA. Huey et al found that 52% of patients with acute MI from LCX occlusion did not show any ST segment elevation in 12 lead ECG while other investigators suggested that LCX disease either may not cause any ST changes or generate only ST depression in the precordial leads [8][9][10]. Scintigraphic studies suggested that thallium myocardial perfusion defects in posterolateral segments are highly specific for LCX disease [11].…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of ST Segment Elevation in Posterior Leads V7, V8 and V9 in Patients with Acute Inferior Wall Myocardial Infarction

Pradhan¹,

Sun²,

Shrestha³

et al. 2013

J Cardiovasc Dis Diagn

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IntroductionECG diagnosis of a posterior wall myocardial infarction is difficult to diagnose through the standard 12 lead ECG, especially in the acute stage. The posterior wall MI may occur as an isolated event or often associated with an inferior wall myocardial infarction Posterior leads V7, V8 and V9 are usually ignored but it is suggested that these leads can provide ECG information that is useful for characterization of inferior AMI and diagnosis of posterior wall MI [1,2]. 15 or 18 leads ECG should be performed to correctly diagnose culprit artery in inferior wall MI. ST elevation in inferior and posterior leads (V7, V8 and V9) is usually associated with occlusion of the left circumflex artery with the involvement of large infarct zone and complications [3,4]. ECG detection of posterior infarction is associated with concomitant ST depression in leads V1 to V3. However these changes are neither sensitive nor specific [5][6][7].The aim of our study was to assess the ST segment elevation in posterior leads V7, V8, V9 for the identification of IRA and the diagnosis of posterior wall MI. We also dealt with relation of ratio of ST elevation in lead II and lead III to assess the culprit IRA for the patient with inferior wall MI. MethodsFor the retrospective study, we had collected 355 patients having an acute inferior wall MI admitted in the cardiovascular department of the First Hospital of Jilin University. The patient's data were collected from Januar, 2011 to December, 2011. Only 121 patients (male 102 and female 19) met our inclusion criteria which include chest pain lasting for more than 30 minutes before hospital admission, elevation of creatinine kinase (CK-MB) greater than twice the upper limit (normal: 0-3.5 ng/ml) and the ECG shows ST segment >0.1 mV (1mm) in at least 2 of 3 the inferior leads (II, III and aVF). The patients excluded from the study who had previous history of acute myocardial infarction, coronary artery bypass surgery or percutaneous coronary intervention prior to current hospitalization, evidence of recent left bundle branch block or left ventricular hypertrophy in ECG, and significant stenosis in both LCX and RCA or triple vessel disease so that a single infarct related artery could not be defined. ElectrocardiographyECG was recorded in all patients at a paper speed of 25 mm/s and voltage 10 mm/mv. For inferior STEMI, the inclusion criteria are ST elevation > 0.1 mV in at least two of three inferior leads (II, III and aVF).In addition to standard 12 leads, three posterior chest leads V7 to V9 should be recorded for the study. Posterior leads are recorded on the same horizontal plane as lead V6 more specifically, lead V7 on the posterior axillary line, lead V8 on the posterior scapular line AbstractObjectives: The aim of the study was to assess the role of ST segment elevation in the Posterior leads V7, V8, and V9 for the diagnosis of acute posterior wall infarction and the identification of infarct related artery (IRA) in patients with acute inferior wall MI. Background:The posterio...

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Importance of posterior chest leads in patients with suspected myocardial infarction, but nondiagnostic, routine 12-lead electrocardiogram

Cited by 73 publications

References 16 publications

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Universal Definition of Myocardial Infarction

Clinical Significance of ST Segment Elevation in Posterior Leads V7, V8 and V9 in Patients with Acute Inferior Wall Myocardial Infarction

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