Prevalence and outcome of ST-segment elevation in posterior electrocardiographic leads during acute myocardial infarction

Posterior reperfusion T-waves: Wellens' syndrome of the posterior wall

“…Because PMI can present in isolation,12 and is associated with increased inhospital complications, dysrhythmias, worse left ventricular ejection fraction and larger infarct size,12 13 prompt recognition and early treatment are important. Moreover, these patients who may have the pathophysiology of ischaemia and spontaneous reperfusion may be at risk of reocclusion even though they may be deceptively free of symptoms on presentation to the ED.…”

Angiographic and Clinical Outcomes Among Patients With Acute Coronary Syndromes Presenting With Isolated Anterior ST-Segment Depression

“…That such patients were more likely to have culprit lesions in the posterior circulation is not surprising, as the difficulty in diagnosing MI involving the posterior circulation is well documented. Patients with posterior STEMI have been demonstrated to have increased mortality compared with those without evidence of posterior infarction, likely resulting at least in part from a delay in recognition as well as complications such as left ventricular dysfunction, mitral regurgitation, ventricular septal defect, or bradycardia, depending on the affected artery (19,20). In patients with left circumflex artery occlusion, the infarct may affect an electrocardiographically silent area of the heart, and the traditional 12-lead ECG may be entirely normal.…”

“…Bedside troponin assays, application of rightsided or posterior ECG leads, or more liberal use of bedside echocardiography may be warranted (8,19,21,22). Therefore, further diagnostic modalities may be warranted in the subset of patients with isolated anterior ST-segment depression.…”

Beyond the 12 lead: Review of the use of additional leads for the early electrocardiographic diagnosis of acute myocardial infarction

“…Patients with posterior or RV extensions to their inferior infarctions have a worse prognosis, 24,25;32, 33 probably because they represent a larger infarct size. In addition patients with RV involvement may benefit from fluid resuscitation to give a higher right‐sided filling pressure 19 .…”

“…27,30 Identification of posterior wall MI is important as it has associated complications such as mitral regurgitation 31 and a worse in-hospital prognosis. 32,33 What advantage is there to body surface mapping?…”