Middle aged patient presenting with central chest pain. Posterior leads V7-9. What does the ECG show?

TOP 100 ECG QUIZ LITFL 015

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

This is the same patient from ECG 014

Posterior leads confirm the presence of posterior wall infarction by demonstrating typical STEMI morphology:

  • ST elevation in V7-9
  • Q waves in V7-9
  • Inversion of the terminal portion of the T wave (“U wave inversion“) in V7-9

CLINICAL PEARLS

How To Record Posterior Leads

Simply move the V4-6 electrodes around to the back in the same horizontal plane as V6. Annotate the ECG accordingly.

Approximate positions for V7-9 are:

  • V7 – left posterior axillary line
  • V8 – tip of left scapula
  • V9 – left paraspinal region

TOP 100 ECG SERIES


Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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