Elderly patient presenting with chest pain and diaphoresis. Describe and interpret his ECG
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
Tips for spotting posterior infarction
Look specifically at leads V2-3 for the combination of:
- Horizontal ST depression.
- Tall, broad R wave (>30ms wide, R/S ratio > 1) — this is a Q-wave equivalent.
- Upright T wave — particularly the terminal portion of the T wave.
One common trick is to turn the ECG over, hold it up to the light and look through it from behind. This inverts lead V2, which then takes on the appearance of a classic STEMI.
In this ECG example, V3 is the most characteristically abnormal lead.
Sometimes it can be difficult to determine whether ST depression in V2-3 is due to posterior STEMI or simply subendocardial ischaemia affecting the anteroseptal wall. The diagnosis can be confirmed by recording posterior leads V7-9 (Quiz 067).