This ECG was obtained from a woman with chest pain who was taken to the cath lab and found to have a 100% occlusion of her circumflex artery.
Posterior wall M.I.
This is from a Cardiac Alert patient, with chest pain, in the Emergency Department. The ECG shows ST elevation in the inferior leads (II, III, and aVF), and in the low lateral leads (V5 and V6). There is reciprocal depression in V1 and V2, indicating injury in the posterior wall. One could argue that "inferior" is just the term we use for the lower part of the posterior wall - the part that faces the floor in a standing person.
If you are an ECG instructor, it is important that you address the subject of artifact on the ECG. Artifact has many causes, and it is important eliminate it whenever possible. We should strive for the "cleanest" ECG possible. As you can see in this example, the presence of artifact has caused the machine's computer rhythm interpretation to be incorrect. The noisy baseline has caused the computer to call this rhythm "atrial fibrillation", but we clearly see P waves in all leads, especially in Lead II.
These two ECGs are from a 57 year old man with chest pain. The initial ECG shows ST elevation in Leads II, III, and aVF - inferior wall STEMI. Reciprocal changes are as expected in I and aVL. Reciprocal ST depression also seen in V1 and V2 indicate probable posterior wall involvement. Not surprising since the inferior wall is simply the lower part of the posterior wall. The first ECG also shows the patient in sinus brady with junctional escape: AV dissociation. The sinus node is often affected in IWMI that is caused by right coronary artery occlusion.
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