Acute Posterior Infarction
Report:
Sinus rhythm 80/min
ST segment depression c/c MI/ischæmia
Probable acute posterior infarction
Comment:
One can never be completely sure. Marked septal ST depression is a feature of uncommonly observed septal ischæmia or, as a reciprocal change, in acute inferior infarction. The inferior leads, however, also show ST depression, albeit of slow-rise, upward sloping variety. The third possibility, most likely in this case, is (hyper)acute posterior infarction; here again the depression is reciprocal to elevation where it cannot be seen, the back of the heart.
The next day, all is clear: V1 has a dominant R wave and an upright T wave: true posterior infarct (Fig 102a).
102a. True posterior MI.
103. 49 year old man following excision of endothelial fibroelastoma on one of the cusps of his aortic valve.
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