Early Posterior Infarction

Report:

Atrial rhythm 61/min

ST/T changes c/w infarction/ischæmia

Comment:

At this stage it is unwise to be more specific. With plump-looking inferior T waves it is possible that this is where infarct pattern will evolve. There is reciprocal depression in aVL and the anteroseptal leads consistent with inferior MI.

What evolved was a true posterior infarct (Fig 47a). V1 is a reciprocal mirror image of it: deep Q, ST elevation and early T inversion at the beck of the heart.

The term true posterior is used to distinguish this from inferior infarcts, which were called posterior in the (now remote) past. This example is the uncommon variety, with no inferior, lateral or anterolateral involvement. There was, however, right ventricular involvement, documented on admission in the right-sided chest leads (Fig 47b).

47a. Acute true posterior infarction in sinus tachycardia.

47b. Right-sided V leads documenting RV involvement. Atrial rhythm.

48. 9 year old boy with febrile illness suggestive of Kawasaki’s disease.