tag:blogger.com,1999:blog-549949223388475481.post1746065819249227880..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Pure (Isolated) Posterior STEMI -- not so rare, but often ignored!Unknownnoreply@blogger.comBlogger16125tag:blogger.com,1999:blog-549949223388475481.post-15430733881445473372018-04-12T13:50:49.907-05:002018-04-12T13:50:49.907-05:00That is what happens with left main occlusion, and...That is what happens with left main occlusion, and it is variable, especially dependent upon whether the anterior or posterior wall ischemia predominates.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-82560919038864738882018-04-12T08:03:30.260-05:002018-04-12T08:03:30.260-05:00What findings seen if there is both anterior MI in...What findings seen if there is both anterior MI in setting of posterior MI... Is there any ST elevation seen in precordial leads. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-90608563816150123072016-07-24T11:11:31.752-05:002016-07-24T11:11:31.752-05:00Yes, there is. And this would be an appropriate i...Yes, there is. And this would be an appropriate indication for posterior leads. See Wung et al., Zalenski et al. See chapter on posterior MI in my book (link to free pdf on the sidebar).Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-73705964046672493952016-07-23T16:25:59.605-05:002016-07-23T16:25:59.605-05:00Is there any good data that shows some patients ha...Is there any good data that shows some patients have STE in V7-8-9 without any ST changes in the 12 lead ECG? If so, there would be an argument for getting posterior leads in all ongoing CP patients. I believe isolated posterior stemi refers to the situation where STE is only seen in posterior leads, but still having some ST changes in the 12 lead.Dominic Larose MD CMFC(MU) FACEPhttps://www.blogger.com/profile/12841805037815499459noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-86681255337295693052015-11-04T06:05:10.526-06:002015-11-04T06:05:10.526-06:00Only old MI has a tall R-wave, and only if there w...Only old MI has a tall R-wave, and only if there was significant damageSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-83541402203610452062015-11-03T07:13:42.890-06:002015-11-03T07:13:42.890-06:00Regarding case 3:
Shudnt a posterior MI have a tal...Regarding case 3:<br />Shudnt a posterior MI have a tall R wave..here there seems to be poor R wave progression... Cud this indicate probably a previous anterior infarct ??Anonymoushttps://www.blogger.com/profile/10570631307749439356noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-90478717432706735712015-06-08T12:50:43.881-05:002015-06-08T12:50:43.881-05:00I disagree with that terminology. It is purely ac...I disagree with that terminology. It is purely academic and makes the whole phenomenon more difficult to understand and visualize. Furthermore, it is really in a posterior location.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-35895232191070582022015-06-06T15:31:40.361-05:002015-06-06T15:31:40.361-05:00posterior MI must be denominated lateral MI. DOI:...posterior MI must be denominated lateral MI. DOI: 10.1161/CIRCULATIONAHA.106.624924Javier Montero Phttps://www.blogger.com/profile/02796775235169216876noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-134160107750970662013-03-19T05:52:23.221-05:002013-03-19T05:52:23.221-05:00except that S-waves are not only negative, they ar...except that S-waves are not only negative, they are also late!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80107077321646833992013-03-19T01:54:39.065-05:002013-03-19T01:54:39.065-05:00I got that. I was just thinking that if the R wave...I got that. I was just thinking that if the R wave is a Q wave for the posterior wall, then the S wave is the equivalent of the R wave for the posterior wall. And if an anterior MI amputates the R waves, then a posterior one should do the same with the S waves. Does that make sense?Anonymoushttps://www.blogger.com/profile/10807079731556500879noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-335573204840120612013-03-18T17:05:37.517-05:002013-03-18T17:05:37.517-05:00the posterior and anterior walls depolarize simult...the posterior and anterior walls depolarize simultaneously, so they have opposite forces. If there is old posterior MI, there is nothing to counteract the anterior forces, so you get larger anterior R-waves. If you have old anterior MI, there is nothing to counteract the posterior R-waves, so you get Q-waves. Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-56041610370990932012013-03-18T03:23:12.176-05:002013-03-18T03:23:12.176-05:00Just one thought: if an anterior MI has small R wa...Just one thought: if an anterior MI has small R waves, shouldn't a posterior MI have small S waves? Anonymoushttps://www.blogger.com/profile/10807079731556500879noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-74887196824249704692011-11-14T10:36:48.101-06:002011-11-14T10:36:48.101-06:00I make it a habit to do a V7-V9 on any patient pre...I make it a habit to do a V7-V9 on any patient presenting with right precordial STD or inappropriate right precordial intrinsicoid deflection of unknown origin. It doesnt cost anything besides an extra strip of paper but could save hours of precious heart muscle. A lot of our newer docs will not activate the cath lab on an ECG with right precordial STD and don't run V7-V9 or even V1R-V6R because they don't feel it's necessary. It's quite frustrating to me and poor patient care in my opinionTroyhttps://www.blogger.com/profile/01227334538616584664noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7539361279154824332009-10-12T07:39:38.299-05:002009-10-12T07:39:38.299-05:00This is a very good question, and not easily answe...This is a very good question, and not easily answered. First, you should know that when there is precordial ST depression due to subendocardial ischemia, it is not necessarily due to anterior wall ischemia. Data from stress testing shows that subendocardial ischemia DOES NOT LOCALIZE on the ECG, and usually is in leads II, III, aVF and V4-V6. But, again, this does not tell you which artery is involved. Second, ST depression in V1-V3, vs. V4-V6, is much more likely to be posterior than subendocardial ischemia. Third, patients at higher risk of NSTEMI (older, more risk factors, h/o angiogram with multivessel disease) are much more likely to have subendocardial disease (vs. younger smoker). Fourth, patients with reasons to have demand ischemia (tachycardia, sepsis, GI Bleed, etc.) are much more likely to have subendocardial ischemia (like in a stress test); those with posterior MI are much more likely to present with onset of chest pain and with normal vital signs. Fifth, look for tall R-waves in V1-V3 (the analog of Q-waves in other locations). Sixth, placement of posterior leads (take leads V4-V6 and place them at the level of the tip of the scapula, with V4 placed at the posterior axillary line ("V7"), V6 at paraspinal area ("V9"), and V5 ("V8") between them. At lease 0.5 mm of ST elevation in 2 consecutive leads is very accurate for posterior MI.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-60506376334650939922009-10-12T07:02:49.890-05:002009-10-12T07:02:49.890-05:00While your blog does an excellent job of highlight...While your blog does an excellent job of highlighting posterior STEMIs that were mistaken, are there any solid criteria to help provide a DDx between anterior or subendocardial ischemia and posterior STEMI? Will posterior ST alteration always be limited to v2-v4?smallvillenoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-15459670656315298812009-06-12T14:54:53.447-05:002009-06-12T14:54:53.447-05:00Dr Smith
Thanks for highlighting this issue, as us...Dr Smith<br />Thanks for highlighting this issue, as usually we do not concentrate on Posterior MI, unless there is inferior MI. In addition, junior doctors do not look well for tall R waves. Even, some disregard quickly and tell it is positional or what so ever.Anonymousnoreply@blogger.com