Slide 1: Active chest pain. Trop=5.0ng/mL. ACS tx started. Cards is on their way. [EKG] What now?

Slide 2: Get posterior leads! [diagram on posterior lead placement]

Slide 3: 1mm STEs in V7-V9!! Activate the STEMI code!

Slide 4: The most common “electrically silent” MI comes from the left circumflex artery! Sensitivity of a standard 12-lead EKG for detecting an acute occlusion of the circumflex is only 32-48%! (Compare that to the sensitivity for an acute occlusion of the RCA or LAD of 70-92%!) Posterior leads improve that sensitivity significantly!


  • Agarwal JB, Khaw K, Aurignac F, LoCurto A. Importance of posterior chest leads in patients with suspected myocardial infarction, but nondiagnostic, routine 12-lead electrocardiogram. Am J Cardiol. 1999 Feb 1;83(3):323-6. PMID 10072216
  • Stribling WK, Kontos MC, Abbate A, et al. Left circumflex occlusion in acute myocardial infarction (from the National Cardiovascular Data Registry). Am J Cardiol. 2011 Oct 1;108(7):959-63. Epub 2011 Aug 4. PMID 21820644

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