Slide 1: What’s your next step? [EKG] (Patient c/o acute chest pain)

Slide 2: Call a STEMI Code! [EKG: did you catch this STE in lead III?]

Slide 3: But– are those the only ST “elevations”? [EKG showing STDs in V1-V3] STD in V1-V3? Think posterior STE! Anterior ST-segment depressions could be reciprocal changes from elevation in the posterior leads!

Slide 4: Your posterior leads show… [EKG with V6-V7 ST elevations] -> it’s also a posterior STEMI

Slide 5: Pro Tip: Worried about a posterior MI? Flip the paper over, hold the EKG to the light, and look at V1-V3. [EKG showing upright 12-lead] [EKG showing inverted 12-lead]

Slide 6: Indications for posterior EKGs. 1. Anterior ST depressions. 2. Chest pain with normal (anterior) EKG findings and clinical suspicion for cardiac pathology. #12LeadThursday throbwack: What’s the most common “electrically silent” MI? 3. Chest pain with prominent precordial R waves (the equivalent of a posterior Q wave)


  • van Gorselen EO, Verheugt FW, Meursing BT, Oude Ophuis AJ. Posterior myocardial infarction: the dark side of the moon. Neth Heart J. 2007 Jan;15(1):16-21. PMID 17612703.
  • Rhee D. Active chest pain. Trop = 5.0. 12 Lead Thursday, Core IM. December 27, 2018. Link.

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