Answers for: ECG case for the 10th of January 2024

This ECG is typical posterior MI  with deep horizontal STD in V1-V3. Patient was transferred to SCGH cathlab  priority 1, loaded with Aspirin 300 mg and Heparin 5000 U iv as per their cardiology advice.

Posterior STEMI:

  • Isolated 3-11 %
  • Usually in context of an inferior or lateral STEMI
  • Horizontal STD
  • Tall, broad RW > 30 ms
  • Upright TW
  • R/S >1 in V2

The progressive development of pathological R waves in posterior MI mirrors the development of Q waves in anteroseptal STEMI

Perform V7-V8-V9 ECG – shows STE – only 0.5 mm is enough to diagnose STEMI.


See the attached file for posterior leads placement.


Thanks to Dr Svetlana Trandos for preparing this case