ACLS Revision: Is this Anteroseptal ischemia or Posterior MI?

Posterior MI

  • 4-10% of STEMIs are isolated posterior STEMI
  • Most common type of missed MIoften misdiagnosed as NSTEMI
  • The triad of ST depressions, upright Ts, and tall R waves (basically the equivalent of Q-waves) in V1-3 is suggestive of a Posterior MI
  • Only 30% are revascularized in 90 minutes
  • Usually associated with inferior or lateral MI due to RCA or circumflex occlusion

How to identify that patient having a heart attack

Clinical factors that INCREASE likelihood of ACS/AMI:
  1. CP radiating bilaterally > right > left
  2. Diaphoresis associated with CP
  3. N/V associated with CP
  4. Pain with exertion

Clinical factors that DECREASE likelihood of ACS/AMI:
Chest pain that is:

  1. Pleuritic
  2. Positional
  3. Sharp, stabbing
  4. Reproducible with palpation