A pre-hospital team is managing a 60-year-old male with acute coronary syndrome. He has ST-depression in V1-V3 with prominent R-waves in V1 and V2. Wh...

Question

A pre-hospital team is managing a 60-year-old male with acute coronary syndrome. He has ST-depression in V1-V3 with prominent R-waves in V1 and V2. When viewed from the posterior perspective, this ECG pattern would show ST-elevation. What diagnosis does this represent?

Accepted Answer

Posterior STEMI - ST-depression with tall R-waves in V1-V3 are the mirror image of ST-elevation in the posterior leads; posterior leads V7-V9 should be recorded to confirm; this patient needs emergent pPCI

Answer

Right bundle branch block - the tall R-waves are conduction abnormality

Answer

Normal variant ECG - no action needed

Answer

Brugada syndrome - the R-waves represent coved ST-elevation

Answer

Anterior STEMI - the ST-depression is reciprocal to inferior changes

uk-dipimc MCQ (SBA): Posterior STEMI Recognition

A pre-hospital team is managing a 60-year-old male with acute coronary syndrome. He has ST-depression in V1-V3 with prominent R-waves in V1 and V2. When viewed from the posterior perspective, this ECG pattern would show ST-elevation. What diagnosis does this represent?