Posterior wall myocardial infarction with inferior wall infaction

A 47 years old male came to JIPMER, Pondicherry, hospital with chief complaint of acute onset retrosternal chest pain since 1 day along which was heaving in nature . There was no history of  palpitation perspiration, giddness. Patient was a known case of diabetes mellitus since 15 years and was on oral hypoglycemic agent. Patient ECG is shown below

ECG (Click on the image to enlarge it)

ECG is showing normal sinus rhythm at 84 beats per minute, there is ST segment depression seen in lead I,avL, V2. There is high take off of ST segment seen in lead 2,3,aVF. Prominent R wave seen in lead V1,V2,V3.

ECG of the patient repeated after 10 minute

ECG is showing normal sinus rhythm at 120 beats per minute, right axis deviation, no ST-T wave changes seen.


In view of continuou chest pain ECG with posterior lead was taken

ECG with posterior lead

ECG is showing ST segment elevation in lead V7,V8,V8 which is only 2 small boxes or in other word less than 0.5 mm, there were high take off of ST segment seen in lead 2,3,avF.

Again ECG of the patient was repeated after 6 hours which is shown below

ECG is showing QS complexes in lead 2,3,avF. So the diagnosis of the patient is inferior wall myocardial infarction with posterior wall myocardial infarction. Patient underwent angiography which was suggestive of LAD 70% stenosis, LCX 90% stenosis, RCA 70% stenosis.


Thank you.