PREHOSPITAL CARE
True posterior myocardial infarction: the importance of leads V7–V9
London Ambulance NHS Trust, Department of Education and Development, London, UK
Correspondence to:
Mrs J Lindridge, London Ambulance NHS Trust, Department of Education and Development, Hannibal House, Level 2, Elephant and Castle, London SE1 6TE, UK; Jaqualine.lindridge@lond-amb.nhs.uk
Accepted 4 November 2008
| The first 150 words of the full text of this article appear below. |
An ambulance crew attended a patient complaining of chest pain with a clinical picture strongly suggestive of acute myocardial infarction (AMI).
A 12-lead electrocardiogram (ECG) was obtained, which demonstrated ST segment depression of 1 mm in V2–V4 with upright T waves and hyperacute R waves in V1 and V2 (fig 1). A posterior myocardial infarction (MI) was considered and a series of posterior views was obtained to confirm the diagnosis. Leads V7 and V8 revealed ST segment elevation of 1 mm prompting removal to the cardiac catheter laboratory for expert assessment.
Figure 1 Standard ECG showing anterior ST segment depression followed by posterior views revealing ST segment elevation in v7 and v8.
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Angiography later revealed a proximally occluded left circumflex as the infarct-related artery; which was successfully stented along with an incidentally critical mid-left anterior descending artery.
Nationally, the Joint Royal Colleges Ambulance Liaison Committee guidelines allow paramedics to administer
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