It is difficult to diagnose isolated (pure) old posterior wall myocardial infarction by ECG.

  Coexistent inferior or lateral wall myocardial infarction will ease the diagnosis of posterior

      wall myocardial infarction.



ECG findings of old posterior wall myocardial infarction

  Tall R wave in lead V1.

  R/S >1 in leads V1 and V2.

  R wave amplitudes in leads V5 and V6 are smaller than those of leads V3 and V4.



Causes of tall R wave in lead V1 other than posterior myocardial infarction

  Right bundle branch block (most common).

  Right ventricular hypertrophy

  Posterior myocardial infarction

  Wolff-Parkinson-White (WPW) syndrome

  Dextrocardia

  Hypertrophic cardiomyopathy

  Misplacement of the chest electrodes

  Normal variant



ECG 1a. The ECG above, belongs to a 49 years-old man who had experienced acute (now OLD) posterior wall myocardial
infarction several years ago.
The infarction was due to occlusion of the Circumflex (Cx) coronary artery. His right coronary artery was normal.
ECHOcardiography on the same day showed dyskinesia of the left ventricular posterior wall.
This ECG shows tall R waves in leads V1 to V3 which should raise the suspicion of old posterior wall myocardial infarction.

Click here for a more detailed ECG



ECG 1b. The ECG above belongs to the same patient.
However, this time leads V7, V8 and V9 were recorded to show the posterior left ventricular wall directly.
The leads V7 to V9 show q waves but no ST segment elevation (old posterior wall myocardial infarction).

Click here for a more detailed ECG




ECG 2a. The ECG above, belongs to a 50 years-old man who had experienced acute (now OLD) posterior wall myocardial
infarction several years ago.
The infarction was due to occlusion of the Circumflex (Cx) coronary artery.
ECHOcardiography showed akinesia of the left ventricular posterior wall.
This ECG shows tall R waves in leads V1 to V3 which should raise the suspicion of old posterior wall myocardial infarction.

Click here for a more detailed ECG



ECG 2b. The ECG above belongs to the same patient.
However, this time leads V7, V8 and V9 were recorded to show the posterior left ventricular wall directly.
The leads V7 to V9 show q waves but no ST segment elevation (old posterior wall myocardial infarction).

Click here for a more detailed ECG