Recognition
- • ST depression V1–V3 (mirror image)
- • Tall broad R wave V1–V2 (dominant R)
- • Upright T V1–V3
- • Confirm with posterior leads V7–V9: ST ↑ ≥0.5 mm
Key findings
- • Often paired with inferior MI (RCA/LCx)
- • Isolated posterior in ~4% STEMIs
Clinical importance
- • Missed on standard 12-lead → treated as NSTEMI
- • Equivalent to STEMI — needs PPCI
Management pearls
- • MONA-B + DAPT + heparin
- • Activate cath lab for PPCI within 90 min
- • Posterior leads if inferior MI or isolated V1–V3 ST↓
