Posterior myocardial infarction: unique diagnosis to an elusive problem

The clinical presentation of posterior myocardial infarction is not easy. The diagnosis is often missed due to lack of ST-segment elevation in standard 12-lead electrocardiogram. The diagnosis is made by seeing ST-segment elevation in the posterior leads V7, V8, and V9, which are typically placed in the left posterior axillary line, left midscapular line, and halfway between the mid scapular and left paraspinal line, respectively. The investigators describe a case of posterior myocardial infarction where additional posterior leads were placed in the left paraspinal line, right paraspinal line, and right midscapular line, displaying more prominent current of injury than seen with traditional posterior lead placement. This may lead to a more robust identification of posterior myocardial infarction that, in turn, may allow for adequate treatment and triage.