Atypical Posterior Myocardial Infarction With Minimal Symptoms: Diagnostic Impact of Point-of-Care Ultrasound

Posterior myocardial infarction (PMI) is frequently under-recognised due to its non-classical electrocardiographic (ECG) presentation and variable symptom profile. We report a case of a 39-year-old male patient presenting with minimal chest pain and subtle ECG changes, in whom bedside point-of-care ultrasound (POCUS) played a pivotal role in diagnosis. Despite an initial low-risk clinical impression and non-diagnostic ECG findings, POCUS revealed regional wall motion abnormalities, prompting urgent cardiology reassessment. Subsequent transthoracic echocardiography confirmed inferior wall hypokinesia, and coronary angiography identified a proximal right coronary artery lesion due to plaque erosion, requiring percutaneous coronary intervention. This case underscores the importance of maintaining a high index of suspicion in atypical presentations and highlights the value of POCUS in early diagnosis, risk stratification, and timely clinical decision-making.