The 12 Leads of Christmas: V3

CONCLUSION: The real culprit Getting to the heart of the matter, there are two main acute lesions we see that cause an isolated posterior STEMI pattern on the ECG: Acute obstruction of a non-dominant LCx. Acute obstruction of an obtuse marginal (OM) off the LCx, or similar artery. The purple arrow points to an acute lesion in the LCx while the yellow territory is the ischemia downstream. You can see how it affect mainly the mid and basal portions of the lateral wall, perhaps also reaching a bit of the infero-basal wall. Image modified from Lippincott Williams & Wilkins “Atlas of Anatomy.” [2]  The purple arrow points to an acute lesion in an obtuse marginal artery while the yellow territory is the ischemia downstream. Image modified from Lippincott Williams & Wilkins “Atlas of Anatomy.” [2]As shown above, these regions tend to correspond to the basal-lateral wall of the left ventricle. There’s a lot of overlap between both the artificially segmented “walls” and the various arterial supplies, however. The LCx and its branches can also supply blood to other territories—the “classic” infero-basal segment, the mid-anterior wall, even the apex (among others)—but we’re talking in generalities here, and in general the yellow region above is the one we care about for isolated posterior STEMI. And this is why we’ve come so far. All of the prior nonsense was just to pave the way for the following state...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: 12-Leads of Christmas Original Articles Vince DiGiulio Source Type: research