Posterior myocardial infarction: the dark side of the moon

The clinical presentation of posterior myocardial infarction is not always easy, not even for the cardiologist. In this article a 70-year-old woman who presented with chest pain is described. The electrocardiogram at presentation showed marked ST-segment depression in leads V-1 to V-5 and slight ST-segment depression in leads I and aVL. There was ST-segment elevation in the posterior leads V-7 to V-9. Elevation of specific cardiac enzymes confirmed the diagnosis of myocardial infarction. True posterior myocardial infarction is difficult to recognise because the leads of the standard 12-lead electrocardiogram are not a direct representation of the area involved. Only with indirect changes in the precordial leads as such the diagnosis can be suspected. This review will highlight the electro-cardiographic fine-tuned diagnosis of posterior myocardial infarction by using the posterior leads V-7 to V-9 leading to easier and faster recognition with consequences for treatment and improved prognosis.