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True Posterior STEMI

A true posterior STEMI is caused by total closure of the coronary artery that supplies the back part of the heart.

This is usually due to occlusion of the circumflex artery but sometimes can be due to closure of the distal portion of the right coronary artery.


This is an angiogram of the left coronary artery.
The arrow points to a totally occluded circumflex artery. 


This is an ECG 
demonstrating a true posterior STEMI.

The classic tombstones (arrow) are present but are inverted rather than elevated.

This makes the diagnosis difficult on some occasions.

After emergency angioplasty and stent placement the blood flow is restored (reperfusion) in the circumflex artery.

Here is an ECG after the procedure.The inverted tombstones have resolved.